Last July, I wrote an article for the Harvard Business Review titled “How to Spread Empathy in Health Care.” I talked about things health systems should do to make empathic care the new norm, including creating a shared vision of what empathy means, understanding what drives patients’ suffering and measuring each patient’s experience to inform improvement.
As I visit with health care systems across the country, I am inspired by some of the innovative ways organizations are rising to this challenge. I recently had the privilege of attending a presentation by Megan King, MSN, RN, director of patient experience forGeisinger Health System, in which she described the organization’s efforts to better understand and improve patients’ experience of care as it relates to pain management. A key element of this has been the development of a new pain scale, an especially important initiative given the sensitivity around appropriate pain medication use.
Instead of just asking patients to describe their pain on a 1-10 scale, Geisinger nurses now use a rating scale that clearly defines what each number means. Each score is associated with a visual icon, a descriptive adjective and a more detailed explanation. For example, a pain rating of 5 is represented by a neutral face, and is described as “distracting.” According to the accompanying detail, this is pain that is “barely tolerable” and limits “some activities.” The scale also frames ratings by severity. Pain rated 6 through 10 is considered severe, while ratings of 4 and 5 are moderate and 0 through 3 are minor.
The new scale is one piece of an intensive education program developed in collaboration with nursing and pharmacology services to help bridge the gap between patient/family and medical staff expectations around pain management. For example, using the information on the scale, nurses can help patients understand that even minor or moderate pain may still be “well controlled” pain, particularly if patients are able to meet their daily care goals, perform activities of daily living, complete physical therapy and enjoy visitors.
By empowering patients with perspective on their pain, Geisinger experienced dramatic improvement on patient ratings of how well their pain was controlled during their hospitalization. Importantly, the improved ratings have also been associated with moderate decreases in narcotics use. This finding is consistent with recent evidence indicating that patient experience scores around pain management are not driven by whether or not patients receive painkillers. It also suggests that connecting with patients in a more meaningful, empathic manner will bring us closer to the compassionate, connected care that we aspire to deliver.