Archive for January, 2009

Best Hospitals … Best Odds for Survival

January 31, 2009

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A recent article in the Gainesville Times (written by Debbie Gilbert,
dgilbert@gainesvilletimes.com) found that, “Patients admitted to the
nation’s top-rated hospitals, a category that includes Northeast Georgia
Medical Center, have a 27 percent lower chance of dying during their
stay.”

The article discuses the factors that lead to higher survival odds at our
nation’s top hospitals.  Lynda Adams, Director of Performance Improvement
at Northeast Georgia Medical Center, mentions several factors that
contribute to better survival rates.  These factors include:
* Having a team in place to look for people who are deteriorating and taking
action.  This to avoid a “Code Blue.”
* Having medications bar-coded and scanned to make sure they match the
code on the patient’s wristband.
* Implementing of a new initiative called “Condition H.” If the patient
or a family member notices something wrong, they can dial “HELP” on their
phone anytime of day or night.

For the full article:

http://www.gainesvilletimes.com/news/article/14174/

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content communication skills programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

(more…)

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Healthcare Professionals Communicating with Patients Through Email: Technology Works if Used Properly

January 30, 2009

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Email is now a standard part of our lives.  We use email in the workplace
to communicate with colleagues.  We use email at home to correspond with
family and friends.  Today, many healthcare professionals communicate with
patients through email.  This method of communication has many advantages,
but there are some critical rules that need to be followed.

Traditional types of healthcare-patient communication are in-person
meetings and written information.  New technology adds another form of
communication, that is, via email and the Internet.  There are multiple
advantages to embracing new technology:

* Allows for simple routine types of questions (but should never replace
an in-person visit with a seriously ill person).
* Provides test results with interpretations and medication instructions.
* Allows for follow-up care and clarification of information provided in
an office setting.
* Provides links to helpful articles or websites.

However, all of the new technology must be tempered with patient
confidentiality and a right to privacy.

The American Medical Association’s has developed guidelines for
physician-patient electronic communications.  This is a link to the
guidelines:

http://tinyurl.com/b9o3un

Many healthcare professionals are concerned this new technology will take
up much of their time, however in many ways, this new method of
communicating may ultimately save a lot of time.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content communication skills programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Giving Bad News: An Effective Three-Step Approach

January 28, 2009

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“Breaking bad news is not as much a delivery as it is a dialogue between
two people.”
— Rabow MW, McPhee SJ. Beyond breaking bad news: how to help patients who
suffer. West J Med 1999;171:260-3.

One of the most difficult tasks for a healthcare professional is to
deliver bad news.  It is never an easy activity even for the most seasoned
of professionals.  However, there are steps we can take to be sure the
news is delivered in the most effective and caring manner.

The Definition of “Bad News”

We tend to think of bad news as telling a patient they have a terminal
disease.  However, that is a type of bad news.  There are multiple types
of bad news.  For example, telling a construction worker he can’t lift
heavy objects for six months is bad news if that is his livelihood.  Also,
telling a person they have a chronic disease, such as diabetes, is also a type of
bad news.

Bad news can be any type of news that will negatively impact a patient in
any way.

Is it Always Necessary to tell a Patient the Bad News?

Fifty years ago, it would not be unusual to withhold a terminal cancer
diagnosis from a patient.  However, recent studies have shown that
patients do want to know this information.  It is important that patients
are given all the details of their health situation; they have a right to
know.  They may want to make decisions regarding wills and other legal
matters.

Based on a case-by-case basis, there may be situations where withholding
information may be a good option, such as in the case where a patient may
have a mental breakout or harm themselves.  In some cases, the patient
themselves may ask not be told.  This should be looked at as a type of
informed consent.

Steps in Giving the Bad News

I. Before Giving the News

Think about the agenda before you meet the patient, so that you have the
significant information available. There are several items to consider
when planning what to say:  specific diagnosis, treatment plans,
prognosis, and support strategies. For a patient who has been shown to
have hypertension, this would be an appropriate manner of discussing:
specific diagnosis (describe diagnosis of high blood pressure, avoid
medical jargon like the term hypertension), treatment plans (discuss
different options to treat high blood pressure), prognosis (discuss
successful options for treating, however be careful of not guaranteeing
100% success), and support strategies (provide resources to help cope).

Prepare for the conversation with the patient.  Think about what you want
to say.  Mentally rehearse your words so you feel more comfortable sharing
the news.

Have a box of tissues in the room in case the patient begins to cry.

II. Giving the News

Physical setting: Find a quiet private place to share the news.  Be sure
you are seated at eye level with the patient.  Avoid any physical
barriers, such as a desk.  Ask the patient who else should be present; let
the patient decide who, if anyone, should be present in the meeting.
Silence all beepers and request no interruptions unless it is an absolute
emergency.

Communication strategies:
* Give the patient a warning that difficult news is forthcoming, such as by
stating, “I’m afraid the results reveal the situation is more serious than
we would have hoped for …”)
* The patient is your first priority, however if the patient has other
people present (e.g., spouse), be sure to attend to those people as well.
* Speak slowly, clearly and concisely.
* Provide the information in small chucks; do not give a long lecture which
can be overwhelming to an already anxious patient.
* After discussing each segment, pause to allow the patient to take in what
you have stated.  This is known as “chunk and check.”
* Be honest about the prognosis; do not give false hope.  Be sensitive, yet
direct.
* Use empathy in the discussion (e.g., “I know this is difficult news.”)

Assess current level of knowledge.  Determine how much the patient already
knows, such as by asking, “What have you already been told about your
illness?” Pay close attention to what the patient says to evaluate their
level
of sophistication regarding the illness and their current emotional state.

Ask the patient how much they would like to know.  Inquire as to whether
they want all the details or just the “big picture.”  Emphasize the
fluidity of the dialogue, so they know they could always ask more
questions at a later time.

III. After Giving the News

Be very attentive to the patient’s feelings.  After you have shared all the
news, listen very carefully to the patient’s reaction while observing body
language.  Use empathy (e.g., “I know this has been very stressful to hear.”)

Emphasize your role as a partner.  Let the patient know you are working with
him or her on this medical issue (“We will be working together to help
you.”).  Confirm your role as an advocate for the patient.

Follow up plan.  This is a time for reviewing, summarizing and making next
steps.  Develop a step-by-step plan, review the plan with the patient and
then agree on follow up plans.  Provide resources, which could be a
referral to a counselor (if needed), brochures, phone numbers and
websites.

Closing Thoughts

Healthcare professionals are taught technical skills to attend to the
patients’ physical needs.  However, when giving bad news, the greatest
skill is effective communication.  Unfortunately, during a healthcare
professionals’ formal education, communication skills are often not given
the vital importance they deserve.  A growing body of evidence illustrates
how the communication skills of the healthcare professional will greatly
influence how well a patient will cope with the bad news.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content energetic keynote
speeches or training programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

The Likability Factor: 10 Sure-Fire Ways to Make It Work For You

January 26, 2009

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As I was driving to a speech, I decided to listen to the radio. The first station I turned on was discussing an actor who was dealing with a substance abuse issue. One of the radio personalities said, “I hope he does well. He is such a likeable guy.” I then began to think to myself, “What does it take to become a likeable person?” I have found it is not a mystical esoteric human quality; it is a factor everyone can enhance with a few simple techniques.

Show Gratitude. Never forget to thank people for kind acts. It only takes a moment to express this appreciation, but it has a long-lasting impression. When I was a child, my mother always had wonderful birthday parties for me. My sense of anticipation was high as I eagerly awaited these festive events. From an early age, my mother emphasized the importance of thanking people for their kindness. After my parties, before being allowed to play with my new gifts, I had to write the thank you notes first. It is easy to send a quick “thank you” email, however if you really want to make someone feel special send him or her a handwritten note or card.

Demonstrate Empathy. When you think of empathy, think of shoes. Empathy involves thinking of what it is like to be in someone else’s shoes. If a person had a flat tire on their way to an important meeting, how do you think they are feeling? Upset? Frustrated? Let people know you are trying to understand their feelings. I remember driving and stopping at a red light. While the light was red, I opened my briefcase to get an energy bar. While I was doing this, the light turned green and the person behind me started beeping their horn. At first, this horn blowing irritated me. Then I thought about times I was in front of a car where the light turned green, but they were not moving, so I had to beep my horn. I wasn’t angry anymore because I realized I had “been in their shoes.” In developing empathy, critical judgments are replaced by acceptance, compassion and understanding.

Honesty is the Best Policy. One of leading deterrents to likability is being seen as dishonest. This seems like a very obvious bad trait. Of course, we don’t like dishonest people! However, this factor could also be very subtle. For example, I agreed to chair a committee. I found a person who was willing to be my vice chair. When we chatted at a meeting, he was very enthusiastic about helping on the committee. However, after the meeting, he never returned any of my phones calls or emails. I perceived that action as dishonest. Could I ever trust him again? Probably not. We need to put our attention on being genuine and trustworthy.

Be Positive. People like optimists. Negative people are very draining to be around; they can suck all the positive energy out of any situation! Unlikable negativity can includes a wide variety of behaviors such as pessimism, complaining, blaming, jealousy, and criticism. These negative behaviors are often associated with people who do not believe in their own power to change things for the better. A negative mindset often develops from a few early failures that have spiraled out of control with negative self-talk. If you are leaning toward negativity you risk being seen as unlikable. Now is the time to challenge those feelings. A positive change in attitude starts when you notice the connection between negative thoughts and poor results. Focus on the link between positive thoughts and favorable outcomes.

Observe Body Language. Each person has their own style of body language. Some of us are gregarious and have big gestures, while others are more subdued with smaller motions. People feel more comfortable being with others who have similar body language attributes. Does this mean we need to change our style for every person to be more likable? No, we do not need to completely morph into something new for each individual. However, what we can do is pay attention to the body language of people and try to adjust ours to make them feel more comfortable. For example, I am a high-energy person; I could easily overwhelm a more introverted person. When I am with someone who is reserved, I tone down my style to make them feel more comfortable.

Pay Close Attention. When you are talking to someone, make them feel like they are the only person in the world at that time. No one else matters, but them. We do this by direct eye contact and facing the person shoulder to shoulder. Say the person’s name during conversation. This is especially important when you first meet. Stating the person’s name upon the initial meeting will help anchor the name in your mind. As you are first greeting a new person, say their name in your head three times to help cement it in your mind. Please do not use the lame excuse, “I am not good with names.” Work at it and you’ll remember names! Make a game of remembering names! For example, a lady from my bank is really sweet. Her name is “Joyce.” I always remember her name because I remember her as a person with “Joy.”

Put on a Happy Face. The smile factor counts! Likeable people are cheerful people. My wife, Beth, and I were at a convention dinner. I had spoken at the event that morning. At our table was a young man, Andy; we are both members of the National Speakers Association. Later that evening, Beth and I both discussed what a great guy Andy is – we just felt good being around him. What was it about Andy? We believe it was his upbeat personality. The fun factor plays a role too. Humor is a sign of playfulness, openness, and happiness, which are all highly attractive behaviors.

Control Anger. People want to be in an environment of harmony and peace. Expressing anger and aggressiveness is a very quick route to being perceived as unlikable. In reality, most anger is a secondary emotion that really represents more basic feelings of hurt, frustration, disappointment, insecurity and fear. People often direct anger outwardly onto others and life in general, when they should be aiming it more inwardly at motivating themselves to take responsibility for making different choices to stop failing and start succeeding. We need to find out what is making us angry and work at more constructive ways to handle life’s difficult times.

Talk About Yourself, Appropriately. During my programs, I often share personal stores because that is what connects us to each other. People often come up to me and say, “When you told that story about your dog, that reminded me of an experience I had.” People may feel embarrassed about a certain life experience, however sharing that you had a similar experience will make the person feel more at ease. When self-disclosing, it is important to be appropriate, in that your sharing fits the moment. Do not tell personal intimate details of your life with people you just met. People will want to run in the opposite direction! Also, do not constantly overwhelm conversations with stories about you. People who are likeable engage in dialogues not monologues. Of course, always be humble.

Notice the Details. Think about eye color. What are the eye colors of your family members? What about your co-workers? Likeable people think in terms of details. When I am talking to a person on the phone and they mention a certain restaurant they like, I will make note of that fact. A few weeks later, I may say, “Let’s have lunch this week. How about if we go to that Bistro on Main Street? I know that is one of your favorites.” Start picking up on details!

Establishing rapport with people is a critical skill in life. It is not an innate gift you were born with, rather it is a learned behavior. You can increase your likability factor by following a few simple rules outlined in this article. The door to happiness is there for you in life, you just need to find the right “likability keys” to open this gate.

Edward Leigh, MA, is a high-content entertaining keynote speaker and seminar leader.  For more information about his programs, visit: http://www.EdwardLeigh.com or call 1-800-677-3256

How Good (or Bad) is Your Hospital? A Tool to Find Out

January 23, 2009

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Information about your hospital is now available through a new tool
created by a joint venture of several government organizations.  The
information on this website comes from hospitals that have agreed to
submit quality information for the public to view.

The website is listed at the end of this post.  To better understand
the benefits of this website, please read the entire post before going to the website.

Through this website you will find information on how well hospitals care
for patients with certain medical conditions or surgical procedures, and
results from a survey of patients about the quality of care they received
during a recent hospital stay. This information will help you compare the
quality of care hospitals provide.

The website shows recommended treatments for some of the most common
conditions that hospitals treat. Research has shown that these treatments
provide the best results for most patients with those conditions and are
an important part of the patients’ overall care. Hospitals should try to
give all of their patients the recommended care when it is appropriate.
The goal for each measure is 100 percent.

Be sure to examine the section, Survey of Patients’ Hospital Experiences.
Two very revealing questions are asked in this section:

* Percent of patients who gave their hospital a rating of 9 or 10 on a
scale from 0 (lowest) to 10 (highest).
  I checked one hospital that a
relative was recently treated at — the response to this question was 53%!
 The national average is 64%.  This low number was a concern.

* Percent of patients who reported YES, they would definitely recommend
the hospital
. Once again, I checked one hospital that a relative was
recently treated at — the response to this question was 64%.  The
national average is 68%.

The information you will find on this website is intended to help you when
you talk with your physician or hospital.

Before making decisions regarding hospitals, do your homework.  Ask lots
of questions.  This your life and you deserve the best possible care.

The website is called Hospital Compare: http://www.hospitalcompare.hhs.gov/

Edward Leigh, MA, is a high-content entertaining keynote speaker and seminar leader.  For more information about his programs, visit: http://www.EdwardLeigh.com or call 1-800-677-3256

Avoid Using “Why” Questions with Patients: Apply Friendlier Language

January 22, 2009

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I took my mother to the foot doctor.  She is supposed to being wearing support stocking due to swelling in the ankles.  Mom has not been very compliant (she is now).  The doctor said to her, “Why aren’t you wearing the stockings?” This type of question puts people on the defensive.  Why questions can come across as abrasive, even hostile.  A friendlier version of the question is, “What can we do, working together, to help you wear the stocking on a consistent basis?”

 

According to the Merriam-Webster Online Dictionary, the word “why” means “for what cause, reason, or purpose.”  We ask why questions basically because we are looking for a reason in regard to an action.  When lawyers have people on the stand, they ask tough questions, why questions (e.g., “Why did you steal the money?”).  However, in healthcare, we are working in a therapeutic environment where certain questions need to be asked in a sensitive manner.

 

Here are some why questions and their better alternatives.

 

Why Question:  “Why didn’t you take the medication as prescribed?”
Better Question: “What was happening that led you to not take the medication as prescribed? Let’s talk about solutions.”

 

Why Question:  “Why are you still smoking? You have many breathing issues that will only get worse.”
Better Question: “I am concerned about your breathing issues. We will explore different options to help you stop smoking.”

 

Why Question:  “Why did you lift that heavy piece of wood when you know you have back problems?”
Better Question: “Your back problems are a concern and I want to help you feel better.  In the future, you will need to careful about lifting heavy objects.”

 

By the way, why questions can also wreak havoc on personal relationships. A friend of mine told me her significant other became her insignificant other because he would constantly ask her why questions.  For example, she would come home from the grocery store and he would ask, “Why were you gone so long?”  He looked at her bags from store and asked, “Why did you buy these groceries?”  One more example, he would walk into the family room and ask, “Why are you watching that TV Show?”  She ended the relationship.  She jokingly quipped, “He never asked why I didn’t want to see him any more!”

 

Edward Leigh, MA, is a high-content entertaining keynote speaker and seminar leader.  For more information about his programs, visit: http://www.EdwardLeigh.com or call 1-800-677-3256

 

Obama Inauguration Speech: What We can Learn to Become Better Communicators

January 20, 2009

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Regardless of your personal political affiliation, we all have to agree that President Obama is a masterful communicator.  He captivates people whether as a speaker to an audience of thousands or as a one-on-one communicator.  We can all become better communicators by looking at and listening to our new President.  Here are traits that President Obama possesses that we can incorporate into our own communications.

Vivid Language:  In today’s inaugural address, President Obama made this comment, “Yet, every so often the oath is taken amidst gathering clouds and raging storms.”  In communicating, we need to paint strong pictures in our listeners’ minds.  Metaphors are an excellent method of capturing peoples’ attention.

Pauses:  We are fearful of silence; we are concerned people will think something is wrong if we are briefly silent.  Pauses are powerful and we must blend them into our communications with others.  If you say something that is very strong, you need to briefly pause to give people time to absorb your words.

Eye Contact:  In today’s address, Obama had excellent eye contact while speaking.  When talking to a single person, we need look at them in the eyes (not staring which could appear threatening).  Eye contact conveys the message that we are interested in the other person.

Voice Inflection:  Vary the pitch and tone of your voice.  Peaks and valleys make for an interesting conversation. If the energy level is constantly too low or too high – that’s boring.  Yes, constant high energy is boring; what makes it boring is the “sameness.” In President Obama’s speech his voice become big and then at other times dramatically quieter.

Match Energy Level:  Today’s’ crowd in DC was charged up and Obama matched their enthusiasm with his energy level.  If you are a big energy person and you are talking to a person who is quieter in nature, tone it done.  Otherwise, you will overwhelm them.  On the flip side, if you tend to be more reserved and you are talking to a big-energy person, you may need to raise your energy level a notch or two.

Everyone can become a better communicator, but it takes work.  Spend some time to practice these skills and you will see big results!

Edward Leigh, MA, is a high-content entertaining keynote speaker and seminar leader.  For more information about his programs, visit: http://www.EdwardLeigh.com or call 1-800-677-3256