Have you ever wondered about the similarity between “hospital” and “hospitality”? Is this a coincidence, or can we identify how they’re connected? Maybe we can also discover how hospitality concepts could help repair the broken relationship between the healthcare system and its patients.
Healthcare revolves around the delivery of patient care. Thus, customer service and satisfaction must play a role in its success. After all, if our patients are unhappy, don’t feel appreciated, and have a sense that their presence barely matters, they could stop showing up, and we’d all wind up unemployed as our nation’s health suffered. Who wants to see that happen?
Back to the Roots
Sources at Harvard University identified that the Latin hostis and hospes are related to the concept of the guest. At the same time, other sources also cite Latin terms such as hospitalis and hospitem as related to the modern terms guest and host.
In this case, it’s worthwhile wondering why, if our name for the modern-day hospital stems from such roots, have we strayed so far from customer service and hospitality in how we treat healthcare consumers?
“Can you think of any healthcare experience you’ve had that’s gone wrong? According to our research, most adults can. It’s interesting to note the culprit is rarely the clinical outcome. Rather, it’s generally how the care was delivered”, states Peter Yesawich, PhD, a consultant and veteran of both the healthcare and hospitality industries. Yesawich is also co-author of “Hospitable Healthcare: Just What the Patient Ordered!” a remarkably insightful review of how principles of hospitality can improve the patient experience.
Yesawich and his co-author, Stowe Shoemaker, PhD, ask, “How can that experience be improved?” According to the authors, the hospitality industry has increasingly gotten things right while the healthcare system falters at the starting gate.
When considering how to make healthcare more hospitable, Yesawich remarks, “Many people in healthcare default to the notion that it’s just about making staff smile, but that’s not the idea. Smiling and a positive attitude can certainly be beneficial, but it’s more about the way providers anticipate and address patients’ anxieties, needs, and preferences.”
He continues, “One of the things the hospitality industry has done very well is to get to know its customers through strategies that allow them to anticipate the kinds of things their customers appreciate.
“In healthcare, providers can prepare for the smooth delivery of care by managing things like ease of access to making appointments, providing an estimate of the cost of care in advance, ensuring a positive arrival experience, recognizing patients for their loyalty, and thanking patients for their patronage. After all, patients are also customers who have a choice when selecting the providers from whom they seek care.”
The PAEER Model
According to Yesawich and Shoemaker, their five-part model for more hospitable healthcare is broken down into an acronym from their extensive research: the PAEER model (Prepare, Anticipate, Engage, Evaluate, Reward). The authors offer specific actions practitioners can take to enhance the patient experience.
Prepare: Healthcare facilities can welcome patients by better understanding their needs and preferences. (Hospitality industry providers do this through “Customer Relationship Management” (CRM) programs that record, track, and analyze guest behavior.)
Anticipate: Once patients’ preferences and needs are more clearly understood, we can avoid what decreases patient satisfaction, which, according to the authors’ research, includes the unwelcoming nature of the check-in experience, repeated requests for the same information, ease of access to making appointments and, most importantly, not knowing the estimated cost of care in advance.
“When you take your car to the garage for repair, book a hotel room or table at a restaurant, you know the estimated cost of that service in advance,” Yesawich states. “Why don’t healthcare providers also give a pro forma estimate of the cost of the service they are about to deliver in advance, naturally with an appropriate disclaimer, especially given that they know what they are likely to charge based on negotiated reimbursement rates?”
Engage: “Yesawich states, “Hospitality industry professionals refer to the points of actual service delivery as ‘moments of truth’, the specific interactions that ultimately determine the customer experience.”
He continues, “They have developed a number of techniques to ensure these ‘moments’ yield a positive reaction, including the introduction and use of acronyms that reflect their commitment to enhancing guest satisfaction that is easy for staff to remember and recite; the introduction of service standards that reinforce the connection with their mission/vision/values (behaviors repeated over and over define the culture of your organization), and providing invoices/bills for the services they deliver that are easy to understand.”
Yesawich makes one additional point: “Many also offer performance guarantees that underscore the confidence they have in the delivery of services for which the outcome is generally predictable (e.g., clinic wait times, turnaround times for test results, prompt resolution of billing disputes, etc.)”
Evaluate: “I marvel at the fact that many healthcare providers don’t follow up with patients after an appointment to see how things went,” Yesawich shares. While this is becoming more commonplace, there’s often a pervasive feeling that providers don’t care about receiving patient feedback.
Reward: While the authors acknowledge that the law prohibits financial incentives for patients with government insurance, there are no restrictions in using recognition and reward programs to attract patients with commercial insurance.
Yesawich adds, “These could include ‘rewards’ that enhance the future health and well-being of patients. Examples include free health screenings, invitations to attend free lectures by providers or nurses on timely health topics, free admission to cooking and fitness classes, etc.”
What Can You Do?
For staff nurses without the authority to change how an organization operates, Yesawich maintains that there are still plenty of ways to introduce principles of hospitality. He counsels the first step in the process is understanding the root cause of most patient dissatisfaction: how the care is delivered.
“You can get management to recognize that most of the dissatisfaction patients have with healthcare has to do with the manner in which the care is delivered, not the clinical outcome, the author states. “Implementing specific principles of hospitality along the patient journey can positively impact the patient experience, even when the clinical outcome is unsatisfactory.”
Nurses and staff can bring suggestions regarding these concepts to leadership. Nurses can also unilaterally assure that patients feel appreciated, bringing genuine warmth, eagerness to please, and gratitude to the nurse-patient relationship. And when staff interact with patients, they can make eye contact rather than staring at a screen.
The basic tenets of Yesawich and Shoemaker’s research and recommendations are rooted in the values of hospitality. As the largest segment of the healthcare workforce, nurses can leverage their influence in service to the patient experience.
Those of us who work in healthcare want our patients to feel cared about; even the slightest effort can have positive repercussions. In honor of the aforementioned Latin origins of terms close to the heart of care delivery, why don’t we strive to reverse the inhospitable nature of 21st-century healthcare? After all, everyone will benefit — nurses, providers, and patients alike. In making such changes, we have nothing to lose and everything to gain.
Healthcare is an industry where careers and patient care are both fueled by relationships. As you navigate the arc of your professional life, your multidisciplinary colleagues can be a special fuel for your future. At the same time, your connections with patients can bring meaning and purpose to your work. All in all, relationships could not be more critical to your career and your personal and professional fulfillment.
A Fuel Source for Your Future
While you may frequently be successful in finding new opportunities by responding to job postings and submitting applications, resumes, and cover letters, positions can also sometimes be found through connections and relationships.
There’s conflicting evidence online regarding how many jobs are actually landed through networking. Still, we can say without a doubt that paying attention to relationships with valuable colleagues will never hurt you and can very likely be a benefit at some point in your career.
Let’s face it: someday, you may need a professional reference, an introduction to a key individual at a facility you’re interested in, some priceless career advice, a mentor, or maybe someone to serve as your preceptor during your nurse practitioner program.
There are many ways in which relationships can benefit you and your nursing career. A connection with a current or previous colleague could hold a key that unlocks something vital for you and your professional development.
You have everything to gain from maintaining collegial relationships, and it doesn’t need to take that much energy. Some of your connections with certain colleagues will easily lend themselves to friendship, being in touch via text or email, or perhaps just a Christmas card once a year. With others, it may look like being aware of one another’s career development on LinkedIn and checking in occasionally.
However, how you go about it, a small investment of time, energy, and positive attention can reap many benefits in the scheme of things.
Lessening the Toll
Beyond networking and keeping an eye on the future, your present experience also holds great importance. You want to feel good at work, and supporting and being supported by others makes hard work feel less taxing.
In your day-to-day work, your relationships with physicians, other nurses, social workers, chaplains, administrators, managers, preceptors, instructors — they all have a potential role to play. Positive interactions and camaraderie can make your days less stressful and more manageable. When you and your colleagues can rely on one another when the going gets tough, the difficult days can take less of a toll.
Professional relationships matter, and the rewards far outweigh the time and energy spent cultivating and nurturing them.
Meaning, Fulfillment, and Purpose
As mentioned above, your connections with colleagues can be critical to how you feel about your work and your day-to-day experience. Add to this the relational aspects of the nurse-patient relationship, and there’s a recipe for increased meaning, fulfillment, and sense of purpose that can add to your feelings of job and career satisfaction.
Relating to patients, communicating with empathy, expressing compassion, and being the kind of nurse who shows caring and kindness all point to the highly relational aspect of nursing. While nurses may provide much patient education, the art of conversation with patients and their families goes far beyond teaching about medications, side effects, diagnoses, and follow-up care.
A great deal of warmth can be generated in the context of the nurse-patient relationship, and we can’t overlook how the meaning behind nursing others back to health or comforting them during illness or the dying process is a significant motivator for many of us becoming nurses in the first place.
Keep Relationships Top of Mind
Whether cultivating connections with patients and their families or nurturing positive communication with your multidisciplinary colleagues, the importance of relationships in every aspect of your career is multifaceted and beyond measure.
Keep relationships top of mind, be aware of the quality of your interactions, and enjoy how connecting with other humans can be one of the most important fuels of a satisfying career.
Infantile spasms are a rare but serious form of epilepsy that is often misdiagnosed. The disorder occurs in approximately 3 cases per 10,000 live births and usually begins in the first 4-8 months of life but can occur in children up to age 3. Most cases are associated with an abnormal brain wave pattern that can cause harm to a young, developing brain. Recognizing symptoms and initiating early treatment are critical in diminishing the long-term effects on these children. Because of this reason, raising awareness and aiding in early recognition is critical.
Recognizing the Symptoms of Infantile Spasms
Sadly, most cases of infantile spasms are misdiagnosed as reflux, colic, or normal startle reflex of infancy. These seizures can look like sudden stiffening of the arms and legs, bending forward of the body, or arching of the back. The key to differentiating these from normal infancy movements is that they often occur in clusters lasting 1-2 seconds and can occur up to 100 times per day. Spasms are also most likely to occur when the baby has just woken up.
Children with infantile spasms are at a much higher risk for developing intellectual disability, autism, and epilepsy. These spasms may also be associated with specific disorders such as genetic abnormalities, brain injury, or infection. In some children, no cause is found. The best plan of attack for infantile spasms is prompt recognition of the spasms, a full medical workup, and early intervention.
Parents vs. Practitioners: A Team Approach is Essential
The first line of recognition falls on parents, but too often, their concerns are dismissed by practitioners. It is important to educate both parties on infantile spasms, including what the spasms look like and the need for prompt evaluation and treatment.
If parents know the symptoms, they need to document and record them in real-time so there’s evidence. Then, they should urgently seek medical attention. Parents are encouraged to use their cell phones for video evidence of what they are seeing, and it can be beneficial in helping the practitioners acknowledge their concerns. Learning the appropriate language to communicate to physicians can also make dismissal less likely. It can be helpful to describe these spasms in detail, including words like “stiffening” and “clusters” and how often they occur.
Healthcare workers need to be informed on how to recognize the symptoms of infantile spasms and the necessary workup and treatment after an initial diagnosis. To find a diagnosis, practitioners are responsible for recognizing the concerns of the parents or caretakers and analyzing the available evidence in addition to a workup that includes a neurological exam, EEG, and MRI. Most of these workups require admission to the hospital so they can be performed in a timely manner, and appropriate therapy can be initiated on an urgent basis. Infantile spasm cases can come into the pediatrician’s office, urgent care, or even the emergency department, making widespread education necessary. Early and effective treatment for these infants can improve the prognosis and lessen the severity of future epilepsy and degree of developmental delay.
Staying Educated and Informed
All healthcare workers are required to complete continuing medical education regularly. Part of this CME could include information and the most up-to-date statistics for infantile spasms. It is the responsibility of the healthcare community to create these in-services and provide this material to bring awareness and education. As mentioned before, these children can present to a multitude of different doctors and clinics, so widespread education is needed for everyone. Recognizing, testing, and treating requires a multi-faceted team approach that could consist of pediatricians, nurse practitioners, Emergency Physicians, and neurologists. These providers can take the information, stay informed on the standards of care, and help spread awareness to their fellow practitioners. This awareness can make all the difference in the world for the next infant that comes into the ER with spasms and gets the correct treatment instead of being discharged.
Recognizing Infantile Spasm Awareness Week
Infantile Spasms Awareness Week (ISAW) is held annually, December 1-7, to raise awareness of infantile spasms for everyone, especially parents and health practitioners. As an ER physician and mother of a little boy with a genetic abnormality, Duplication 15q Syndrome, I understand the essential need to spread awareness of this seizure disorder. When going through the stressful process of diagnosing my son, my family was a victim of a physician dismissal even though I’m a physician myself. We had recognized developmental delay issues in our son for almost an entire year before we convinced the pediatrician to run the necessary tests that led to his Duplication 15q Syndrome diagnosis. This specific genetic condition is associated with hypotonia, developmental delay, and infantile spasms with a high incidence of future epilepsy. Even as a physician, I was unprepared and uninformed when it came to his diagnosis and complications while also being a physician in the past who was not educated on infantile spasms or similar disorders.
As a result, I decided to educate myself on the most up-to-date information regarding spasms and their evaluation and treatment. I took every opportunity to educate my co-workers on my son’s diagnosis as well as on infantile spasms so that we could spread awareness and effective medical care. Receiving my son’s diagnosis was the hardest thing I have gone through and came with a huge emotional journey. However, it has also made me a much better physician. Since his diagnosis and my educational journey, I have conducted seminars on infantile spasms and personally cared for and treated several babies in the ER with possible spasms. I have been able to recognize the symptoms and arrange full workups and consultations to identify the underlying cause and initiate treatment. I encourage other healthcare workers, especially those who work in ERs, to seek similar education on infantile spasms and understand how critical early intervention is with this disorder.
By the time an assassin’s bullet killed Dr. Martin Luther King on April 4, 1968, the much-loved – and much-hated – SCLC leader knew he might never see his daughters grow up. Once he entered the spotlight during the 1955-56 Montgomery, Alabama bus boycotts, King and his family lived through his remaining years like a city under siege, constantly calculating acceptable risks and trying to anticipate the next threat.
King was a target of violence throughout his non-violent crusade for civil rights, and 10 years before his assassination, he had a very close brush with death. He continued his work for another decade, partly due to the skills of Goldie Brangman, CRNA, MEd, the nurse anesthesiologist who treated him in 1958.
Brangman worked at Harlem Hospital for 45 years and directed its nurse anesthesia educational program for some three decades, and in 1973 became the first (and to date, only*) Black president of the American Association of Nurse Anesthetists (AANA). In the December 2015 issue of the AANA Journal, she shared her recollections** of that September 20, 1958, day when King was rushed to Harlem Hospital.
In 1958, King’s would-be killer was not a white supremacist but a mentally ill 42-year-old Black woman stirred by the conspiracy theories, anxiety, justifiable paranoia, and mistrust that spread through terrorized Afro-American communities during the “long, hot summer” era of the mid-1960s. Convinced that the civil rights leader was a “communist” and a “flimflam artist who pimped the community,” she armed herself with a pearl-handled letter opener and attended the book signing. When she neared King, she aimed right for his heart and managed to drive her makeshift knife six centimeters into his chest.
King was rushed to nearby Harlem Hospital with the letter opener still in his chest. His treatment was initially delayed when a bizarre political debate erupted. Being anxious over his reelection chances, New York Governor Harriman initially urged hospital staff to transfer Dr. King to Columbia-Presbyterian or Mount Sinai Hospital.
As the AANA article put it, the governor was worried “that Harlem Hospital was not fit to treat Dr. King, but he also wanted to show respect for the Black community by endorsing Harlem Hospital and its staff.” The vacillating politician was finally persuaded that the future Nobel Peace Prize winner was in good hands.
By 1958, King was already a widely recognized public figure at the center of the increasingly heated debates over segregation and racial injustice. Brangman recalled that their patient was engulfed by a crowd even as he was rushed into surgery. “To this day,” she said, “I don’t understand why they allowed so many people in the OR.” The team examined his wound and found that the weapon had penetrated King’s sternum. Brangman said the tip of the letter opener was tightly lodged between Dr. King’s innominate artery and aorta. Her team was on edge, knowing that “Every breath would move the blade.” She is confident that “The time saved by [performing the surgery] then and there at Harlem Hospital did save King’s life.”
The AANA article reminded readers that the danger of the situation was exacerbated by the fact that CRNAs had little technological assistance in the 1950s, so thoracic surgery did not necessarily include mechanical ventilation or paralysis.
Brangman recalled, “You bagged them in those days; you could sense [respiratory] changes like compliance that way.” They used manual blood pressure determinations and monitored their patients by “listening, looking, and feeling. You had your hand on the patient the entire time.”
Once Brangman and anesthesiologist Dr. Helene Meyer placed King under anesthesia, surgeons worked for over two hours to remove the letter opener. The surgery left King with a scar, a constant reminder and warning that he could be taken at any moment. As he told a friend, “Each morning as I brush my teeth and wash my face, I am reminded by the cross-shaped scar on my chest that each day could be my last day on this earth.”
Thanks to Harlem Hospital’s team, King survived his first significant brush with death for ten crucial, history-making years, and millions of Americans breathed a sigh of relief. A white admirer from White Plains, New York, was moved to cheer the minister’s recovery in a letter that became famous:
“I read in the paper of your misfortune and of your suffering. And I read that if you had sneezed, you would have died. And I’m simply writing to say that I’m so happy you didn’t sneeze.”
The earnest missive delighted King, so he shared it with various audiences over the next decade. In fact, during his final speech in Memphis, Tennessee, he read it aloud once more and added, “I want to say tonight that I, too, am happy that I didn’t sneeze.”
While King may have been unaware that in 1958, his CRNA’s skilled “listening, looking, and feeling” helped preserve his life, nurse anesthetists can take pride in knowing that one of their own played a key walk-on role in history.
**A special thank-you to Ebony magazine for saving and sharing the 2015 AANA story on Brangman.
In an evolving healthcare landscape, many hospitals and health systems have a diverse nursing staff of tenured employees, contractors, specialists, and more. While this can be a recipe for a dynamic and collaborative environment, it also has the potential to become precarious without proper management.
Disorganization and lack of communication ultimately trickle down to patients. In fact, a Joint Commission study found that 80% of serious medical errors result from miscommunication during nursing handoff.
Hospital and departmental leadership must ensure everyone works together to care for patients effectively and efficiently. This requires breaking down any barriers and engaging staff to build strong working relationships in the following forms of engagement.
A Healthy Work Culture
With the continued staffing shortages in healthcare, organizational culture is ever more critical for maintaining morale among existing staff.
For one, nursing departments should strive to create balanced schedules and assignments that work for each employee and even out workloads as much as possible. Departmental leaders should be transparent about organizing so there is no perception of inequality. If everyone feels they are pulling the same weight, they will work together better.
However, in departments that rely heavily on contract and travel workers, there can be friction for similar reasons, including doubt about contractors’ workloads, level of commitment, and their skills and qualifications. This is where leaders must emphasize clarifying any misconceptions and the benefits they provide beyond crucial coverage for short staffing, such as adaptability, diverse perspectives, and specialized knowledge.
Shared governance is also becoming a standard practice in many healthcare organizations to empower nurses and foster collaboration. It is a working model where nurses can join councils, allowing them to be involved in decision-making for their departments and patients.
Clear Roles and Responsibilities
There shouldn’t be any ambiguity about assignments and responsibilities among everyone involved in patient care, from RNs to LPNs and UAPs. Along with their daily schedules, consider writing down each employee’s responsibilities in a shared document that everyone can access and reference. This ensures each employee knows exactly what their tasks are and that there is no gap in patient care coverage.
However, it’s also essential to leave room for spontaneous teamwork. For instance, a nurse has a free moment and responds to a patient not in their assigned block to help out another nurse with their hands full. While this isn’t a requirement or expectation, it should not be frowned upon.
Established Onboarding and Training Processes
Onboarding and training can be essential for setting the tone – what the standard operating procedures are, what the day-to-day job will look like, and the organization’s culture. If the goal is to have a cohesive team, these processes should be standardized for all types of staff, whether direct hire or contract worker.
In addition, all staff should have the same continuing education and growth opportunities, promoting a culture of equality and professional development and ensuring that every team member has the resources and support necessary to excel in their roles.
Transparent Communication Among Nursing Staff
In a hospital or clinical environment, losing track of so many moving parts is easy. Nursing teams need multiple modes of communication to ensure they are organized and on the same page.
This includes having proper tools to communicate, especially around patient care. Traditional chart notes and whiteboards in rooms are not going anywhere. Still, many organizations are also integrating newer technologies, such as HIPAA-compliant messaging platforms, for instant communication between staff members. This is especially helpful during emergencies to speed up response time to critical patients.
Good teamwork also means holding one another accountable, creating an environment where employees feel comfortable discussing their challenges and concerns, and collaboratively working to overcome them.
However, there should be an established feedback process for issues that need further addressing. For example, a staff member is consistently underperforming or making mistakes, affecting others – or worse, patients. Staff should know who to escalate these issues to, whether it is department leadership or HR, and how so that they can address and resolve the issue immediately.
Regular Team and Staff Meetings
Teams and departments should be meeting regularly to share important information and updates, as well as coordinate and plan, ensuring alignment of goals and objectives for the team and the organization. Meetings can also provide a forum for problem-solving, decision-making, and feedback, allowing employees to voice their opinions, share ideas, and actively participate in discussions. Additionally, meetings are an opportunity for recognizing and acknowledging individual and team accomplishments.
All these forms of engagement instill a sense of duty and shared ownership, which are fundamental components of a positive workplace culture and effective teamwork. Pair this with solid operational organization and communication to create an unstoppable nursing team that puts patient care at the forefront.
Clinicians need to have a better understanding of the potential impact of patients’ anxiety sensitivity, or “fear of fear,” according to an article published in American Journal of Critical Care (AJCC).
When a patient has anxiety sensitivity, they misinterpret nonthreatening symptoms as threatening, assessing the potential meaning across physical, social or cognitive domains. These “what if” thoughts may trigger a spiral effect, stimulating the nervous system and resulting in stronger sensations and further catastrophic misinterpretations.
It may lead to a patient avoiding activities they associate with anxiety-related sensations, such as physical activities or social situations. While in the hospital, they may resist interventions, such as repositioning or being weaned from sedatives. They may avoid physical or occupational therapy or struggle with efforts to help their recovery.
“Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-term Recovery” provides an overview of anxiety sensitivity in patients in intensive care units (ICUs) and after their discharge from the hospital, as well as implications for critical care clinicians.
“Patients with anxiety sensitivity may falsely believe that their symptoms are the early signs of something bad, such as a heart attack, cognitive decline or social isolation,” she said. “It’s important for clinicians to be able to identify the difference between anxiety sensitivity and other medical conditions,” says Leanne Boehm, PhD, RN, ACNS-BC, FAAN, assistant professor at Vanderbilt University School of Nursing, Nashville, Tennessee, and investigator at the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University Medical Center.
For example, patients who have difficulty weaning from mechanical ventilation should first undergo a detailed workup to search for any underlying medical causes before anxiety sensitivity is considered as a primary cause.
ICU clinicians should be aware of patients’ possible anxiety sensitivity so they can use clear communication and implement pain management or relaxation techniques to mitigate distress and improve patient outcomes.
The Anxiety Sensitivity Index (ASI-3) is one tool clinicians can use to measure the extent of a patient’s physical, cognitive and social concerns about their anxiety. Providing basic psychoeducation to ICU patients on common symptoms may temper anxiety sensitivity, reassuring them their feelings are not unusual and putting their symptoms into context.
After discharge from the hospital, patients may continue to experience anxiety sensitivity and need increased assessment time, detailed explanations and extra demonstrations before participating in physical therapy or other activities.
Research specific to anxiety sensitivity in the critical care setting is limited, and future studies should incorporate assessment and management techniques across the critical care recovery continuum.