Process Improvement Needed to Reduce Patient Suffering

By Megan Murdock Krischke, contributor

April 1, 2014 - The vast majority of patients who enter a hospital are experiencing physical pain and/or disability. While hospitals and their staff excel at addressing physical ailments a patient might experience, a patient’s experience of suffering often expands significantly beyond physical discomforts or impairments.

Interestingly, sometimes the same elements that are improving medical care can add to patient suffering.

Thomas Lee: Reduction of patient suffering should be a top goal.
Thomas Lee, MD, CMO at Press Ganey, said that in addition to treating medical conditions and improving efficiency, the reduction of patient suffering is a goal that leaders and clinicians can and should get behind.

“We have had tremendous progress in medicine, and there is so much more that can be done to slow or even cure diseases than in the past,” commented Thomas Lee, MD, chief medical officer for Press Ganey, a company focused on improving the patient experience. “A side effect of all this progress, however, has been that there are more and more clinicians involved in care, and they are often focused on one organ, or one issue.

“The patient’s big picture can get lost in the shuffle,” Lee continued. “It actually feels to many of us that we have reached the point of a true crisis in the coordination of care.”

“In palliative care we often talk about the concept of total pain,” began Timothy Corbin, MD, medical director for hospice and palliative care services at Scripps Health in San Diego, Calif. “We evaluate for social stress as well as spiritual suffering and emotional distress. Patients and their families may be experiencing anxiety and fear as they wonder what a diagnosis means for their lives.”

“Creating a plan around social, emotional and spiritual needs is just as important as treating someone’s physical condition,” Corbin said. He added that the hospital environment itself can be a source of suffering--including the unfamiliar sounds, the equipment, the interruptions and the pace and flow of the day.  Clinicians may be used to this kind of environment, but patients are not.

“Hospitals are a place for medical care, but not necessarily healing. We do surgeries, tests, and interventions that can be overwhelming and confusing to patients,” he stated.

When patients have undesirable experiences that extend beyond their physical ailments, they are often referred to as “sub-optimal patient experiences.” Press Ganey is working to reframe those experiences as “patient suffering.”

“We think this change of terminology is significant because the term ‘suffering’ commands attention and will help accelerate healthcare’s redesign around meeting the needs of patients,” commented Lee.

“Clinicians are not trying to produce such suffering, of course, but they are frequently not organized in ways to prevent or reduce it,” Lee continued. “That is why a first step to reducing suffering is to measure it.”

Lee’s vision is that eventually data on patient outcomes, including suffering, will be collected on every patient, every time.

“Some systems, like Novant in North Carolina, are actually measuring the percentage of time their nurses spend at the bedside of patients, and redesigning work flows so that time is increased. Obviously, if you are terribly understaffed, it is going to be hard to give patients the attention they need and deserve,” noted Lee.

“But even with plenty of personnel, it is all too easy to focus on patients’ diseases,” he continued. “We can do a very excellent job of treating various disease processes, but overlook and fail to reduce suffering from dysfunction of the delivery system.”

Timothy Corbin: nurse staffing consistency improves quality and the patient experience.
Timothy Corbin, MD, said that schedules designed to increase consistency in the nurses who provide care for a patient can improve the quality of care.

Both Lee and Corbin believe that care teams are a key strategy in reducing patient suffering.

“In order for suffering to be minimized, caregivers need to see the patient as a whole person and to consider how their loved ones are also affected by the disease,” Corbin explained. “Palliative care teams are made up of physicians, nurses, chaplains and social workers. This multidisciplinary approach helps patients get the holistic care they need.”

“You have to organize teams with the right personnel to respond to the kinds of suffering we are discussing. It’s not going to be about individual doctors or nurses working harder or being nicer--it’s more about how well we work together to meet patients’ needs,” Lee added.

“Real teamwork doesn’t happen by accident or through good intentions alone,” he continued. “One of the more exciting ideas I’ve heard lately is Wellstar’s Accountable Care Units within hospitals. Doctors have most of their patients on one unit and work constantly with the same group of nurses rather than run all over the hospital, and try to work with a dozen or more groups of colleagues.”

Common sources of patient suffering are the patient not understanding what their care plan is and sensing that their clinicians are not communicating with each other.

“An approach we are using in our medical ward at Scripps is offering patients a care navigator and having clinicians round as a team,” stated Corbin. “The navigator works with the physicians, the bedside nurse and the pharmacist to answer patient concerns and to develop a plan so that patients and their families know what to expect.”

Corbin added that small things can often make a significant difference to a patient’s experience, such catering to special food requests.

“I know of one hospital that has a quiet time in the afternoon. They turn down the lights and give patients a break--recognizing that rest is important to healing,” he said.

“It is important for hospital administrators to talk to patients and get a sense of what they want,” encouraged Corbin. “That can move a hospital beyond being a place of medical tests and procedures to becoming a place of healing.”

Related articles:
Engaging Clinicians and Other Staff in Improving the Patient Experience

© 2014. AMN Healthcare, Inc. All Rights Reserved.