Start with “why”

Challenges for healthcare are enormous: increasing demand, decreasing budgets and shortage in skilled personnel puzzle many healthcare administrators. Next to that we think the next decennium should be the era of the rising self-empowered patient, in where we will embrace the patient, their family and informal care into the healthcare team. Technology is changing possibilities and lowering in costs of it faster than ever, sometimes even exponentially. To cope with these aspects, Radboud University Medical Center launched a program called REshape.

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Active Listening Response

Corine Jansen
april 17th, 2014

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Many doctors and nurses fear that active listening will trap them for minutes hearing information that is unrelated to the disease.  Listening to it, will only distract them. Many health care professionals worry that they do not have the time to listen for stories. But many doctors and nurses who have incorporated listening into their practice more often find that time invested early is recouped quickly.

Indeed, the first few visits with a patient may take more time, but time is saved shortly by having developed a more robust alliance, knowledge and trust from the start.

The serious consequence of not being able to do this kind of listening is that patients’ symptoms get dismissed, their “non medical” concerns get ignored, and treatable disease gets missed.[1]

I would like to give some examples from patients:

Situation: A 23-year-old young man described a skin lesion.
Patient’s statement: “When I look at it, I wonder what it is.”
Diagnostic response: “How long has it been?”
Active listening response: “You are wondering? What kinds of thoughts have crossed your mind?”

Some patients indirectly addressed underlying concerns.

Situation: A 68-year-old non-smoking woman described her cough.
Patient’s statement: ” It’s not that it is that bad but, it’s back. It started to get better with the cough medicine, but now it’s back.”
Diagnostic response: “Have you had any trouble waking up short of breath?”
Active listening response: “The way you describe your cough, I wonder if you have a specific concern?”
Patient’s concern: The patient was concerned about possible lung cancer, because she lost a friend with this disease.

Situation: A 62-year-old man with diabetes.
Patient’s statement: “I’ve found on Google that hypoglycaemia can damage the brain. Is that true?”
Diagnostic Response: The doctor explained the brain’s unique carbohydrate metabolic needs.
Active listening response: “Before I explain, you searched on google, I wonder if you have experiences or concerns about hypoglycaemia?”
Patient’s concern: Having recently experienced an episode of dizziness, and having had several episodes of misplacing his glasses. This patient is worried that he might be developing dementia.

What I’m trying to convey is the kind of listening that will not only register facts and information but will, between the lines of listening, recognize what the teller is revealing about him self.

Health professionals have begun to do research and to write about how they can listen more effectively to their patients. [2]

Dr. K.P. points to a number of barriers physicians face in addressing patients’ emotions. “Physicians are trained to be medically oriented, not psychologically oriented, and patients often express their emotions very indirectly,” she says. “The patient may say ‘the tumor is getting bigger,’ which represents an opportunity for the doctor to acknowledge the emotion that the patient must be feeling. Instead, the medical perspective: ‘Yes, it was 4 millimeters and now it is 6 millimeters.’

Listening to patients’ narratives is critical to effective patient centred care.


[1] R. Charon, Narrative medicine, honoring the stories of illness (2006)

[2] Mack Lipkin jr, Samuel Putnam, Aaron Lazare eds, The Medical Interview and Robert Smith, The Patient’s story

The friction between guidelines & innovation

Rutger Leer
april 15th, 2014

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I’m writing down my thoughts because I just want to share my insights and hope to learn from others as well. My thoughts are mostly about data but I’ll be writing about other related subjects as well.

I am working on a project in which innovation is key and for which there are, as far as I know, no predecessors. In this project I’m experiencing all kinds of different challenges and contradictions and they’ve kept me busy.

My current project revolves around patient centered data, patient gathered data but also about sharing this data with specific caregivers and/or family. In short, the project is about creating an eco-system of information gathering and sharing. Through this we try to create a carecycle in which the patient gains more insight. This will enhance the patient empowerment and will make it possible for the patient to share their data with people of his choice. You can read more about this project on our website or on hereismydata.com.

In the past few years, I have implemented several patient portals in the Netherlands and was part of the implementation of an EMR. These projects have taught me a lot about data gathering, data sharing and the importance of privacy and safety of medical and patient related data.

Because of the importance of these two aspects there was a lot of focus on safety and security during the implementations. For example, implementation of patient registration processes, 3-step authentication and hacker tests were always an important part in these projects. And while I recognize their importance, they have also been some of my greatest annoyances because they interfere directly with user experience, entry levels for patients and therefore, the success of the portal.

Our current project is different, in this project we are ‘innovating’ and thus making it a project with a lot less boundaries and restrictions. This due to the fact that we are implementing a patient-focused portal so that guidelines and protocols that are normally compliant do not count. Sometimes I even find myself wishing for the strict and clear guidelines on sharing EMR data. Although those boundaries and restrictions were one of the most annoying things during the implementations they gave direction on where we should be going.

Thus innovation brings a different set of challenges. We have to follow guidelines that are not yet implemented, nor developed, but on the other hand most probably will affect our product. This because we have decided to stick to some regulations that aren’t tailored to our product yet, bringing friction between these guidelines and innovation. Some of the regular guidelines have evolved into innovation killers. On the contrary, I’m hoping that “not-tailored”, partly followed, guidelines will help us explain to people that what we are doing is ‘safe’ and that we try to follow the existing regulations, as far as we can apply them to our product.

People have asked me: “How can we organize innovation?” In my opinion we shouldn’t want to organize innovation, because that would be the noose that will soon kill it. The moment we start validating or registering innovation, we are directly killing innovative power and motivation as well. Innovation is often an organic process, non-planned, not regulated and spontaneous.

But there comes a time where an innovation no longer an innovation. When does innovation become a product or even a process? Because at that moment, the need for regulations is valid. For me it’s still unclear when innovation ends and implementation starts. I guess sometimes in innovation questions remain Unanswered…

Wrap-up: Masterclass Patient Experience

Robin Hooijer
november 26th, 2013

James Merlino Patient Experience

We had the honor of listening to James Merlino yesterday, James is the Chief Experience Officer at the Cleveland Clinic. He shared with us his inspiring story on how they turned the topic of patient experience to a #1 priority at the Cleveland Clinic.

Our director Lucien Engelen started the masterclass with his presentation on where we are heading as Radboudumc and REshape Center. He talked about all the eGo systems that are currently used in healthcare which should be turned into an eCo system. The only constant in healthcare is the patient, so why don’t we give them ownership of their data? (More about this on our HereIsMyData page)

Lucien then gave the word to James Merlino, and one of his first questions to the audience was: “Who wants to be a patient? I offer you a trip on a private jet to Cleveland so that you can get heart surgery tomorrow! Nobody? See, no one wants to be a patient.” This point has been made very clear at the Cleveland Clinic, everybody who works there has to learn how it is to be a patient and also: How to communicate with a patient.

To realize this, they’ve taken patient centered care (although we like to call it ‘patient as partner ;-)) and took it to a whole new level. They have trained all their 46.000 employees to be aware of the world of patients and focus on patient communication for physicians and other caregivers. Even though the costs of this massive ‘overhaul’ were around 9 million, the costs of not doing it would have been even higher, not just in money.

When asked by someone from the audience if the Cleveland Clinic acts by ‘do it the Cleveland way, or get out’ James says that there has to be a zero tolerance policy for employees. The patients should be first and employees second. This does not mean that employees are completely out of the picture. Study has shown that patients wants their caregiver to look ‘happy’ or more so not angry, in a rush or frustrated. Patient wants their caregiver to have full attention for their problems and worries. As Merlino says, “It’s a matter of asking over and over again, taking the time to get the real opinion of the patient.”

Merlino then showed the audience the following video about empathy:

         

 

His final slide showed us the Cleveland Clinic slogan: “Every life deserves world class care.” We couldn’t agree more with this statement.

UPDATE: The masterclass about Patient Experience is now available online:

         

Collaborating with students for new insights

Robin Hooijer
november 22nd, 2013

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Today we have started a new round in our collaboration with about 20 students from the HAN University of Applied Sciences. These students are currently working on a semester called ‘Develop and Maintain an E-Community’ (DMEC) and are looking for new ways of connecting people with each other.

They will be working on two different concepts: one of them will include Google Glass, the other is an assignment of our Director to stimulate what he calls “Collective Intelligence” and that’s nót about spying ;-) but all about about co-creating and collective-knowledge.

This is the third time we’ll work with students following this semester and it still amazes us how fast and creative they work and think. How they also stimulate us, finding new approaches, new angles, come up with crazy ideas. That’s exactly why we love working with them.

We like to do things differently and help others to think out of the box at REshape. On the counter hand we offer them projects and real life problems that can solve actual society problems related to health(care).

You might want to check out the following video about what a connection between an EMR (electronically medical records)  and Google Glass might look like, it was made by the students from last year:

         

 

We look forward of the results of this new round of idea crunching.