Customer Service/Patient Experience...Bethesda Healthcare System 7 The Heart Head Heart Sandwich in Action • Let’s see what the full sandwich looks like: The patient says, “If

Bethesda Healthcare System 1

Customer Service/Patient

Experience

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Making Our Case

• Bethesda Health understands that we all have lots of demands

competing for our precious time. But we must remember that to

fulfill our mission statement of “providing quality health services

in a caring manner”, we all need to hone our communication

skills to the highest level in order to exceed customer

expectations.


Summary of Value-Based Purchasing (VBP)

• Our HCAHPS scores comprise 30% of the VBP payment. In order to capture the full 25% of the VBP HCAHPS money that has been set aside, we must attain the 50th percentile nationally on the following indicators:

• Rating

• Communication with Nurses

• Communication with Physicians

• Information About Medication

• Pain Management

• Quiet and Cleanliness

• Responsiveness

• Discharge Instructions

• Care Transitions


Heart Head Heart Communication

• A complete, satisfying communication with patients and other

customers has two parts:

– Heart to Heart Communication (about the human side)

– Head to Head Communication (about the tasks or business

at hand)

• These days, we’re very task-oriented and pressured. So, we

tend to respond mostly from our heads and much less from our

hearts. When we respond from our heads, not our hearts, does

this mean we don’t care? Absolutely not! It’s just that we often

don’t express our caring. And patients and families think, “I’m

just a number to these people. They may be competent, but

they don’t seem to care about me as an individual.”


Speaking From the Heart

• When we speak from the heart, people become:

– Less anxious

– More cooperative

– Less demanding

– More trusting

– And they actually heal faster


The More Heart The Better

• The more heart we give in each interaction, the better the communication.

• It’s easy to remember this, if you always think in terms of the Heart Head Heart Sandwich:

• For example:

Speak from your heart first. Show personal caring and empathy.

“That sounds so upsetting for you!”

“I’m so sorry that happened!”

• Then speak from your head. Ask questions, explain, discuss options or say what you are about to do. Meet people’s needs for action, information and solutions.

“Let me explain……”

“The options are…….”

“Here’s what I’m going to do…..”

• Close the interaction by speaking to the heart again.

“I’m so glad you told me about this. I want to help you out.”

“Thanks for understanding. I really appreciate it.”


The Heart Head Heart Sandwich in Action

• Let’s see what the full sandwich looks like:

The patient says, “If I could get out of bed myself, I wouldn’t have

asked you for help in the first place.”

• Heart – “I realize this is very frustrating for you.”

• Head – “Before this surgery, you could do this easily yourself.

Now I want to help you rebuild your strength, so I’m asking you

to try.”

• Heart – “I’ll be there for you so you’ll be safe.”


The Heart Head Heart Sandwich in Action

• Let’s look at another example of the Heart Head Heart

sandwich:

• Your coworker says, “When you ask ME to help, I’m always

there for you. But you’re always too busy to help ME.”

• Heart – “You sound pretty annoyed with me.”

• Head – “What do you need me to do?”

• Heart – “I want to help.”


First Things First

• When speaking in a Heart Head Heart manner, it’s best to first

quickly assess what the person is likely to be feeling.

– For example, if a patient says, “I’ve put up with this delay

long enough! I want to be discharged immediately”, it’s

pretty obvious that the person is angry.

• However, the deep down feelings in some situations aren’t

always so obvious and need some thought.

– For example, if a patient says, “I never have the same

therapist twice. How can I possibly learn anything when you

keep switching staff on me?”, this patient is likely feeling

insecure and unimportant.


• An excellent example of a Heart Head Heart response which

addresses the likely feelings of this patient could be:

• Heart – “I’m sorry we’ve had to change your therapist. I realize

that can be quite unsettling after you build your confidence in

one person.”

• Head – “The fact is, Jim’s hours are different today, and we

want to make sure you get the therapy you need, even though

he isn’t here.”

• Heart – “We always want you to get the therapy you need from

our expert therapists. I appreciate your understanding that we

have your best interest at heart when we assigned Sue to you.

She’s very experienced and an excellent therapist.”


Tips for Acknowledging Feelings

• When the people you serve are full of feeling, it’s healing to

acknowledge their feelings. And you come across as the caring

person you are.

• The word “sound” is often a good one to use when reflecting

back a person’s feeling. Here’s an example:

Patient: “Wow!” It’s not cancer? I can’t believe it! I was so sure it

was.”

Caregiver: “You sound relieved!”

Or

Our Patient: “I’ve been waiting an HOUR!” Did you forget about

me?

Caregiver: “You sound annoyed, but I do want to help.”


Feeling Words

• Remember that there are hundreds of words to describe

feelings even though most people only use a few (like mad, sad,

glad, happy).

• The better our vocabulary of feelings, the more effective we can

be when acknowledging the feelings of another.


Here are just a few feeling words that can be used to reflect back feelings:

• Afraid

• Angry

• Nervous

• Out of Control

• Distressed

• Surprised

• Sad

• Happy

• Impatient

• Hopeful

• Brave

• Accepting

• Resentful

• Lonely

• Hopeless

• Upset

• Ambivalent

• Unsure

• Anxious

• Distrustful

• Eager

• Energized

• Gloomy

• Invisible

• Overwhelmed

• Powerless

• Worried

• Frustrated


Body Language

• If someone is feeling afraid, you might observe shall breath,

rigid posture, wide eyes or rapid eye movements.

• If someone is feeling hopeless, you might see sagging

shoulders, little eye contact, low energy or slow responsiveness.


Your Body Language

• And speaking of body language, remember that your body

language is just as important, if not more, as what you’re saying.

The fact is that usually others believe our nonverbal

behavior more than they believe our words. They are

constantly reading our nonverbal behavior to see if our words

are credible. If you words and nonverbal behavior aren’t saying

the same thing, people tend to believe your nonverbal behavior,

not your words.


Body Language While Listening

• It’s paramount to show nonverbal signs of listening when someone is talking to you. Nonverbal signs of listening include:

– Moving to the person’s eye level

– Turning toward the person

– Making eye contact

– Raising your eyebrows

– Nodding

– Leaning In

• Bethesda nurses are required to “Take 5” with patients, as often as possible. This means that they sit down at eye level with the patient and use the good listening skills listed above to enhance communication.


Multi-Tasking

• Even though we often applaud others who are good at multi-

tasking, multi-tasking is NOT appropriate when we are in

situations in which it is important to show that we are

listening and that we care.


Being Present

• With all that’s on our plates every day, many of us find that the

most difficult part of Caring Communication is the ability to

remain in the present. Being present isn’t always easy, but it is

learnable, with practice. In the end, it actually helps you save

time because you are concentrating more and making the most

of your time.


Gift of Positive Regard

• Positive Regard is a gift we can give to patients, families, or

coworkers while they are going through difficult, challenging

experiences.

• The gift of Positive Regard can be done in at least 4 ways:

– With your respectful attention and presence

– By saying thanks

– By expressing appreciation

– By conveying admiration


Positive Regard is Usually Given:

• When people are calm, kind and cooperative and you feel

warmth towards them

• When patients, families or coworkers are going through a

difficult time

• When the heat is on in a difficult situation, people are angry, and

you don’t want to become defensive


The Wording of Positive Regard

• Here are examples of great wording for expressing positive

regard:

– “I admire you for………”

– “I really appreciate that you ……..”

– “Thanks so much for ……….”

• When expressing Positive Regard, the people you serve and

your coworkers feel noticed and special, important and valued.

Of course, everyone can recognize a phony so make sure you

are honest, speak in a complimentary tone of voice, and don’t

just say the same thing to everybody!


Examples of Positive Regard:

• Here are some examples of how to give the gift of Positive Regard:

• The family member insists on staying in the room during a procedure. The patient seems uncomfortable about that.

– In this situation, it’s admirable that the family member feels protective. You could then say, “I appreciate your wanting to be protective of your family member.”

• A coworkers angrily complains that she is doing more than her share of the work.

– In this situation, it’s admirable that the individual is working really hard, and it’s admirable that she speaks up when she’s feeling unduly pressed. You could then say, “I appreciate how hard you work and all you do for the team.”


Practice Makes Perfect

• It’s easy to practice giving the gift of Positive Regard in your department. Ask yourself these questions:

– Do I smile and appear glad to see my coworkers?

– Do I thank them for their kindnesses to me?

– Do I thank them for their patience when things aren’t happening on schedule?

– Do I say things that show I admire them?

– Do I refer to them in a flattering way when others are in earshot? (This is also called “Managing Up”)

– Do I respond with respect and positive regard even if a customer appears angry?

– Do I listen intently when they are talking to me?


Explaining Positive Intent

• Positive Intent is a valuable Caring Communication tool, as well. When

you explain your Positive Intent, your patient/customer/coworker knows

you are acting in their best interest. You make your good will explicit.

This reduces anxiety and helps the patient/customer feel your caring.

• When explaining positive intent, it’s not only important to explain what

you are doing, but also how they will benefit.

• Here are some examples:

– “I want to protect your privacy, so I’m closing the curtain.”

– “I want to help you since you’re under so much pressure.”

– “I want you to feel involved and respected as we plan your

treatment.”

– “I want to give you an update so you won’t be wondering what’s

happening.”

– “I want to tell you about your medication side effects so you can let

me know if you experience any of them.”


Applying Positive Intent

• Here are some examples of how to apply Positive Intent:

• Let’s say a coworker has done something that is really making your work difficult. To express Positive Intent, you can say, “I want us to have a good working relationship. So I want to talk with you about the situation that happened yesterday.”

• Let’s say a patient refuses to do his daily walking. To express Positive Intent, you can say, “I want you to keep doing what you need to do to get stronger. Tell me what’s going on with you today so I can figure out how to help you continue on the improvement path.”

• Let’s say a coworker sends you an e-mail about a procedural change that’s going to affect you. To express Positive Intent, you can say, “I want you to know how much I appreciate you giving me the heads up on this change.”

• Note: Did you notice that the person writing the e-mail expressed Positive Intent by giving the coworker the “heads up”, while the coworker expressed Positive Regard by acknowledging appreciation for the “heads up”?


Quiet Time

• Have you noticed that we use Positive Intent when announcing

the end of visiting hours at Bethesda? By using the verbiage “to

allow our patients the opportunity to rest” we let visitors know

that our positive intentions toward our patients are why we ask

visitors to leave at a specific time.


The Blameless Apology

• The Blameless Apology is a very special way to use the magic

words, “I’m sorry” to show compassion so that the person on the

receiving end feels your caring.

• When you offer a Blameless Apology, you say “I’m sorry”

without placing blame on yourself or anyone else.

• With a Blameless Apology, you show your sincere regret that

the other person has had an unpleasant experience.

• Start with saying, “I’m sorry” but always follow it up with saying

what you’re sorry for.


Tips for Expressing the Blameless Apology:

• When you say, “I’m sorry”, say it with caring. Be sincere.

Sound like you mean it.

• Speak in the first person. Use “I”, not “we”. Because people

don’t know who “we” necessarily is, it works much better to

speak for yourself.

• Be specific. Refer to the person’s experience that you feel sorry

about.

• And don’t forget to try to fix the problem for the patient and do

Service Recovery!


The More Skills the Better!

• As always, feel free to mix the Blameless Apology with other

Caring Communication skills. Make your Heart Head Heart

sandwich a big, delicious deli sandwich. The more Heart, the

better!


Piling It On!

• Here’s a good response to a situation that incorporates more

than one Caring Communication Skill.

• Family member says, “My mother said there was so much noise

last night that she couldn’t sleep.”

• Staff member says, “I’m really sorry your mother had so much

trouble sleeping. I realize that it’s maddening when you struggle

to sleep. I’m going to ask my manager to talk with the people

here at night about keeping the noise level down. I really want

your mother to have a restful night.”


The Caring Broken Record

• Every once in awhile, in spite of all you’ve done and how well

you have communicated, the customer still complains, resists,

accuses, or doesn’t take “no” for an answer. If you have done

all you can to reasonably accommodate the person and the

person still isn’t satisfied or cooperative:

• Repeat your bottom line message, with lots of heart. Your

bottom line message, packed with expressions of caring,

becomes your Caring Broken Record.

• Keep repeating the Caring Broken Record, in a calm way. Don’t

address each argument or excuse. Just hold your ground by

kindly repeating yourself.

• Again, be very selective when using the Caring Broken Record.

It’s very important to utilize your best Caring Communication

Skills, as well as using your best skills in accommodating the

customer, before resorting to the Caring Broken Record.


Benefits of Using the Caring Broken Record

• The benefits of using the Caring Broken Record include:

– You can say hard things and hold your ground in a caring

way.

– The person on the receiving end hears your message

clearly.

– You can remain calm and non-defensive with no regrets later

about losing your composure.

– You can avoid argument and time-consuming debate

– You can end the interaction without damaging the

relationship.


The Caring Broken Record in Action

• Here’s a good example of the Caring Broken Record in action.

– A visitor stops at the nursing station and asks how the patient Mrs. Harris is doing. Mrs. Harris is out of the room having a procedure. You know that Mrs. Harris has not identified this person as the contact person who may receive information.

– You say, “I appreciate your wanting an update on your friend. We are very careful here to protect the privacy of our patients. For the sake of patient confidentiality, we have a practice of asking patients to identify a contact person who family and friends can call to get an update. Mrs. Harris’s contact person is her daughter. It would be a good idea to contact her for an update.”


The Caring Broken Record in Action

• The visitor then says, “Oh, come on! I’m her best friend! She

would want me to know how she’s doing and she isn’t here to

tell me herself.”

– You say, “I’m really sorry that I can’t update you. I realize

how frustrating this must be for you. Mrs. Harris is lucky to

have your concern and support. Still, we have to protect the

privacy of our patients. That’s why we ask patients to

identify a contact person who manages communication with

friends and family. Why don’t you touch base with her

daughter?”


The Caring Skills Combined

• Using lots of Heart is the key to Caring Communication. If you

practice, you’ll get the hang of it! It’s not only fun to pile up that

Heart Head Heart sandwich, but life becomes easier, all around,

if communication improves.

• Here’s another example of Caring Skills Combined:

– A patient says to his phlebotomist, “I don’t want you to take

my blood. I want someone else.”

• Heart:

– The phlebotomist says (with good nonverbal behavior), “I’m

really sorry you have concerns about me drawing your blood

(Blameless Apology). I want you to feel confident in the

care you’re getting (Positive Intent).”


• Head:

– “If you allow me to draw your blood, I will take very special

care to be gentle. Or would you prefer that I see if another

phlebotomist is available?”

• Heart:

– “I realize getting your blood drawn can be uncomfortable and

anxiety provoking. (Acknowledging Feelings). I really

want you to have a good experience. (Positive Intent).


Managing Up

• “Managing up” our co-workers is an excellent way to help

patients and families feel more comfortable. Managing up

simply means that you openly express the positives of your co-

workers. For example, if you are a nurse and the respiratory

therapist comes into the room, you can say, “You’ll be in good

hands with John. He is an excellent respiratory therapist.”


Bethesda Docs Rock Cards

• Don’t forget that all employees can recognize physicians for

going above and beyond by completing a “yellow card” and

dropping it in the blue/yellow card box outside of the Dining

Room.


The End

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Customer Service/Patient Experience...Bethesda Healthcare System 7 The Heart Head Heart Sandwich in Action • Let’s see what the full sandwich looks like: The patient says, “If