The Patient's Experience with Care: Getting out of the box

Vernon Pertelle

We have heard countless clichés regarding the focus on the patient [which of course is intended to improve employee engagement with campaigns] to raise HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey scores.  The reality is that the vast majority of organizations rely on folks on the front lines to positively impact change, however the people who are in direct contact with the patients are typically overworked and stretched so thin that they tend to be task oriented versus patient centric.  The challenges with improving the patient’s perception of care stem from not having enough time to spend with each patient to make them feel like a person instead of an object.  The truth is that 'patient as customer' can sometimes be a burden on the healthcare worker when it comes to delivering exceptional person centered care.  

So, the question is how do we positively impact the patient's experience and most importantly how do we embed the processes and tactics into the culture of an organization? The answers vary based on the size and complexity of systems, workflows and whether or not best people is central to the organization.  However one prevailing fact is that people are people and if we start with the patient as person then that is a good beginning.  

The Arbinger Institute produced and wrote a book called "Leadership and Self Deception - Getting Out of the Box", in which the authors emphasized the need for everyone to be mindful of the roles they play in improving a situation or making it worse. The book provides life examples in a story on how various circumstances causes us to treat others as objects that help us accomplish our goals.

The authors have coined the term as "being in the box".  This of course is in contrast to viewing others as people, with hopes, dreams, desires and needs in which case the person is then considered to be "out of the box".  

It all sounds interesting right? It actually is and the book is very insightful and should be mandatory reading for an organization that is trying to shift the culture to one of accountability and patient centricity.  Put plainly, when a person is "in the box", they are essentially betraying themselves by not fulfilling their obligation to view each individual as a person.  Just imagine for a moment how you may have interacted with someone yesterday or today in which you were so focused on completing a task that your only concern was how the person [or object in this case] would contribute to you getting the job done.  This type of behavior limits our ability to excel, be fully engaged and mindful of the individual as a person. 

We often try to treat each individual as a person; but when we are deceived by the need to get the job done, and focused on our selfish needs; it forms the basis of self-deception.  This leads to blaming others, viewing ourselves as righteous, thus justifying our behavior.  In essence self-betrayal in practice causes self-deception.  When people question our behavior, we view them as enemies, however when they reinforce and agree with our behavior we view them as allies. 

When we apply these same concepts to patient care it is easy to understand why it is difficult to sustain the gains made from campaigns to improve the patient's perception of care. If we focus on the results alone then we are "in the box". When we are too busy with the task and our own results, versus the patient and what's best for the patient as a whole then we treat them as objects. 

The problem with being in the box is that it causes lack of commitment to each other and the team; conflict, stress, lack of trust, accountability and poor communication. The way we get out and stay out of the box is by having the servant mentality, being mindful of the needs of others and focused on the results of the organization and success of the team instead of ourselves.  So, now think for a moment, and ask yourselves the question:  How often am I "in the box" toward others?  As a leader, how often am I in the box towards my colleagues and subordinates? As a caregiver, how often am I in the box towards my patient? You'll be surprised by the answers.

In order to be effective with consistently improving the patient’s experience with care, the focus must be on the patient as person and must be a part of the culture.  Take a chance and read the book, then share it with others in your organization.  Then, suggest the book be a requirement of all new hires as well as existing staff, then have each person create three powerpoint slides in which first they describe their reaction when first asked to read the book; second, their perception after reading the book and third what they intend to do with the new knowledge.  Your patient’s will be the direct beneficiaries and your scores regarding their perceptions of care will improve.

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