If you observe the practice of compassionate health workers you do indeed find magic. Time appears to slow down. Difficult patients and lists of problems seem to dissolve away. Interruptions are infrequent. The job gets done with an ease and a skill that’s hard to define. Patients smile and laugh and sometime cry. There are moments of deep stillness and quiet. Less is done but more is achieved.
Behind the magic lies rigorous science. Compassionate practitioners are intently mindful and deliberate in their approach to each patient. Many of the practices are counter-intuitive yet they are backed up with sound research and practical wisdom: If you don’t have time, slow down; If the patient makes too many demands, invite more!
At Hearts in Healthcare we have painstakingly gathered the evidence and learned from the masters. Here are the seven strategies we know make a practical difference. Each strategy is a matter of personal choice – you don’t need permission from your boss or help from your teammates. The same strategies can be applied by the student nurse or the senior doctor, they are universal.
He describes the scene when at 6am his sleep is interrupted by the nurse coming to administer his dose of iv antibiotics. She bangs open the door, switches on the bright room light, marches up to his bed and roughly pulls back the bedclothes to check his id band. After flushing the iv line, she injects the dose of antibiotic, records the dose, then marches out the room leaving the light on. ‘There is no possibility of sleep,’ my friend says.
The research evidence is really clear that our own actions create much of the patient demand that overwhelms us. When we treat symptoms and complaints, rather than root causes, our patients will always return for more. When we impose our own clinical agenda, instead of truly listening to each patient’s needs, we create enormous amounts of unnecessary work and expense. When patients feel neglected and unsupported, they suffer far more pain and complications. Our frantic pace of work is generating enormous amount of rework and leaving our patients dissatisfied.
On the other hand, compassionate care remarkably improves patient outcomes, dramatically reduces rates of interventions and costs, and helps our patients be more resilient. The key is to invest some time up front at the beginning of each patient encounter.
The key is to find out your patients’ concerns and needs up front. One inspiring nurse we met was nicknamed ‘The Angel’ by her workmates – she had such a caring manner with patients, who all loved her. How did she start her morning shift? She collected a clean wash-cloth for each of her patients and moistened them in the sink; then warmed them in the microwave oven. Handing each of her patients a warm wash-cloth – just like the air stewards do on Singapore Airlines! – she’d ask them how she could best attend to their needs and comforts that day. What she learned in that few minutes with each patient, she said, transformed the care she gave during the rest of the day.
Many hospital have implemented ‘Hourly Rounds’ for nursing care. No matter how busy the nurses are, they stop their tasks each hour to round on each of their patients and pro-actively find out their needs: do they need to go to the toilet, need pain-relief, have all of their belongings within reach, have any other needs for comfort? The research shows that hourly rounding dramatically improves the efficiency of nursing care. Call-buzzers fall silent. Nurses can get their work done without unplanned interruptions. Patients feel much more satisfied and cared for.
Typically, the research shows that hourly rounding can free up about an hour of nurses’ time during a shift – time to provide the face-to-face personalised care that nurse so dearly want to deliver to their patients. One study asked nurses to wear pedometers. Those who adopted hourly rounds walk a mile less each shift than those who didn’t.
Hourly rounding also has a major impact on patient safety: in the hospitals that adopted this practice they witnessed a large reduction in patient falls, and also the incidence of bed sores.