The Big Picture on the Little Things

“It’s the little things.”

I keep hearing this phrase from health care leaders, employees and physicians, and it’s true. When we talk about improving satisfaction of patients, physicians and employees, it’s those little things that can make a difference in how a patient feels about the care experience and how he or she may respond to survey questions.

So what are those little things? More importantly, how do we ensure we are consistently doing them every day and holding staff, leaders and physicians accountable to do them, even when no one is looking over their shoulder? Many types of health care organizations struggle with this; they may know the little things, but leaders say that turning that knowledge into action at the bedside is quite another story.
It is clear that we need to reconsider how we persuade direct caregivers to change behavior.

I think you need to start with specific, well-defined values or standards of behavior that spell out some of those little things – such as acknowledging people by saying “hello,” making eye contact with the patient, sitting down, building a relationship, answering questions and involving the patient in care decisions. If you don’t already have these defined, get the caregivers involved to help determine how they will treat patients and each other. Then provide education about the expectations and hold caregivers and leaders accountable. If you don’t, you will never have consistency across the organization. Tell stories to drive your expectations home.

Here’s one for you:

One of my “yogi buddies” has cancer. This woman is strong; yoga enthusiasts will understand when I say she can hold the crow position as well as the side crow. I am jealous as I typically do well to keep from doing a face plant when attempting either. As she goes through rounds of chemo, and after her low point with nausea and fatigue, she bounces back, and when she feels strong enough, she goes to yoga. It’s hot, core power yoga, and it’s tough, but we both love it. She amazes those around her that she can go through this difficult time and still have brief glimpses of what life use to be – lots of exercise, being a great mom, wife, sister, daughter and friend. She appreciates her old life and can’t wait to get back to it.

She found a great hospital that has a tremendous support team for her. She can’t say enough good things about it, from diagnosis to surgery to chemo, it has met and exceeded her expectations. But as luck would have it, she encountered another problem, and had to see a specialist. Yes, we know specialists are busy people, but this physician didn’t follow through as my friend’s other physicians had. He failed to make eye contact, adequately answer questions or make her feel involved. When this doctor left the exam room, my friend had another question and asked a staff member to get the doctor back. He returned, saying he had answered all the questions he needed to and had other patients to see. She felt bad about asking to see him again.

Does this physician know the expectations of him? Does he know that his performance is worse than his colleagues’? Does he even know about bedside manner at all? Apparently, the answers are no, no and no. He has not been engaged in the process and is not being held accountable. This one event has put a damper on what had been a good encounter with the health care system; it could drag down the reputation of the entire organization.

Standards of behavior bring our mission and values to life. They are about treating patients as you want your family to be treated – it’s our calling as health care providers and support personnel. We must build consistency across the health care continuum and grow the number of caregivers who know the expectations, know how to deliver on them consistently and are held accountable for them. We must remember that it’s the little things to caregivers that are the biggest things to our patients.