Why It’s NOT About “Patient Centered Care”

“Patient Centered Care. Patient Centered Care. Patient Centered Care.” How many times have you sat through orientation for a new job and had that shoved down your throat for what seemed like EVERY slide for the entire day (waving hand right here)! We get it. It’s about the patient. Never once did it cross my mind that with nursing, the focus would be anywhere else, just sayin. I mean, isn’t that why we all went into this profession? We wanted to help people AKA: THE PATIENT? So heres the deal. I know why hospitals shove this down everyone’s throat. Healthcare is not just about physical healing and caring for people anymore. It’s about hospitals feeling the need to make patients feel like mother freaking VIP because their money is on the line! It’s not just about good, safe, and effective care. It’s now about pleasing “customers” on a level that goes WAY beyond physical patient care and that none of us signed up to do! 

Let’s talk about this for a sec. Health care today is all about reimbursement. Reimbursement is based off of scores. HCAHP scores to be specific. So what does HCAHPS stand for? It stands for “Hospital CONSUMER (yes, just like someone who consumes coffee from Starbucks and tacos from Chipotle) Assessment of Healthcare Providers and Systems. So basically a patients’ perspective of hospital care. “A Patient’s Perspective”….Oh boy.

These are the types of things that patients get asked about:

◦Communication With Doctors

◦Communication With Nurses

◦Responsiveness of Hospital Staff

◦Pain Management 

◦Communication About Medicines

◦Care Transition

◦Cleanliness of Hospital Environment

◦Quietness of Hospital Environment

◦Discharge Information

◦Overall Hospital Rating

◦Likelihood to Recommend 

So as a Nurse, here’s my problem with this survey. Simply put, it’s subjectively evaluated and well….not accurate. At the end of the day, all a hospital wants is for a patient to be HAPPY. They want them to feel like a rockstar and that we’re so thankful they chose our hospital for care. That means that they go to unreasonable lengths and measures to make these sometimes not-so-pleasant and irrational patients happy. Not ALL patients who complain are crazy. There are definitely circumstances that warrant attention and recovery, but more often than not it’s not been super reasonable in my experience. Happy Patients = Good Surveys. Good Surveys = Money. Healthcare is no longer about the life saving interventions that only Healthcare Professionals and Facilities are equipped to do for the patient, but it’s about what we can do for them BEYOND safe and effective care. We’re talking the food we offer. The linens we cary. The channels our TV’s have. The strength of drugs we give. The chapstick we carry. The soda we offer….you know, all that REALLY important stuff that is going to get our patient through that really “emergent” time.

My problem with these surveys is that they don’t accurately evaluate care. And in my experience as a waitress back in college, people rarely ever give good reviews. We only heard the bad ones. People rarely take the time to review a satisfying experience, but when they do, it means A LOT! But most of the time, it’s the bad stuff. Hurt and angry people are emotional. And typically when one thing went wrong, the perspective of a hurt person is that EVERYTHING went wrong. Angry and dissatisfied patients give bad reviews across the board. And what has this done? It’s punished Nurses and Healthcare Providers.

It’s no longer about doing what’s best for the patient, but it’s about what’s doing what is right in the patient’s eyes. And last I checked, these patients don’t have doctor and nursing degrees, yet it seems like they have more say in what WILL happen to and for them than the doctors and hospitals. While I 100% agree that a patient should have control and a say in what happens in their care (and actually encourage that), it is not okay when it’s at the expense of their personal health and staff being undermined and disrespected in the process. (I don’t mean just disrespect from the patients, but also disrespect amongst staff in the hospital itself during these situations).

Now that Patient PERSPECTIVE (not always reality) of their stay is what determines reimbursement, we’ve gone to extremes to make patients happy. We can educate ALL we want about the drugs we give, the surgeries we perform, and the schedule in their day, but if that ONE meal after surgery isn’t brought on time….BAM. That could ruin it all. So we’ve now implemented this GIANT  “Shove DOWN YOUR THROAT” initiative called “Patient Centered Care.” It’s all about the patient. Their needs. Their wants. Their EVERYTHING. So even if that means feeding a post-PCI patient McDonalds (yup, seen it) because we messed up their food tray, then so be it. It’s all about those damn scores, not about HEATLH or CARE!

Why Patient Centered Care Doesn’t Work

Let me explain the problem with “Patient Centered Care.” Patient Centered Care (and I’m referring to “patient centered care” by definition of what the hospitals thinks it means, not what it REALLY means), in my honest opinion, is hurting hospitals and the Health Care Profession. We have nurses and staff walking around on egg shells every single day and night because of the pressure of “Patient Centered Care.” Patient Centered Care is a hospitals attempt to put the patient first and do WHATEVER needs to be done to keep them happy. Do you know what happens when that message is SHOVED down the throat of staff hospital wide and then we walk into a shift where we’re short staffed with the most ridiculous assignment of patients (which happens more often than not)? We get stressed out. We get overwhelmed. We become anxious. We feel hurt. And you know what hurt people do? They hurt other people. They EMOTIONALLY hurt other people because they can’t handle the stress, the pressure, and the situations that they’ve been handed. Patients difitnely not the center. The HURT and STRESS becomes the focus. How do you think that impacts patient care? Not good.

It’s hard to walk into a room with a smile on your face when you’re hurting. And I’m a firm believer that when you fake your happiness, it can still be felt. People notice. You can’t hide being hurt. And the ways that I’ve seen hospitals handle “Patient Centered Care” efforts is KILLING their staff. I’m a pretty happy person, and it took a toll on me to the point that I left. This is what I’ve seen:

•More audits- Charge nurses being encouraged to stand at the door and listen to all that nurses are asking their patients. They’re LOOKING for the things they’re not doing or asking.

-What does this cause? MORE HURT.

•More Charting- Whoops, looks like Nurses aren’t good at doing “this”, guess we’ll have to create a place to document so they have to do it and then create a module for them to confirm they know how to do it!

– What happens? MORE HURT

•More Micro Managing- We have more nursing jobs auditing charts & pa-TROLLING than we do with actual help on the floor.

-What happens? MORE HURT

You catch my drift?…..

When you can’t get through your day without sticky notes being posted all over your computer about pain reassessments, your phone ringing with patient needs and new admissions, or bump-barding emails to finish computer modules, it’s hard to not hurt. It’s hard to not feel overwhelmed. It’s hard to not CRY when ALL that you want to do IS take care of your patients, make sure they’re not hurting, make sure they don’t need to use the bathroom, and make sure they’re comfortable. We don’t need someone to scorn us or to tell us we’re not doing it. We need time to really care. We need grace. And we need support. THAT will create effective change and benefit EVERYONE, including the PATIENT!

Hospitals today, in my opinion, function like Robots. There is no emotion behind what they do. They encourage those “wow moments”, but at the end of the day, that’s for your own purpose and fulfillment and a plus for them when they happen. It’s seems to really just be a matter of them wanting us to get it all done, get it all charted, keeping patients happy by going to the EXTREME, and not caring, nor supporting the middle man who actually makes a lot of the “good” happen. That’s us. The Nurses. Plopping out a food truck on Nurses Week our front of he Hospital is actually insulting, for the record. I don’t feel valued. I feel insulted that I’m worth a cancer causing meal to you!

Why “People Centered Care” Is The Answer

What do I think the solution is to all of this? Well…I don’t think there’s an exact solution. I think it’s a journey of figuring out what makes it better. But I do think there is a better approach. It’s called “People Centered Care.” I was at first going to call it “Nurse Centered Care”, but the WHOLE hospital affects patients. From EVS to the Docs, we’re all a part of a patient’s experience. And I think there is one thing that ALL of these people have in common:

We all want to feel loved, safe, and appreciated. 

Every single one of us……

And just for the record, this isn’t a “millennial thing.” This is a HUMAN thing.

Underneath so much hurt that is given out is a HURTING person. Remember that.

HURT PEOPLE, HURT People.

Emotionally. Mentally. And sadly, sometimes physically.

When you shove “PATIENT CENTERED CARE” down peoples throats in the ways that hospitals do, it’s like nothing matters except the patient’s perspective. So YOU don’t matter, but your actions do. It’s a conditional relationship. When you do good, I like you. When you perform poorly, we’re not friends. No body wants to be around or in a relationship like that, do they? And in my opinion, that’s how a lot of leadership is trained and how a lot of hospitals function. They’re trained to look at all that’s going on on the outside, but they’re not trained how to love and lift up people within. They’re not trained how to encourage. They’re not trained how to grow other leaders. They’re trained to cover the hospitals butt at all expense and most of the time, that means stepping on people in the process. I’ve seen this happen all too much.

I’ve been one of those people stepped on. I’ve been a nurse who loves deeply and cares a lot.  I’m a nurse who has always gone above and beyond. And I’ve messed up. I’ve been thrown under the bus. And it took me about 2 months to stop hurting when that happened. Do you know how hard it was to go take care of others when I was hurting myself?  Do you know how hard it was to show up with a smile at a place that “hurt me” and then shoved “Patient Centered Care” down my throat? Then factor in my poor health at the time and the awful relationship I just got out of that was contributing to my hurt. I was hurting deeply. And that’s the reality of the world that we live in. There are a LOT of people walking around hurting. Hurting for so many different reasons. And people deal with that hurt in SO many different ways. And the only way to deal with that hurt is to take appropriate action to heal. That means getting help and support.

It’s Not About The Pateint. It’s About PEOPLE!

“So Kelsey, why are you rambling about all of this, what does this have to do with Patient Centered Care?” Because I don’t think having good scores has to do with keeping patients at the center at all. It has to do with keeping PEOPLE at the center: the nurses, techs, respiratory, environmental services, the doctors, the lab, the patients, EVERYONE. When our focus is taking care of each other, loving on our staff, giving grace when needing, listening, being patient, speaking respectfully and kindly, and helping when it’s not convenient or not even your job, people begin to feel loved and appreciated. People who feel loved and appreciated are generally happy people. Happy people inside of a hospital want the best for others INCLUDING the patient!

People Centered Care CREATES Patient Centered Care. 

I think hospitals have it all wrong by pushing“Patient Centered Care” in the way that they do. There’s nothing genuine about that. We all know the hidden agenda and no one is sitting and thinking to themselves “ Aw how sweet, they care!” While I think that there are some places that genuinely care, we know that the motive is to make whatever needs to happen, happen ultimately to keep that patient happy so that our scores come back good and well….they get paid.

When hospitals can learn to foster an environment that greatly encourages good mental and physical health and provides appropriate resources to support their staff in that, things will begin to chanuge. Part of dealing with hurt and life is TALKING about it and getting help to TAKE STEPS TO CHANGE. Many people want to change, but they just don’t know how to start. What if hospitals had ons ite counselors and coaches for that? Why don’t THEY is the better question?

When a hospital can stop implementing stupid documentation classes and start bringing in professionals who care about people and teach classes about how to effectively and respectfully communicate, lead, and be a freaking good human being, things will start to change. These resources exist, I promise.

When hospitals start fostering an environment that focuses on “PEOPLE Centered Care”, meaning ALL of us, I promise that patients will be happy. Have you ever walked into a restaurant  and you felt the tension of being short staff and busyness going on? The waiter walks up to the table with a fake smile and introduction and you just KNOW things aren’t good? You kinda feel for them, but it also kinda ruins the vibe and “experience” at that restaurant? It happened to my husband and I yesterday. We went to our favorite restaurant and had a HORRIBLE experience! Had we not had good experiences prior, we probably would have left a comment. We both saw where people could have jumped in and helped who were doing other jobs, but we identified how that’s where good and effective leadership comes in. Attitudes shift when people feel supported EVEN when short staffed. Support can come in the form of VERY simple actions and words, and when people just see that you care, they want to care too. These are simple things that just need to be TAUGHT.

Well the same thing happens within a hospital. You can feel how your Nurses and Staff are feeling. And whether it’s an internal staffing hospital problem and or a problem that a staff member is dealing with personally, I think there is a BIG shift that could be made within healthcare to support both circumstances. When people are hurting, others are affected by their hurt.

Things that make people hurt: 

Their Health. 

Their Family/Home Life 

Their Finances. 

Their Relationships

Lack of Emotional Support

When we can create a culture and foster an environment in a hospital where it’s not just about Patients getting well, but its about ALL PEOPLE getting well, things will start to change. When you have happy, healthy, and WHOLE employees who feel loved, appreciated, and supported by one another, you’re all going to want best for each other. You’re all going to want to work together to do what’s best for that patient. I mean, that’s why we all went into healthcare. To help PEOPLE. Keeping PEOPLE in the center by supporting them in their physical, mental, and emotional health IS keeping patients in the center!

The Current “Patient Centered Care” system is like medication. Meds treat the SYMPTOMS of bigger problems, but never really fix the problem. A bandaid essentially. They’re expensive and don’t always work the same for all, nor do they fix the problem long term. 

“People Centered Care” is addressing the ROOT CAUSE. When you address the root cause of conditions (emotional health, diet, and lifestyle), that’s when TRUE long term change happens. 

When you are in an environment where people just want to help each other in what ever way possible, it’s contagious. You just want to keep helping too. It’s toxic to hurt! It’s toxic to feel negative. It’s toxic to know that you’re not doing a good job. It’s toxic to not feel good about your physical and emotional health. I don’t believe that people intentionally want to suck or hate their jobs. It’s that we’re all walking around fighting our own battles….it’s not just our patients. When we can all work together to point out healthy paths, support employees with healthy resources, speak kind words, and learn that it’s not ALL about the patient, but that when it becomes about each other and helping EVERYONE become individually WHOLE, the patient WILL feel at the center…..

Because WHOLE people can HELP People!

THIS, in my honest opinion, is the answer. PEOPLE CENTERED CARE.

Your heart is mine,

Kelsey

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