What Else My Dogs Teach Me about PX

I reread my essay on what my dogs teach me about patient experience and I realized two things.  First, my essay may have been interpreted as comparing medical staff to dogs.  To be clear, I was not.  Folks in healthcare, both clinical and non-clinical, work hard for a paycheck that seems insufficient for the importance they bring to industry.¹ My essay simply identified things that aren’t literally true but helps explain an idea or make a comparison.²  The second that I realized is that I have learned far more from my dogs that help me navigate the patient experience world than I discussed in that essay.  Hence another essay.

Respond to non-verbal stimuli, especially repeated non-verbal stimuli

A fact that will likely surprise NO ONE is that not only do I talk to my dogs, but they will also answer me back.  To be clear, not in a “this boy needs a 72-hour behavioral health observation stay” kind of way.  But instead that when I talk with them, I keep up both sides of the conversation.³ I know that my girls know certain words.  Ellie, the yellow lab, will absolutely lose what little composure she has when she hears the word “food.”⁴ Tsunami, the mixed rescue who is 1% wolf, will calmly and quietly retreat to an unreachable spot under my desk at the word “shower.”  But as they might respond to certain words, they absolutely respond to non-verbal cues.  Yes, they both know the word “walk,” but they will respond with exuberance and expectation to the simple act of me getting up from my comfy chair at a certain time because they assume that this means the evening walk is coming.  It doesn’t matter that I stood to bring a plate to the sink or go to the bathroom, as I am now committed to our evening constitutional. 

I often talk about how patients respond to non-verbal stimuli as well.  Tone of voice, body language, eye contact, all tell someone what the expectation is for any communication.  My favorite example of this (apologies if I have given it before) is when you pass someone in the hallway and acknowledge them with a nod and a “how are you doing?” while not breaking stride.  What is the last thing you want them to do?  Tell you how they are doing.  Don’t they know that this is a pleasantry designed to show connection without any response or responsibility?  Yes, I asked how they were doing, but the body language clearly indicated that I was not interested in conversation.⁵  Likewise, as you blaze through the discharge instructions like the seat you are sitting in giving electric shocks, a patient knows that when you ask “Do you have any questions?” this questions is performative.  You don’t want them to have any questions.  Frankly, since this is often the last stop before they get discharged, they don’t want to prolong the conversation, either.

Talking about patient experience can suffer from the same nonverbal problem.  Consider how you talk about patient experience in a department meeting.  If you put PX as an item at the end your agenda and it often gets cut or shortchanged because other items ran long, you are telling staff that this is not as important as anything else.  Yes, meetings can run long.  But if the pattern is chronic, not only does it send the wrong message in the short run, but it also causes two problems in the long run.

• No one knows what to do with the time slot.  If someone asked you to present for ten minutes at a meeting, you would put together a few slides and some notes.  If your time was cut and your presentation was bumped, you might be disappointed.  How many times would this need to happen before you simply stopped doing any significant prep work because you anticipate being cut?  When you finally don’t get cut, you will likely rush through your slides.  Either you think that its exclusion in previous meetings indicates a lack of interest, or you are unprepared for how long your update will take, so you rush. 
• If a meeting is actually running ahead of the clock, people start hoping that the meeting will close early and they can go to the bathroom or stand in the sun.  Given that PX was treated as an obstacle to the end of the meeting before, the audience will hope that it can be skipped again, as those five bonus minutes feel like actual gold.  If it is not cut, the audience will look at you like you are the annoying kid who reminded the teacher that they forgot to assign homework at the end of the school day.  This will, no doubt, be perceived by the presenter who will rush even faster.

At least in this scenario, there is dedicated, if ignored, time for patient experience conversations.  When organizations adopt a strategy where only downturns in PX data are worthy of conversation, they create the woodshed model that I have spoken of before.  This also creates a defensive posture for everyone called to “discuss” patient experience, since they only get called to such “discussions” when there is a problem.  Just as we can associate emotions and memories with specific songs or smells, we can attach similar emotions to workplace non-verbal cues.  The attached dread and defensiveness rarely lead to congruent conversations.

Your needs don’t matter

As I mentioned in my last essay, if Tsunami wakes me up at night, it is because she needs something, usually a trip to the bathroom.  This might be inconvenient for me, but I know that if I don’t listen to her and give her what she needs, she will be uncomfortable and once that discomfort becomes too much to bear, she will take care of her needs in the living room.  So, I can do the right thing by getting up and allowing her to go to the bathroom, because this takes less time than cleaning up any mess.  Alternatively, I can do it because I don’t want her to suffer.  Either way, my need for sleep is less important than her need for relief. 

Likewise, with training on new PX strategies, it might be nice that EVERYONE comes to one meeting for training, they pay close attention to it, and they leave completely comfortable to execute it immediately.  That would be nice.  That would work with my schedule.  That would be my dream state.  That is not reality. 

Expecting everyone to attend one session is unreasonable.  Not only can we not shut the hospital down for one hour so everyone can learn how to communicate effectively, but it is also unreasonable to expect people to come in on their day off, or four hours before their shift starts (or ends).  You can be demanding in that way, but in doing so, you are creating a nonverbal message that your staff will interpret as “their time is not important to the organization.”

I remember doing training at a Baltimore hospital.  I worked with the local team to set up a few different times to accommodate various schedules.  They asked if I might do one session at midnight, so the overnight staff could attend.  Did I want to energize myself so I could bring a memorable message to a session that would not end until 1am?  No.  Was I excited about the fact that I would have to be up at 6am the next morning to attend an executive recap meeting and then rush to the airport to catch my flight home?  No.  Did I want the audience to feel appreciated that a special session was set aside, underscoring their value to the overall success of the hospital?  YES.  So I said, “Absolutely!”  I did it and then caffeined-up for my morning meeting and the TSA line, before sleeping the whole flight home.  My needs were less important than the needs of those swing-shift nurses.⁶

I have noticed that audiences are more receptive and engaged in meetings or presentations that I do at their clinic or hospital, rather than when the schedule dictates that they come to a central auditorium.  It is less efficient to engage in this retail approach rather than a wholesale mega-auditorium approach.  But not only do I think it shows respect for the work that they do.  It also allows me to have honest conversations and thoughtful Q&A with a smaller group, even if I have to do it more often.  Plus, it allows me to see their world so I can tailor my message to them.  I can see their waiting room, parking lot, exam space, and staff, so I can speak about the specific challenges they have and help them build targeted responses.  I cannot do that if I am delivering the broadest blandest version of my presentation so it can resonate with all the various clinical and non-clinical experiences in the room.

This essay is not a humblebrag about how I will walk ten miles, uphill both ways, to deliver a message just because I care too much.  Some of you may consider what I do to reach an audience as the bare minimum.  Others may think I am crazy or codependent and that their time IS more valuable than that.  My point is not to consider my behaviors but instead consider that every meeting requires sacrifice of every attendee.  Comparing your sacrifice against theirs can help you think of ways to balance the scales a bit.  At the very least, I hope that it inspires you to deliver a message worth hearing and not wasting their time…and therefore yours.

¹I toyed with explaining the difference between dogs and humans by pointing out that dogs are loyal, empathetic, and loving.  This snark, though, would undercut my main message that people who might be offended at the possibility that dogs and humans behave similarly should check the definition of “metaphor.”

² Which again is a metaphor.  I would remind you, again, of what my father would observe: I will never use one word, when seventeen will suffice.

³For some, this may still be suggestive of some mental health assistance.  I cannot argue with that point.

⁴Those who know labs will know that they will also come running at the sound of the fridge door opening.  Heck, if I am standing in the kitchen too long, while getting a cup of coffee, she will come in to see if there is anything for her. 

⁵Another one that I roll my eyes at, is when you are at the grocery check-out and the cashier asks, “did you find everything?” they really don’t want an answer.  Further, the people behind you in line also don’t want you to answer.  If you could not find your preferred brand of organic sugar-free persimmon preserves, go to customer service and stop wasting our time. ⁶That midnight training session in Baltimore was notable for a number of different reasons.  Perhaps I will share that story in more detail some othe