How Much Evidence is Enough?

If it doesn’t directly impact clinical care, is it still worth doing? That’s the question I was recently asked while speaking to a physician group.

(Before I go any further, let me say that I welcome having my beliefs questioned. It’s one of the benefits of being able to travel all around the country and interact with so many wonderful people. I have many opportunities to learn and to become better.)

Anyway, a physician in the room stated that he did not believe the patient satisfaction survey was of much value due to the fact that it does not impact clinical outcomes. He also felt that a patient could be very satisfied, yet not receive good clinical care.

Let me address the second comment first. I agree. It is possible for patients to rate their care high in a survey and still not receive great clinical care. This is where an organization’s values come in. I don’t know of any organization that feels good if patient satisfaction is high and quality is not.

The inverse is also true. Many times an organization’s clinical quality can be excellent but other issues can lead patients to feel they did not receive excellent clinical care.

My comment the other day to a group of physicians in an academic medical center was, "Let’s have the patient’s perception of care match the clinical quality you are providing."

Now, let’s go back to the challenge that started this blog entry: My first attempt to link the survey to the issue of clinical care was to read the questions. How well was your pain managed? How well were your needs responded to? How well were your questions answered? How well were things explained to you? How well were your home care instructions explained? I explained that I feel each of these can impact clinical care.

The physician disagreed, stating that these issues still may not change the clinical outcome. I then said, "So if a patient’s clinical outcome will not be impacted, then you don’t want your patient’s pain managed? Nor call lights answered?" The physician answered that of course he would want these steps to be taken.

That’s when it hit me. While I can connect the dots and also show more research that indicates a connection between patient satisfaction and clinical outcomes, the evidence really isn’t the point. There are times when even if actions do not impact the clinical outcome, certain behaviors and actions still need to be done.

Hospice caregivers do great work. Do their efforts change the clinical outcome? My first grandchild was stillborn. While the care and support given to my son and daughter-in-law did not change the clinical outcome, were they worthwhile? Yes, without a doubt.

Why do some people fight making some basic changes? I can’t take inventory for others, but based on years of experience, I do have some observations of my own.

For some people, it has to do with not being comfortable. If I am asked to do something that I am not comfortable doing and can come up with a reason not to do it, I have found a way to stay in my comfort zone. For others, I believe it is the fear of failure. They would rather not try at all than try and fail. I believe this is one reason best practices are hard to transfer in healthcare.

Some people may feel they are the voice for others. Have you ever noticed when someone is pushing back, he or she may often say, "Everyone," "Most people," or "Others," rather than coming out and saying, "Here is how I feel." Still others may feel they need more data before they can make a change.

It’s that last group of people, the data-seekers, who bring me back to the point. How much evidence is enough to make a change worthwhile?

I have come to this conclusion: There are times in life when we do the behavior even though there is not overwhelming research data to support it. We do it because it is the right thing to do. I can think of no reason more powerful than that one.

Sincerely,

Quint Studer

Passion and Gratitude List

Passion and Gratitude: It seems that the more I don’t want to do something the better it is for me to do it. A good friend of mine, Marv Wopat of Milton, Wisconsin, for years has told people to sit down each day and make a gratitude list. It is what it sounds like, a list of what a person is grateful for.

I have also heard a phenomenon that when given the choice, the great majority of people would not trade places with someone else.

In healthcare a majority of people are in a job in which they make a great difference in the lives of others, work in relatively clean environments and like most of their colleagues, have good benefits and pay. When I ask healthcare workers, how many of you work two jobs to make ends meet financially, very few say they do. I understand this is not everybody, but most do not. In essence, healthcare workers do a job or provide a service in which they have a good aptitude and skill set. They make enough money that they don’t have to work another job to fulfill their passion. Not many people are this fortunate.

My father loved to duck hunt. He liked nothing more than to sit in a duck blind for hours on the Mississippi river, in cold weather, waiting for a flock of ducks to fly by. If he could, he would have done this every day of his life. So what’s the problem? He couldn’t find a professional duck hunting job. In order to afford the equipment to hunt with and to travel to his favorite duck blind and stay in a cabin year after year, my Dad had to work two jobs. During the week he worked in a factory, which covered family expenses, and on weekends he worked in a junk yard to earn money to fulfill his passion of duck hunting.

When I was last in Nashville, I asked some of the employees in the hotel what they were there for. Many said they were working odd jobs, like the one in the hotel, but they were really musicians or song writers or a publicist, etc. See, they have a passion. They also have talent, but in order to meet their goal they need to earn money doing something else.

Healthcare is loaded with passionate people, like you, who earn enough money doing what they are passionate about and can afford to live a fairly good life. We are some of the fortunate ones.

Marv was right. Every time I finish my gratitude list I feel better. Let me know if it works for you.

Thanks.

Sincerely,

Quint Studer

Emergency Room Nurses Have the Best Stories

It’s true. If you ever want to laugh until you cry ask an ER nurse to tell you a story. If you ever want to be stopped in your tracks with your eyes welling up with tears ask an ER nurse to tell you a story. I worked as an ER nurse for awhile, as did my wife, so I have a great love and admiration for what ER nurses do.

We’re coming up on ER Nurse’s Day (October 14th) so I have been thinking a lot about ER nurses and their stories. Isn’t it amazing how stories, in general, can move us? If you think about it stories are how we learn. Probably your favorite teachers were those that told great stories and didn’t just read from a book.

What can we learn from ER nurse’s stories? First of all we can learn that within those stories there is much inspiration. I spend a lot of time encouraging people in healthcare to share their stories as I speak around the country and I talk about stories a lot in my book Inspired Nurse as well as in my blogs and on the Inspired Nurse Facebook page. I do this because I have learned the power of our stories. They connect us back to who we are, where we’ve come from and what we are “made of” as nurses.

So…how can we make the best use of the amazing stories that live in our ER? Wouldn’t it be amazing to have a few of the ER nurses in your organization write their stories, their greatest moments in the ER and perhaps even their funniest ones? After they’ve done this perhaps post them in your newsletter, highlight them at a celebration, have them read these stories at a board meeting or even post them in the ER for all to see? Why? Because these stories will inspire. They will remind us why we do what we do. They will bring us back to the foundation of what we are as nurses.

As I always say when I speak at hospitals across the country, our stories are our “bricks.” They are what built us. Often, we don’t focus on these “greatest moment stories” though do we? Usually we tend to share more of the most recent and negative stories. After awhile, it seems as if those inspirational moments are few and far between. But they’re not. It’s just a matter of focus and attention. When you focus your attention on the negative, well, that becomes our perceived reality. Maybe it’s time we focus on some of the other stories?

So, dust off those amazing ER stories. Find some creative ways to get them out there and share them with your team. It’s often said that great organizations are known by the stories that they tell. So are great ER Nurses. Honor your ER nurses this year by laughing and crying along with their stories. I promise you two things about those ER stories. They’re never boring and they’re always inspirational.

One more tip. If you are a senior leader, another great way to honor your ER nurses would be to make rounds in the ER on ER Nurse’s Day to thank the nursing staff for the great work they do every day.

Be Well. Stay Inspired.

Rich Bluni, RN, Studer Group National Speaker

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If you are looking for ways to celebrate this special day, seats are still available for the Nuts and Bolts of Service and Operational Excellence in the Emergency Department on October 14 – 15, in Phoenix, Arizona. You may also consider presenting staff a copy of Inspired Nurse by Rich Bluni or Excellence in the Emergency Department, which was just published by Studer Group coach Stephanie Baker.