Thursday, April 19, 2012

Is there anything else I can do for you?

Bonnie Brossart, CEO of the Saskatchewan Health Quality Council told this story at one of the sessions of this week's Health Care Quality Summit.  I asked her to send it to me, and I reprint it with her permission.  It provides a remarkable example of what it takes to deliver exceptional care.  Sometimes, all that is required is for a nurse or doctor to remember to ask, "Is there anything else I can do for you?"  We know that in other service industries -- from hotels to stores to restaurants -- people make a practice of this.  Why can't those folks who work in hospitals?  Hint: It is not because we are too busy.  Or that we don't care.

My son Matthew lives with Autism Spectrum Disorder and a moderate intellectual disability.  About 5 years ago he was also diagnosed with Cyclic Vomiting Syndrome (sometimes known as an abdominal migraine).  Essentially, something triggers Matthew to throw up and he can’t stop without the support of intravenous medications. When he has an episode it’s not uncommon for him to go the ER three or four times within a two day period.  A couple of years ago, he was having quite a bad spell with episodes happening every two to three weeks.  Matthew became quite well known in the Pediatric ER with many of the nurses and doctors greeting him personally and giving him very thorough and kind care.  But could I (or Matthew) say the care was truly patient centred or exceptional?  Once we could – here’s why.

When an episode starts, Matthew’s communication completely shuts down – in part due to the incessant vomiting and second (we think) because of the pain or consequence of the migraine.  The only way he really prefers to communicate during this time is with hand signals. One afternoon in the ER, with Matthew semi-resting following the administration of the pharmaceutical cocktail that helps appease the vomiting, the pediatrician in charge came by and sat on the corner of Matthew’s bed.  We had established a bit of a relationship with her in part because she’s treated Matthew a number of times and she has been involved in some quality improvement efforts in the Pediatric ER (and knows I work in a quality improvement organization).

On that day, we were talking about patient experience surveying (and the results within her hospital) and I asked her how she would know when a patient has received exceptional care, and to make it easier, I suggested we use Matthew’s current experience as an example.  She thought about that for a moment and then began to offer a list of what I would say were very legitimate and contributing factors to an exceptional experience – the team provided very clear explanation about the condition and what they were doing (including checking and naming the medications before they were administered, what the medications were for, etc), she demonstrated active listening, ensured I understood what to do upon discharge, etc.

I agreed these were all wonderful things and I (and Matthew) really appreciated them.  I then asked her if there was anything else she would do.  She replied she didn’t think so but was curious enough to ask, “Do you think there’s something else?”  To this I replied, "Why not let Matthew have the last word (if he chooses)" -- since neither of us were sure he would speak but noticed see he was awake.

So she asked “Matthew is there anything else I can do for you today?”  Quietly and croakily Matthew replied, “Popsicle.”  After throwing up more than a couple dozen times, can you think of anything more relieving or soothing?  For Matthew, this is what exceptional meant.  I knew it and so did the pediatrician.

Matthew’s health has improved considerably and it’s been quite a while since he’s had an episode.  I can’t help but wonder whether that curious, thoughtful pediatrician still asks the patients she sees (or their parents if they can’t respond) the same question she asked Matthew that day.  I hope so because that’s the kind of care everyone deserves, every time.

1 comment:

Pamela Ressler said...

Thanks, Paul. What a wonderful reminder that we in healthcare often neglect...ASK THE PATIENT! Dr. William Osler imparted this wisdom so many years ago, still as relevant today as it was then: "Listen to your patient, he is telling you the diagnosis" and I will add will also tell you what they need to heal.