On a Tuesday morning at Condell Medical Center in Libertyville, staff members cluster around an orthopedic surgeon performing a total hip replacement. Orthopedic technician Tony Rosnick provides commentary, explaining every manipulation of a joint, muscle or tendon. He’s not talking to surgical residents but to surgical neophytes: spellbound nurses, aides and secretaries, all in an effort to bring home the realities of surgery.
“Tuesdays With Tony” is just one effort by area hospitals to inject a little empathy into staff. Lying in a hospital bed, waiting for a call light to be answered can be cold and lonely, made worse if you’re in pain, don’t speak the language or fear a diagnosis. The hope is that by putting staff members through the rigors of patienthood, they will be better able to empathize with patients and respond effectively.
“When I took over as unit manager, I noticed staff didn’t quite understand a patient’s pain,” said Denise Anderson, manager of the orthopedic surgical floor. “I thought that staff should observe what surgery was like and know what to look for during recovery.”
So, about a year ago, “Tuesdays With Tony” began. After watching a knee or hip replacement, the entire orthopedic unit became much more aware of what surgery involved, Anderson said. “They got to see where the incisions were and how to maintain the wounds. Afterward, everybody was onboard with the urgency of getting patients’ pain medications to them and assisting them with therapy.”
Mary Myers had been an orthopedic nurse for 15 years before she saw her first hip and knee surgeries. “It was the most fascinating thing I’ve ever experienced outside of open-heart surgery,” she said. “I was able to understand more why patients had the pain they did.”
Surveys show fewer patient complaints and increased compliments since the program began, Anderson said. Patient-sensitivity training makes perfect sense, said Shane Foreman, president of 3d Health, a Chicago firm that helps medical centers develop business techniques. “Anytime anyone in health care can better understand what the patient goes through, it’s a great thing. With any job there could be a tendency to become immune to the fact that you are often dealing with very sick people, and that type of training is a reminder of why you got into the business in the first place.”
In August, new nurse hires at Advocate Christ Medical Center in Oak Lawn underwent an eight-hour “personal patient experience training.” Manager of clinical operations Mike Moonan had nurses drink two bottles of water within an hour. Next, he asked them to enter a patient room, hit the call light and wait.
“I was standing there about to burst,” said Eileen Cabela, 31, a trauma nurse at Advocate Christ. It took about 10 minutes for the call light to be answered. “It really opened our eyes to how important it is to answer the call light promptly. Most patients are incapacitated and can’t get up without our help.”
In another exercise, staff members lay on a bed in an empty patient room until assistants showed up to transport them to a test. “They pushed us down the hallway and talked about things that had nothing to do with us, like what they were doing after work,” Cabela said.
Advocate Christ has adopted a call-light prevention program for all staff to eliminate the need for the call light. The hospital requires all nurses to make hourly rounds on their patients, with the focus on the three “P’s”–potty (does the patient need help getting to the bathroom?), pain (is pain being managed?) and position (does the patient need to be repositioned in bed for comfort and prevention of bedsores?).
“You’re better off giving them no reason to use the call light,” Moonan said. “The three P’s are 90 percent of why patients use the call light to begin with.” Less need for the call light translates into fewer patient falls and pressure ulcers and less nurse stress.
Swedish Covenant Hospital feels so strongly about improving patient care that it is entering its second year as a Planetree affiliate. Planetree Alliance is a non-profit group that works with hospitals to better serve patients’ needs.
The Planetree initiative includes full-day retreats with activities that put staff in patients’ shoes. For example, in “Shipwrecked,” staff members are asked to close their eyes and imagine they are stranded on a desert island with no TV, communication or family nearby. When asked what would make the experience better, “they realized they need communication, kind people and familiar faces and foods,” said Gillian Cappiello, senior director of access services at Swedish Covenant.
Swedish Covenant has many non-English speaking patients who may have trouble communicating with staff or using the telephone. As a result of the exercise, administration developed a list of bilingual staff members that help as needed. The hospital also has translators through its phone service to assist patients.
When focus groups revealed that some patients have difficulty understanding staffers’ accents, the hospital undertook an accent-reduction program in conjunction with a local community college. Groups of employees are enrolled in a 20-hour class to learn how to pronounce certain words clearly to improve communication. “Employees benefit in their self-esteem and confidence, and this benefits the organization,” Shearer said.
During orientation at Rush North Shore Medical Center in Skokie, employees attend “Walk in My Shoes,” an interactive workshop that helps staff members understand what it’s like to have a sensory impairment, said Sonia Lee, clinical educator at Rush North Shore. Employees learn that the best way to communicate with a patient with a hearing loss is not to shout but rather to lower one’s voice to decrease its pitch.
Lee also passes out “instant aging kits” that include garden gloves, yellow-tinted sunglasses, a pill bottle with child-safety cap, a page from a telephone book and a ribbon. Employees are asked to don gloves and sunglasses and imagine they are 80-plus and about to visit a granddaughter in California.
A flight attendant tells them to follow the green arrow to baggage claim, but the bespectacled employee can’t distinguish blue from green. He or she must find their relative’s telephone number, extract a pill from a bottle and tie a bow in their granddaughter’s hair while wearing gloves to simulate decreased tactile sensitivity.
The goal of the training is to decrease patients’ anxiety, Lee said. “We want to make patients feel they are not rushed and have things under their control.”
After all, a little compassion can be powerful medicine.
