You should all be aware that GCEP 2024, coming out at DDW, will be the first educational product anywhere to have a dedicated module on DEI. And I encourage you to subscribe when it's launched. Now, we'll see what's on the audience members' minds and dive into some questions and some of our case studies. We have two questions so far. One is on cultural diversity. How are we finding ways to give patients their written instructions, post-procedure care, et cetera, in other languages? And the other one is, does anyone have prior areas for Muslim patients who are waiting for a long time in endoscopy units? Either one of you want to take that, Lisa or Sayan? Yeah, so we work within the EPIC. And right now, our system is challenged with only providing discharge instructions in Spanish. And so they are looking to see if there are other avenues for providing discharge information in other languages. But right now, currently, that's all we have available is English and Spanish. Yeah, Lisa, we share the same issues. We do have it in English and Spanish. But some of the other languages, we don't have them readily available. And it's something that we need to work on and address. In regards to the question about prayer rooms, right now in our endoscopy suite, we do not have any kind of dedicated space for our Muslim community to do any prayers if they're in the endoscopy suite for extended periods of time. But that is a great suggestion of how maybe we could build an area or a flex space to have that available for our patients. So great suggestion. Yep, same with us. We do not have an area. And that is an excellent idea. I have not even heard that in our forum here at our system. So that's excellent. So I can mention that in our hospital system, we do have a kind of a meditation room that serves as an all-religion area that people are able to go to for recognizing their particular traditions and religious practices. So often, we direct them there. Regarding language, we do have a customizable language form that we have been using. It's actually just within our hospital system. But obviously, since we have converted over to Epic, it often makes it a challenge to incorporate some of these templates into Epic. And so we're working with them to improve that situation. Why don't we go to our first case? It doesn't look like we have any other open questions. So this is a patient complaint directed to the endoscopy unit director and nurse manager. He states that the pre-procedure nurse checking him in was rude. The anesthetist didn't provide enough sedation because he was in pain the entire time of his procedure, and the endoscopist failed to talk to him about his results after his procedure, although he really didn't remember anything until he got home. He indicates he wants to talk to the chief executive officer about his dissatisfaction and threatens to post his complaints on social media. So how do we handle this situation? Lisa, you're first. So, of course, we've probably all experienced this in some form. And usually the approach I take is when there's a patient complaint that either comes directly, it would come directly to me or through the patient relations advocate is I would gather information from the team, identify the team that cared for the patient, and just start information gathering to find out, you know, what do they remember with my staff. I would also then talk to the provider available that managed the case. What do you remember? Share the information. One of the things that I was really, I always honed in on was I would, I would do a service recovery like immediately, like within like a day, getting back to the patient, letting them know I'm looking into this. We take your concerns very seriously. We want our patients to have the best experience, you know, using all that scripting. And then once developing informational from the providers, the team, maybe getting the patient advocate involved, and ultimately circling back with the patient. And it was also, it's helpful to have the provider reach out and call their patient to navigate through this on their perception. Those are, those are great points, Lisa. I think for us, I, whenever I get these patient complaints, I always try to just allow the patient to express their own words without interrupting what went on to just kind of acknowledge and hear what their experience was. I typically will try to apologize and say that I'm sorry that we fell short. Because it's not who's right or wrong. They really perceived that we fell short. And I should say, we apologize that we, you know, fell short in terms of your expectations of the care that you received today. And then typically, we always discuss the idea that this isn't you, you're giving me a complaint. I apologize. And that's it. And I really stress that. I want to say, I'm thankful that you're giving us this feedback, because we actually use feedback to make change. And that's really important for them to understand that if we don't think of them as complainers, we really say that this is something we value, we want to hear from their perspective, what went wrong, where we fell short, so that we can take this look back at what we do, help our providers help our staff provide a better patient experience. And typically, it is always nice to follow up, especially if the provider already has a relationship with that patient. And they can also engage in following up with them as well. But I do think that all is so, so important. Yeah, so sometimes you can get patients who are, of course, just angry about everything. But then you have other patients who truly have a vested interest in improving care going forward for others. And so sometimes, we are able to identify a patient who would be willing to serve on the patient experience committee and involve them in the week-to-week things that happen and the projects that are ongoing to improve patient satisfaction overall. And they often feel very grateful to be part of a better process for everyone. And so that's also another opportunity to engage people who have legitimate complaints and bring this up to be involved in making the type of care, the quality type of care available even better in your unit or institution. We'll go on to the next case if we have time. We do. Okay. So here we are looking at the CAHPS survey. And the nurse manager is identifying a trend regarding unproductive and unprofessional communication, at least in the terms of the eyes of the patients coming from the registration staff that assist with endoscopy procedures. Subsequently, the nurse manager conducts observations of this area and observes some of the behaviors that the patients are commenting on. So here, the nurse manager is getting information data about issues with patient care, then goes to investigate on her own and finds that this is confirmed. So how can she help to solve this situation and improve patient care from the registration staff? Right. So the nurse manager, I've taken this route before, meeting with the staff, the team that registers the patients, discuss some of the observations and then the patient concerns, talk to the team about ideas on how to improve communication, highlighting best practice. And fortunately, we do have resources here at our organization on best practices for crucial conversations, customer service. So providing additional education for the team. And then I guess most importantly for me would be outlining expectations to the team on how to best serve our customers and what's expected in the role and how we communicate with our customers, being our patients, their families, and how to drive improvement. Yeah, Lisa, well said. I think one of the things that's very challenging, and I love what you talked about earlier, is that you share the CG-CAHPS scores with everyone on the team so they can see how they're scoring. And it's important to give them feedback, giving them the resources to improve. Also, what I'll say is we have to be very mindful as leaders that we not only dwell on the bad patient experiences, but the positive. So we always want to make sure that we're not just But also, if we get a great score, it's often very important to say, hey, guys, great job. Look at this patient feedback. So that it's the good and the bad are balanced. Because if the team only hears about what they're doing wrong, that can kind of get the morale down. So it's important to share the scores. It's important to have those discussions. But I'll ask all our leaders to be very mindful about also sharing the good and the bad. to share the scores. It's important to have those discussions. But I'll ask all our leaders to be very mindful about also sharing the positive scores that come back. Because, you know, usually there are 10 really great comments, and usually, you know, one or two not so good ones. So try to give as much cheering for the positive things that they've done well, so that they'll feel more empowered to say, okay, let me correct the small things that I may be doing wrong, so that we can keep this momentum going and keep morale high. Yeah, one thing that I have learned is to give positive feedback first, then the negative side last. And I think one of the other things that an approach could be that, you know, you give a simulation where the registration staff are in a situation in which they're trying to make an appointment themselves, and the physicians or the nurse managers are using the same behaviors that were used with the patients to see, to just make people, I guess, recognize from a different perspective what happens and why people can get upset. Sometimes schedulers in this situation may not even realize that the behavior is bad, they may think that this is normal. So sometimes that helps. I don't know if the audience has any suggestions for this. So it looks like somebody already has put in something. So they've talked about apologizing to the patient, again, for not meeting expectation, thanking the patient for bringing it to their attention, assuring them that there's follow-up discussion, ways to improve, valuing their input, making sure that they're heard and address their concerns accordingly. All great suggestions. Anything else that the audience would do? So we have, while people are thinking about potential solutions or answers for this, another question has come up. How do you deal with gender-sensitive topics such as pregnancy testing before anesthesia? And believe it or not, I think that was one of our third cases, correct? Yes. Yes, I think someone was reading our minds. Yeah. You want to put that third case up? Let's move to that. And so here you can see John is a trans man. He's presenting for colonoscopy and he's clearly identified as he, him, his. He has not had gender-affirming surgery, still menstruating, and the staff expressed concern to the nurse manager regarding following the policy for performing a urine pregnancy test prior to sedation. And so how should this be handled? So it goes to one of the questions that the audience has. Yeah, this is a great question. And first and foremost, it is okay, as I talked about, to ask important questions for healthcare needs. So in this case, at least in this case presented here, you've done the first step, right? Which is an organ inventory, right? So you can ask the question or present it to the patient like so. In order to ensure that you're getting the appropriate care, are you still menstruating? And if the patient says yes, then you can clearly say our current policy for any patient that is menstruating is that we obtain a urine pregnancy test. Is that okay with you? Often the patient may say yes or even say no because, and that's okay. Usually we have paperwork. If someone says no, that they're for anesthesia for following the pregnancy test and understanding the risks. But the important thing is these are questions we have to ask to get good care. And so if we educate ourselves on how to take organ inventory and ask those questions, then I would proceed. If the patient is menstruating, asking for our policy to have a urine pregnancy test. Great question. Yeah, excellent. This was actually a real life case scenario in our unit. And so initially we didn't really master this patient's experience. It caused like a flutter, right? You know, staff banging on my door. What do we do? What do we do? Talk to the provider? Can we just put a note in and do we have to ask the patient? So ultimately they learned, everyone learned from this experience and, you know, they didn't follow all of the great tips that were pointed out in your presentation, Dr. Abdi. I believe one of the nurses did ask, you know, are you engaged in sexual activity, which was off-putting to the patient. They did ask you, is there any chance you could be pregnant, which could have also been seen as off-putting. Ultimately the provider put a note in and gave the okay to forego the pregnancy test as it was determined that the patient, there was no risk of them being pregnant at this time, but there's always something to learn and go forward. And we did use this like as a case study within the unit.

patient care

diversity

communication issues

gender-sensitive topics

patient complaints