Blog: Great players alone don’t make a great team
Let’s team up with patients and their families to save lives and create better patient experiences
By Ryan Chesterman, MPA, Service Experience Coach, North American Partners in Anesthesia (NAPA)
In an article published by the British Medical Journal in 2016, preventable medical errors ranked as the third leading cause of death in the U.S., after heart disease and cancer. Each year more than 200,000 Americans die needlessly, leaving heartbroken loved ones at a loss to understand what happened. In 2009, Laura Batz Townsend was one of those grieving, trying to comprehend how her beloved mother, Louise H. Batz, went from successful total knee replacement surgery to respiratory depression in a matter of hours. Eleven days after her surgery, the Batz family—a family of physicians—made the painful decision to discontinue Louise’s life support. Seeking answers, Laura and the medical team who cared for her mother undertook a root cause analysis to discover how her mother’s death might have been prevented. They concluded that a fatal combination of errors included:
- A lack of teamwork: The clinicians and family did not communicate effectively. For example, when Laura told a nurse that she didn’t think her mother’s pain warranted the planned administration of Demerol, Vistaril and Morphine, her concerns were ignored.
- A lack of knowledge: The patient and family members did not have the information they needed to make an informed decision. When Laura wanted to stay with her mother, a nurse told her to leave, but Laura didn’t know that good reasons such as the nurses’ monitoring schedule would have warranted her spending the night in the hospital.
- A lack of technology: Louise had no oxygen or heart monitors, and the hospital standard of care was to check on the patient every four hours. By the time a nurse noticed that Louise was in distress, it was too late.
Watch Laura Batz Townsend tell “The Story of Louise H. Batz: from Tragedy to Hope.”
Laura sadly learned that her family’s experience was not unusual: Across the country, patients and families who try to provide potentially lifesaving insights are routinely ignored by medical caregivers. “If we could have all worked together with the nurses and doctors as a team, the outcome could have been different,” says Laura. “We had a great doctor, great nurses, a great family, but great players do not necessarily make a great team. My Mom’s death did not lie on the shoulders of one person; it was a team failure. Until we all work together, these mistakes will keep happening.”
Clinicians are typically “great players” who invest enormous energy and time in building their physiological understanding and skills. But even the greatest clinicians can fail to appreciate the fact that patients, as experts in their own experience, can and should play a meaningful role in their own course of care. This devaluing of a patient’s self-knowledge, most often manifested as a lack of listening to and validating patient and family input, contributes to what researchers call information asymmetry—a power imbalance and/or systems limitation—that regularly has a negative impact on patient safety and the patient experience.
“Reducing information asymmetry is a potential differentiator between care that is high value versus merely average,” says the authors of a recent NEJM Catalyst article. “After all, while clinicians mostly understand pathophysiology and the natural history of disease, patients have a monopoly on their experiences, symptoms, functional status, and the outcomes that matter most to them. These aspects are at the core of their health concerns and should guide clinical decisions and treatment goals….Data consistently show the dominant influence of patient perceptions of health and experiences of care, including the level of communication and trust in their doctor, on outcomes and quality.”1
Looked at from another perspective, a 2017 analysis of Yelp reviews (which capture patients’ perceptions of their experiences) and clinical quality measures (preventable readmissions and mortality) showed that Yelp is a valid indicator of hospital quality. The study revealed a strong positive relationship between high Yelp ratings (patient experience) and low preventable readmissions (patient safety).2
In other words, patients and their families should not be viewed as “obstacles” who get in the way of the jobs that clinicians do, but as important and respected members of any care team. A valuable NEJM Catalyst article notes, “Patient- and family-centered care encourages the active collaboration and shared decision-making between patients, families, and providers to design and manage a customized and comprehensive care plan.” Elements of patient-centered care as described in the same article include these important points:
- Patient and family preferences, values, cultural traditions and socioeconomic conditions are respected.
- Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level.
- The presence of family members in the care setting is encouraged and facilitated.3
Consider that in other countries, there is a cultural expectation that when a loved one is hospitalized, the patient’s family will be there throughout the hospital stay to actively assist the professional caregivers. Such families are valued as partners in the perioperative spectrum of care.
Now compare that to the American approach, in which physicians may all too often be heard to say, “I’m not here to make you happy; I’m here to save your life.” But are these things mutually exclusive? Can we as healthcare providers save lives AND make people happy?
In the era of healthcare reform, the answer must be YES. In APSF Newsletter, The Official Journal of the Anesthesia Patient Safety Foundation, Dr. Adam Blomberg says, “With the rise of consumerism in health care, patients are increasingly more involved in their medical decisions. They are demanding transparency, and want to better understand their options and the reasons behind physicians’ decisions. And they should—patients should feel that they have a voice in their care. Arming patients with knowledge and giving them greater control over their care leads to better outcomes.”4
In healthcare, it’s too easy to lose sight of the human being (the patient) and their loved ones as we develop the plan of care. It’s too easy to forget that the human being sitting in front of us is scared, anxious and at the mercy of what we say and do. It’s too easy to think that we don’t have time to make patients “happy,” when “happy” simply requires that we treat patients with respect and dignity, ask for their experience and opinions, allow them to discuss their internet information and questions, provide them with explanations and expectations, and permit them to have a say in their treatment. “Happy” is more than valet parking, a nice waiting room and smiling medical team members. As clinicians, knowing what we know about medical errors and quality outcomes, we know that the real meaning of happiness lies where our efforts to ensure the highest levels of patient safety and patient experience intersect.
Following her mother’s death, Laura Batz Townsend made it her mission to reduce preventable medical errors. With her family, she founded the Louise H. Batz Patient Safety Foundation to empower patients and their families with the knowledge and tools to participate in their own healthcare, and to educate physicians and nurses about the critical need to listen. The Foundation’s many resources include The Batz Guide for Bedside Advocacy: Teaming Up for the Patient—a 60-page booklet that helps patients and families collect and record important health data, communicate more effectively with clinicians, and understand how to monitor and enhance patient safety measures. The Foundation also offers an iPad app that helps families, patients and medical staff monitor care in real time. Laura says, “Our greatest hope is that families, patients, and caregivers will work together as a TEAM to improve safety in our hospitals.”
As NAPA’s Service Experience Coach, my hope is that as we look to the new year, healthcare providers everywhere will team up with patients and families to create exceptional patient experiences, every day.
A doctor's mission should be not just to prevent death but also to improve the quality of life. That's why you treat a disease, you win, you lose. You treat a person, I guarantee you, you win, no matter what the outcome. Share on X– Hunter Doherty “Patch” Adams
1 https://catalyst.nejm.org/information-asymmetry-untapped-patient/
2 https://patientengagementhit.com/news/is-yelp-an-effective-patient-resource-for-treatment-decisions
3 https://catalyst.nejm.org/what-is-patient-centered-care/
4 https://www.apsf.org/article/education-improves-patient-satisfaction-and-patient-safety/