The importance of listening

“When [going into] an examining room,” said Dr. David Ruben, Chief of Geriatrics at UCLA, “you’ve got to be ‘out there’ for the patient. It’s very much like going on stage. It’s not that it’s insincere, but you have to be optimistic for patients. You need to engage them completely with your attention and be observant of everything that’s going on with them.”

That comment is from a story broadcast recently by National Public Radio. “On stage” was the phase that struck me because, although we are not “acting,” we in health care certainly are at center stage for patients and family members. Patients and family members study us, as if we were performing at a recital, giving a reading at our place of worship, or making a speech in front of our social group.

They watch closely to discern clues about what’s going on with their care or with their loved ones. Are we excited about something? Are we confident? Distracted? Are we sensitive to the patient’s discomfort or anxiety? This is the way we human beings communicate, by closely watching others to see if actions match words. And the more important something is (such as hospital care), the more closely we observe.

This year the federal government will start observing us – through the eyes of our patients. Surveys will be mailed to the patients of CGH and all other hospitals across the country. This is called the HCAHPS survey (pronounced “h-caps” and meaning “Health Consumer Assessment of Healthcare Providers and Systems”). The results of these surveys will be reported publicly, starting in 2007, by the federal Centers for Medicare and Medicaid Services (CMS). Eventually CMS intends to use the hospital patient satisfaction scores to determine how much they pay us for the care of Medicare patients.

CGH will voluntarily participate in a test run of the new HCAHPS survey this summer. The official survey process begins this fall.

Press Ganey Associates, a professional polling organization that already surveys CGH patients, has worked with the HCAHPS survey to determine what patient values are most correlated with high hospital satisfaction. According to Press Ganey, patients who give hospitals high marks well feel they have been listened to by the nurses and other staff.

“You need to engage them completely with your attention and be observant of everything that’s going on…” is the way Dr. Ruben put it, an excellent definition of effective listening.

The experts say that how we perform our jobs is as valued by patients as what we do in the jobs. “Scoring highly (on patient surveys) does not require [hospital staff] perform any additional tasks or duties but simply conduct their existing activities in ways that build relationships with [patients and families],” according to the experts at Press Ganey. Examples? Greeting the patient by name, and asking for help to pronounce the name correctly. Making eye contact with the patient and family members when speaking with them. Asking about a patient’s comfort and helping make the patient comfortable. Explaining what you are doing – and why. Using those most-important words consistently: “excuse me,” “please,” and “thank you.” Before leaving the room, ask, “Is there anything else I can do for you?”

Health care workers are hardly actors in any theatrical sense, but we are clearly stars to our patients when we listen to their needs, when we show concern for their comfort, and when we demonstrate courtesy in the many things we do every day.