Beaumont Hospital, Troy Case Study
“A woman with abdominal pain came to the ER and had soon dismissed a surgeon and ‘fired’ two nurses. I was next up to see her, and decided to apply some Communication in Healthcare skills I had just learned. As I listened without interrupting and prompted her with ‘What else?’ to tell me more, I uncovered not only the abdominal pain but her fears about sudden weight loss and, more importantly, that she might have pancreatic cancer like her brother who had died from the disease. The new information she shared prompted us to do further testing and to find a pancreatic tumor. The extra minutes it took me to listen empathetically resulted in a correct diagnosis and a transformation in the patient. She became completely cooperative once she’d voiced her fears and been heard.”
— Chadi Ibrahim, M.D., Hospitalist
The leaders at Beaumont Hospital, Troy, in southeastern Michigan, knew something had to change. Physician and staff clinical skills were excellent, but allied staff members were looking for guidance on handling difficult conversations.
“Our satisfaction scores were flat. We were trying initiatives here, there and everywhere, but we weren’t seeing sustained improvement,” says Amanda LaVoie, Director of Service Excellence. “Our training as healthcare workers doesn’t necessarily support how to communicate with patients, especially in highly emotional circumstances,” she explains.
“Some people do it naturally or have a good mentor. Many staff struggle with emotion-driven, angry, anxiety-laden exchanges with families. We wanted to provide our staff and physicians the tools to handle these situations.”
LaVoie, along with key administrators and physicians, began looking for a program that had the power to transform the hospital’s communication and culture. They zeroed in on a Communication in Healthcare curriculum developed by William Maples, M.D., founder and former CEO of The Institute for Healthcare Excellence (IHE). The core of the program is a four-hour course with training in communication skills and opportunities for practicing those skills.
Several components of the course matched what Beaumont leaders felt they needed to bring about a culture change:
“Our patients are worried about things we might consider minor but that are often more important to them than their own health. One woman was anxious to leave the hospital but far too sick to go home. The staff learned that she was concerned about a pet bird at home with no one to feed it. Once her nurse contacted the woman’s landlord and made arrangements for the bird to be fed, she was able to relax and focus on getting better.” — Constance O’Malley, former Chief Operating Officer at Beaumont, Troy and current President of Beaumont, Farmington Hills
Lead administrators and physicians took the Communication in Healthcare course before nurses and other caregivers and support staff at Beaumont Troy.
O’Malley noticed how the course re-oriented priorities for nurses. “I’ve been a nurse for 31 years. Along the way, you can lose a connection with patients when you’re too task-focused. Going through this course, we saw staff nurses coming out of classes totally energized. This teaches you not to try to fix every situation; just listen.
“As healthcare providers, we’re often interrupting and trying to fix things. We move fast and talk fast. But if we give people two minutes and let them talk, they feel the impact of that. Showing empathy and caring is what we should be doing as caregivers.” O’Malley recently became president at Beaumont, Farmington Hills, and hopes to introduce a similar communication program at her new hospital.
At Beaumont Troy, President Nancy Susick observes, “Staff members are really embracing the program. People are learning one-on-one, practicing skills in class, and relating to situations they’ve had at work and home. It’s really touching their hearts and minds. They’re more mindful and more fully present with patients, families and each other. I’m noticing staff spending more time sitting at the bedside listening.”
Twelve months into the program, about 35 percent of Beaumont employees have taken the communication course.
“We are committed to training every employee on site at our hospital, from kitchen staff to environmental services to nursing,” Susick says. “We’re making the classes multidisciplinary to ensure another level of teamwork and are giving people skills to help them be successful in their work."
“This is not a flavor of the month. This is what we’re doing. It’s part of who we are.”
As Susick personally introduces the program to each new cohort, she shares that the training has the power to improve relationships both at work and at home. For example, it has helped her to practice focused listening and to be more fully present when talking with her family members.
During the communication course, participants learn to practice “PEARLS” of communication. All employees receive a PEARLS card to keep these principles top of mind and refer back to them when communication isn’t going well.
Susick recently asked managers to identify employees or physicians who are carrying out PEARLS concepts. She publicly recognizes extraordinary behavior with co-workers present, reads a brief account of the person’s exemplary actions and presents a pearl pin for the individual to wear on his or her name badge.
To further reinforce mission and momentum, Susick leads weekly Caring Connections meetings every Tuesday morning for all managers, physicians, and administrators to review progress. Staff members are invited, as well. “I like to conduct the meeting myself, because I want the staff to know how committed I am to this effort. For the rare times I cannot attend, Dr. Lynch fills in for me.”
The tone of the meeting is positive and encouraging. Attendees share caring stories from the previous week, review communication priorities, discuss how each unit is performing and listen to ideas for improvement. Each meeting ends with a show of appreciation for the work everyone is doing to improve experiences.
Even when a unit is struggling to increase patient satisfaction, people from other units offer suggestions and support. Improvements may be anything from making the cardiac diet more appealing for patients to reducing noise on a patient unit.
“We have excellent attendance at our weekly meetings and people report it’s uplifting and energizing to be there,” Susick says.
Working closely with Susick is James Lynch, M.D., Senior Vice President and Chief Medical Officer. He is one of two physicians who have spearheaded the push for better communication and awareness at Beaumont. The hospital’s other physician champion is Chadi Ibrahim, M.D., Hospitalist.
“A couple of years ago, I was asked to attend a conference on improving the patient experience,” says Dr. Ibrahim. “As an internist and hospitalist, I thought ‘patient experience’ was a trend we needed to follow to improve service, but that it didn’t have much impact on the quality of our patient care.”
He continues, “I’ve heard that 50 percent of prescriptions end up in the trash. Patients want us to help them, but clearly we aren’t always meeting their concerns. We need to connect in a way that they trust us and fill the prescription. That’s clearly going to have an impact on how they recover.”
Dr. Ibrahim embraced Communication in Healthcare as the right fit for Beaumont. He talked to anyone who would listen about the importance of the patient experience. He wanted to show fellow physicians how a focus on excellent communication could improve their careers and their patient outcomes.
Dr. Ibrahim offers his own experience as an example: “Before doing this communication work, I knew practicing medicine was important, but it felt like something was missing. I didn’t know if I was doing as good a job as I could be. Now, there’s no question about it. Patients consistently tell me, ‘Wow, thank you. No one has ever listened to me that way.’”
He feels like he’s a better doctor and more efficient. “The first visit takes about the same amount of time or a little longer than the way I previously did things, but developing trust makes subsequent visits so much easier.” Dr. Ibrahim recently became a Certified Patient Experience Professional.
He notes that HCAHPS questions (Hospital Consumer Assessment of Healthcare Providers and Systems) focus on how hospital staffs communicate with people. The scores at Beaumont Troy are starting to improve.
Dr. Lynch says of his own personal journey to provide excellent care, “This four-hour Communication in Healthcare course took my listening and communication skills to the next level. It was eye-opening. If I’ve finished a patient visit and am walking toward the door, and that patient asks to discuss one more thing, I know that I’ve failed the patient. I sit back down and listen, but I want to cover all of those things before I walk toward the door.”
Both doctors agree that a true shift in hospital culture can’t happen without the full support and engagement of its physicians. A third of the physicians have already enrolled in the course.
Dr. Lynch notes that it takes time to change a culture: “I’m feeling small, incremental changes. We expect our medical staff to behave with respect, reflective listening, and patient-centered focus—and we’re seeing that more.
“The message is that everyone needs to give this a try. We’re working to make it mandatory for people to take the course to be re-appointed to the medical staff. Once you get up and running, everyone starts pushing, and it gets easier to push this boulder up the hill.”
Dr. Ibrahim adds, “The value of this program is not that every participant becomes markedly improved. We just need every person to improve a little. When everyone learns the skills and improves a little, the impact is great.”
The Institute for Healthcare Excellence partners with healthcare organizations to nurture relational skills necessary to create a culture that embraces trust, respect, compassion and teamwork—creating an environment where quality, safety, and efficiency can flourish. Through this work, physicians, nurses, and the caregiver team reconnect to purpose and restore joy to the practice of medicine. The result of the culture-transforming work is a restoration of humanity to medicine.