In the last month of my residency, I had one patient who woke me up to the fact that the care delivery model could be different. He’d been in the ICU for 28 days after an open heart procedure. He had problems with multiple organs failing including his lungs, his kidneys, his gut, and his heart. I sat down at the foot of his bed only because I had been up all night and was tired.
I watched as the cardiologist came in with the nursing team, the pulmonologist came in, and the urologist came in. One was checking the urine bag, one was checking the ventilator, and one was checking the telemetry machine. Each was dealing with their piece of technology and was treating the patient as if he was nothing more than a diseased and broken body part. No one touched the patient.
Each specialist entered information into the chart about their small piece of what they were dealing with and didn’t communicate that information to the rest of the care team, to the patient, or to his family. After the specialists departed, I entered the room and touched and talked to the patient as I examined him. I was left to communicate with the patient’s family. As I spoke with them in the waiting room outside the ICU, I realized that nobody had synthesized or integrated all the information about the patient’s status nor had they communicated relevant information to each other. The light bulb went on for me. I realized that my patient wasn’t diseased and fragmented; the system was. He was a whole human being and deserved to be treated as a whole human being. He was not the coronary artery bypass graft (or “cabbage” as we typically referred to patients who’d had bypass surgery) in ICU bed number two or the pancreatitis in room 309. He had a name, a face, a family.
This was my crucible moment: the realization that the richness of medicine is in the interaction I have with patients and their families. The fragmented system and burdensome technology were stripping that away from me, and were stripping away the joy I had for the profession.
Around this time, I read a paper Earl Bakken had written about how to build the most healing hospital in America. What I learned from that paper, and my phone call to him, led me to choose an uncharted career path: I wanted to try to restore humanity to healthcare and to “fix” the broken system.
I went to the head of the hospital I was working in and asked if I could be the inpatient navigator or Sherpa or guide for hospitalized patients. My request was approved, and in 1991 we launched a program that became known as the hospitalist service, before the hospitalist concept was popular.
The hospitalist service was created to enable continuity of care without requiring the primary care doctor out in the clinic whose patient was admitted to the hospital to travel to the hospital to admit their patient. With the hospitalist service, the hospitalist was always in the hospital and could do it.
When I started as a hospitalist, I would walk into the patient’s room and say, “Your doctor has asked me to care for you while you’re here because he cares about you. I’m here in the hospital all the time.” Then I would call the doctor during the patient’s stay and provide updates. Prior to discharging the patient I would call and say, “I’m sending your patient home today, and in case he shows up in your emergency room or in your clinic on Monday, here’s what happened.”
The hospitalist role was designed to improve efficiency, care transitions, and care coordination. The hospitalist service is often so large that the physicians just have time to round on the patient and enter their note in the chart. They have little time left over to communicate to the referring specialist or the patient’s primary doctor. The hospitalist is supposed to be the inpatient navigator or guide and help with communication and care transitions. But it has devolved to a role with a shift worker mentality that prioritizes operational efficiency in a dehumanized way. The hospitalist often faces antiquated processes and technologies that impede their work. In many organizations, it’s led to an impersonal experience where the patient doesn’t feel any connection or relationship with the hospitalist.
What’s most disconcerting to me is that a specialty I helped create is now one I’m spending a lot of my time helping to humanize and fix, which causes me great angst. The good news is that there are technologies that can humanize this experience for everyone involved and provide critical information to the entire care team about that patient.
For over 20 years my passion and career focused on improving the patient experience, and led to my appointment at the Cleveland Clinic as the nation’s first chief experience officer. I was charged with creating an office of patient experience and a strategic plan that would position the Cleveland Clinic as the national leader in patient experience.
However, after 30 days of walking in the shoes of patients and staff, I reported to the board that we could not improve the patient experience until we first improved the staff experience. That meant improving culture, rebuilding relationships, and deploying technology that would create consistent, seamless communication between providers. This model has now been adopted around the world and has led to the emergence of the CXO role in in almost every healthcare institution in the country. At Vocera, we lead one of the most preeminent networks for physicians and nurses who are paving the way forward with this work.
Communication failure is the number one cause of quality and safety issues in hospitals, and the number one cause of patient dissatisfaction. At Vocera we have a team of clinicians that helps hospitals map the gaps where communication breaks down. We see where communication can be improved and then design and deploy a technology solution to close the gaps.
One of my roles as Chief Medical Officer at Vocera is to lead our national thought leadership strategy through the Experience Innovation Network. This is a community of chief experience officers and other leaders who are committed to defining for the nation the next standard of clinical practices that will humanize the patient and staff experience. This network understands that we need to address culture, communication, and relationships. One of the most critical issues we are addressing is the burn out of a generation of healthcare providers due to administrative bureaucracies and technologies that take them away from patient care.
I’m passionate about what I do at Vocera because our technology eases the burden of being a doctor or nurse. It puts the clinician back at the bedside, and can help restore the sacred relationship between a doctor and nurse and how they communicate with each other and then with their patient.
One of our customers asked us to assess the women’s health program at their hospital. They were losing labor and delivery to a competitor across town. I spent half a day with all of the obstetric-gynecologic physicians. They identified all the reasons why they thought they were losing patients to the competing system. There were about a hundred reasons and we ranked them. The number one reason was a breakdown in the physician-nurse relationship and communication.
The physicians said they used to be able to walk up to the nursing floor, know each nurse by name, and know where their kids were going to school. They found that what had changed is that they were now writing their notes into the electronic medical record, and they’d stopped coming up to the floor to talk with the nurses and to say, “Here’s what I’m thinking about this patient or what I’m worried about.” Not only were they not communicating about the patient, they were losing their professional and collegial bond in relationship.
Our Vocera technology restores the voice to healthcare, which in turn helps restore trusted relationships between doctors, nurses and patients. This customer deployed our technology throughout the entire hospital. Now doctors and nurses can connect quickly and easily by saying, “Get me Dr. So-and-So” or, “Get me Nurse So-and-So.” They can actually have a real conversation about critical issues related to that patient versus only entering them into an electronic medical record.
We worked with another hospital that found their patient intake process was broken. The nurses were given a checklist of things to ask the patient but they weren’t the things that mattered to the patient. We helped them identify the questions that would matter, and automated the intake process through Vocera Care Rounds to create a sacred moment on admission. They now ask patients questions like, “What are your greatest fears and concerns? What tools or services do you need to address your stress, anxiety, or depression? Who would you like to be your family navigator? What’s the best way to communicate with you and them on a regular basis? What spiritual needs do you have that we could address? What are your food and nutritional requirements? What temperature setting would improve the comfort in your room?”
They rolled out the “sacred moment on admission” throughout the entire hospital. In measurements of patient satisfaction, they went from being one of the lowest scoring hospitals in their large system to being in the top percentile.
This isn’t soft touch; it isn’t fluffy. This isn’t teaching doctors to look up, smile, and be nice to the patient. This isn’t about scripting them. This isn’t just about hourly rounds. In hardwiring the sacred moment through technology, we are creating new clinical standards that restore humanity to healthcare.
I’ve spent an entire career looking at what’s broken in healthcare communication. My team and I have worked to disrupt the status quo, change the system, look at innovative technologies, and try to make it better. I’m committed to bringing solutions to bear that restore humanity and also improve quality, safety, and the patient experience.
Through Vocera, we partner with the most transformative, progressive-thinking leaders in healthcare. Together we work to address the brokenness and to come up with processes and technology solutions that optimize human performance and restore humanity back to healthcare. We are easing the burden of being a doctor or nurse in healthcare today. I am proud to be part of the Vocera team.
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