Catherine Wilson, Bureau Chief
Westchester Medical Center
Dealing With Patient Concerns
On Easter Sunday, my mother was admitted to the Westchester Medical Center. The pros and cons of that experience were outlined
in the April 3, 2008 edition of The Guardian. Shortly after that article, Ms. Kara Bennorth, Senior Vice President of Marketing and Corporate Communications for the Westchester Medical Center contacted The Guardian to discuss the issues we raised.
“The Medical Center’s patient services are in a state of continuous improvement” Ms. Bennorth admitted. “We have programs in place
to address the patient experience in four categories: Service Excellence, Responsiveness, Structure and Systems, and Resources”. Ms. Maureen Eisner, the Director of Patient Experience for the Medical Center explained some of the aspects of the service excellence and responsiveness programs.
“We conduct role-playing with all new residents. We stress the im-portance of making eye contact and introductions, and communicating
with patients and their family members. We hold conferences with medical leaders and patient-relations training for all members of the
nursing and clinical staff. We also conduct patient communications training for all front-desk and all levels of the admitting staff,” Eisner said.
Ms. Bennorth noted that the Medical Center stresses “service recovery” with all staff members. “The key is to identify the problem and fix it ‘in the moment.’” Bennorth said. “We explain to staff to concentrate on perception and expectation of the patient and the family. Even
if the problem is perceived, rather than actual, it still must be resolved. If the patient perceives a problem, then to them it is a problem. For
example, if a patient is complaining that they were waiting five minutes to be attended to, that may be a normal wait time. But if that patient is in severe pain, then any time is too long from their perspective. Our training for our staff stresses that it is the responsiveness to the patient’s concerns that is important”.
Ms. Eisner noted that the Medical Center does not wait to hear patient’s complaints or concerns in order to respond. “We conduct surveys
with both patients and family members and ask them to provide us with their input” Eisner said. “The feedback we receive can sensitize the staff to the perception of the patients. We use the information we receive from the patients and family members to help our staff to improve their communications. And we stress that they should actively respond to all concerns as quickly as possible.”
Ms. Bennorth stressed, “The communication training for all levels of the staff is a continuous loop of improvement.” She noted that the
Medical Center is improving patient care in other ways. “In our ‘Structure and Systems’ program we are upgrading and improving our facilities to enhance the patient experience,” Bennorth said. “We are in the middle of expanding our emergency department. We are redoing our Labor and Delivery ward and we are upgrading our units in the University hospital. Plus we are in the planning stages of a new lobby.
And we are addressing the ‘way-finding’ issue of our campus,” Bennorth said. “We are aware that we have a very large campus and it is difficult to navigate and find buildings. We’re working on making this easier”.
Eisner noted that changes in laws and regulations can affect hospital communications. Referring to issues about providing family members
with information, Eisner said “HIPPA is now the norm so a patient with full capacity has rights – they are entitled to keep their medical
information private. But every family and every case is different so we train our staff to understand family and patient dynamics to address
Bennorth stressed the unique status of the Medical Center that compounds the privacy issue “since we are a regional trauma center, and a children’s hospital, we face a difficult challenge. We often have extended families and community members come in with the patient – we can have twenty family members show up with one patient. That requires a better understanding from the staff. “Clinically our staff is concentrating on providing the best care and the best communication as well. But there can be many people to deal with for one patient, sometimes extended family members, sometimes unrelated individuals. We’ve expanded our patient advocate services to cover evenings and weekends and increased staff to handle this”.
Ms. Bennorth stressed that the Medical Center also tries to anticipate problem areas in advance where possible. “Insurance rules change all the time so we try to understand where the frustrations will occur. We try to predict the problems so we can address them when they arise”.
Ms. Eisner noted that, above all, patients are their own best advocates and can provide the best information about their own health issues
and needs. “It is very important for patients to discuss their health care wishes with their health care providers and personal advocates before
an issue arises,” Eisner stressed. “It’s important to bring medications, or a list of their medications, with them to the hospital. The patient should also bring a brief medical history,” she said.But most important of all, Eisner stated that a patient should never be afraid to ask questions. “Patients often feel that they may be perceived as stupid for asking a question. But they have a right to know what is happening and they should never be afraid to ask,” Eisner said.
The national accreditation program for hospitals, the “Joint Commission”, has established a “SPEAK UP” initiative for patients. “We’re
following that initiative,” Ms. Bennorth agreed. “We want patients to be aware of their rights”. Ms. Bennorth provided the SPEAK UP educational materials to The Guardian to share with our readers:
• Speak up if you have questions or concerns and if you don’t understand, ask again. It’s your body and you have a right to know.
• Pay attention to the care you are receiving. Make sure you are getting the right treatments and medications by the right health care professionals. Don’t assume anything.
• Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan.
• Ask a trusted family member or friend to be your advocate.
• Know what medications you take and why you take them. Medication errors are the most common health care mistakes.
• Use a hospital, clinic, surgery center, or other type of health care organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards such as that provided by the Joint Commission.
• Participate in all decisions about your treatment. You are the center of the health care team.
The initiatives of the national SPEAK UP program are to help prevent errors and provide understanding for patients and providers. In addition to the patient education programs like SPEAK UP, the commission also established an official “do not use” list of abbreviations for health care providers and pharmacists. The list recommends not using the letter “U” which can be mistaken for “0” or using “MS” which can mean either “morphine sulfate” or “magnesium sulfate”. The Joint Commission has also issued their National Patient Safety Goals for 2008 which sets standards for a variety of areas such as patient identification, communications, and safety.
Both the Medical Center and the Joint Commission stress the importance of a health care proxy for all patients. A health care proxy allows an individual to appoint an individual they trust to make health care decisions for them in a situation where they are incapacitated or otherwise unable to decide for themselves. Without a legal proxy, a family member cannot stop treatment even if they know that is what
the patient would choose under the circumstances. A health care proxy also allows a patient to select a specific family member or individual to avoid potential confusion and family conflicts.
Ms. Eisner cautioned that patients must do more than draw up a health care proxy. “Patients need to discuss their wishes with their representative so that their wishes are actually known” she noted. “Sometimes we encounter a representative who does not even know that they have been selected by the patient as their advocate”.
Accord-ing to the New York State Department of Health, the patient’s representative will not be allowed to refuse or consent to treatments
such as arti-ficial nutrition unless they can show they reasonably know the patient’s wishes. Such a simple I/V can be denied if the advocate
doesn’t know if the patient would want it! The Department Of Health recommends that the advocate know the patient’s medical wishes as well as their moral and religious beliefs and lists examples of medical treatments that should be discussed:
• Artificial respiration
• Artificial nutrition and hydration
• Anti psychotic medication
• Electric Shock Therapy
• Surgical Procedures
• Blood Transfusions
The patient can choose to either write their instructions on the proxy or simply discuss them with their advocate. The patient should also appoint an alternative representative in case their original representative is not available. If a patient has specific instructions for their care, they can denote them in a living will. However, since a patient may not always know in advance all of the decisions that could arise, a health care proxy would allow the patient’s representative to interpret their wishes as the medical circumstances change.
As part of their patient education program, the Westchester Medical Center recommends to patients to carry a wallet-sized version of their
health care proxies with them in case of emergency. Ms. Eisner noted that the Medical Center offers these to all patients and provided
a sample to The Guardian for our readers.
In addition, patients can register their proxies with a national registry for access by health care providers. Or patients can obtain a medic alert
bracelet or I/D tag from local pharmacies to carry at all times. These tags are not just for medications and any medical issues – they can be
used to simply denote the contact information of the wearer’s representatives and personal physicians.
A parent can attach a medical I/D tag to a child’s keychain or backpack for emergency contact purposes. Caregivers for at-home patients and elderly parents or dementia victims can take the added step of registering the patient’s/parent’s information with an emergency service such as Life Alert. The Westchester County Department of Seniors, http://www.westchestergov.com/, or 914-813-5000, can assist elderly residents with this registry. Westchester County also has Health Care Proxy and Living Will forms online for county residents to access.
Local residents should have their emergency contact information with them at all times. In addition to the wallet-sized health care proxy, EMS workers recommend using personal cell phones for this information. Using a system initiated by a British paramedic after the 2005 London bombings, first responders advise individuals to enter emergency contacts in their cell phone address books under ICE (In Case of Emergency). This system has become so popular worldwide that some new cell phones come with ICE as a separate heading in their phone number lists. There are websites dedicated to spreading the word about I.C.E. and provide free I.C.E. cards for emergency information, proxy and living will data, language spoken for translators, and blood type and medical conditions – a template to print these cards can be found on http://www.ice4safety.com/.
Finally, health care workers advise placing an I.C.E. sticker on the back of cell phones to alert EMS workers that the victim’s emergency contacts can be found in the phone’s address book.