In "The E-Factor", written by my colleague, Craig Deao, MHA, he describes engagement as giving discretionary effort (even when no one is watching) because of the level of commitment one has for the work they are doing.
Patient anxiety during healthcare visits or hospital stays is commonplace, perhaps brought about by pain, concern over the financial impact of care, or merely a disruption in their daily routine. When patients get anxious, they often don't listen well, don't communicate vital information, become defensive, feel overwhelmed with even basic instructions, or don't follow through on physician recommendations. Caregivers may misinterpret this behavior as a lack of engagement or discretionary effort to comply with their care plan. In actuality, the patient is likely confused, scared or simply coping with general anxiety.
Decrease Patient Anxiety and Increase Patient Commitment
Nothing builds trust with patients as quickly as effective communication in which healthcare professionals express empathy and build the patient's confidence in the caregiver's expertise. AIDET® is Studer Group's communication framework that addresses what patients say they want most from their caregivers: empathy and competence.
When AIDET is used effectively, it works to decrease patient anxiety and increase their commitment to their own healthcare. It's a simple way to incorporate fundamental patient communication elements throughout the healthcare culture so that it influences every patient interaction. AIDET is not a script. It is a simple framework for all healthcare professionals to follow to ensure patient communication consistently addresses key concerns, conveys empathy, builds confidence, and promotes patient ability to collaborate with their healthcare team.
I have seen real-world application of effective communication and AIDET to drastically improve patient activation in many of the large healthcare systems I have coached.
A Cultural Competency
To fully leverage the talent throughout an organization, it's important that every interaction is positioned as an opportunity to reduce anxiety and promote patient activation; the responsibility of empowering and activating patients is not strictly reserved for clinical staff. Recently while onsite at a Studer Group partner organization, I was validating the use of the AIDET communication structure with an Environmental Services (EVS) employee on an oncology unit. In that evaluation, we saw how impactful each interaction can be when an employee takes advantage of the unique opportunities in their everyday work.
The EVS employee demonstrated strength in her overall AIDET competency, and completed her "tasks" efficiently. During her 3-minute interaction with one patient, I'd checked off everything on my competency checklist except for one thing; she hadn't taken the opportunity to "manage up" others on the care team to foster ongoing collaboration. As we were walking out of the room, I was about to discuss my reactions with the employee, when she stopped. She realized that the patient didn't have a tray in her room and asked if she had eaten breakfast. The patient said she had just finished a round of chemo and wasn't hungry. She said she didn't think she would eat breakfast that day.
The employee calmly replied, "You know you need to eat so that you can get better and go home. And I have seen what we are serving for breakfast. In fact, that's what I had for breakfast. I could have had breakfast at home, but I prefer to have breakfast here because it's so good."
The next thing we knew, the patient changed her mind. "Well, you know what? I think I could eat just a little bit now." The employee promptly connected with the dietary aide delivering trays, and the patient had her tray within minutes. We were only on that unit another 20 minutes, and by the time we walked back by that patient's room, she had eaten her entire meal. That EVS employee made a difference that day - for the nurse on that unit and for the patient - simply by managing up the quality of the food.
Partnering with Patients
One of the most important reasons to foster a cultural communication competency such as AIDET that promotes better partnership with our patients is so our communities are better served through our work. I was recently rounding with a COO on a Med/Surg unit, validating AIDET with a respiratory therapist.
We went into a patient room and the respiratory therapist went through the motions of AIDET - she introduced herself, explained why she was there, and what the treatment would entail. Before the respiratory therapist could even finish, the patient stopped her and said, "Not right now. I just don't feel like it." Just looking at the patient, we could tell the patient didn't feel good, and he wasn't breathing well either. He clearly needed that treatment, but the respiratory therapist followed the patient's lead and postponed the treatment. I didn't say anything at that time as I was still processing the exchange, but then we went to the next room and again the next patient refused therapy. The respiratory therapist told the patient she would come back and left without giving a treatment.
When we left the room, I asked the COO when the respiratory therapist would circle back to those patients to give them their treatments. I knew she was about to go off shift. He said, "I guess she will just make the rounds until it's time for her to clock out. We don't have a respiratory therapist on at night. The next shift in the morning can try again." That means those patients could conceivably have gone 12 hours before anyone tried to give them another treatment.
It was just then that the COO had a lightbulb moment. "One of the biggest complaints we get from our providers is that they get calls in the middle of the night because their patients can't breathe, and now I think I know why!"
I took the opportunity to coach the respiratory therapist and said, "Let's try something different. I want you to go back in the room and acknowledge the patient, manage up your knowledge and experience and what you have done to prepare for this treatment."
With the intentional use of AIDET, the same patients that said "no" half an hour ago said "yes" the second time. One right after another, we saw the same result.
That COO now understands the positive implications of consistent use of AIDET and effectively advocates for each employee to influence their patients in a way that best serves their needs. Since they have hardwired the use of AIDET in patient encounters, patients rarely miss treatments and the organization optimizes their revenue opportunities related to these treatments.
The Bottom Line
As we know, our revenue margins have decreased significantly throughout healthcare. Not only can we not afford for a respiratory therapist to make multiple rounds over five hours hoping to eventually give treatments to all their patients, we can't afford the inefficiency that comes from a disengaged patient base.
In this era of healthcare, we need patients to assume more responsibility for their role in improving their health. However, they are at a disadvantage. Patients typically don't have clinical expertise, and, on top of that, they are sick and vulnerable. Providers have the responsibility to reach out and engage them. And we need to take the time to train our healthcare teams to better engage patients. If we do that, patients become partners in the solution. We can first reduce their anxiety to a point where they are willing to engage, and then intentionally communicate in a way that makes it possible for the patient to actively participate in their care.
The bottom line is that with the level of efficiency we seek to achieve in healthcare, there is no way we can make transformational changes without our patients' partnership. We must commit to not only involving them in their care but also "building a better patient" through their time in our care. As healthcare leaders, we maximize the investments we make in our organizations when we intentionally leverage our clinical expertise through a cultural competency that activates patients to also invest in the things they can do to improve their health.
Michelle Bright is a Studer Group coach with over 20 years of experience in healthcare, primarily in organizational development and strategy divisions, with extensive work in large Catholic healthcare systems. She has also worked in rural health facilities with an emphasis in critical access.