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Do you know how patients/caregivers perceive your employees and agency? Here’s why it’s important to observe your staff on the job.

In our last blog, we encouraged you to teach your hospice team to self-reflect across that vast ocean of health care and determine how they can educate patients and caregivers in an improved manner that showcases your agency’s quality of care.   The next step is observing your staff members with patients and caregivers to determine what that patient or caregiver’s perception of your employee and agency may be. to really see and hear their delivery of your agency’s quality. Make sure that a member of your management team is performing on-site observations, even if only for a few minutes, several times a year.

As a hospice manager, I aimed to observe every staff member at least twice a year. More often than not, it doubled or tripled as I traveled and ran into them performing in-services, care plan meetings, or seeing other patients myself on occasion. Even for a large agency, it is a doable task for a management team. If you run into an employee in a facility, accompany them for 5 minutes, or go along on a planned visit for 15 minutes. It doesn’t have to take your entire day per employee.

Is your staff focusing on the right things?

I worked with a nurse named Jane who was so terrified at the prospect of a manager observing her that she sent me an email asking me to speak with her coworker rather than accompany her to see a patient. Her email said that she ran into a nurse coworker, Sally, at a facility, and Sally saw her with a patient. Could I please just talk to Sally to get a report on how Jane worked, instead of observing her myself? Some people just do not like to be under the proverbial microscope.

I called Jane to tell her “nice try” and scheduled our joint visit. When I did follow the nervous Jane for the first time, I reassured her that it was not a punitive visit. I wanted to see how she really did her job and delivered the quality our agency promised.

Jane and I went to see Gloria, a pancreatic cancer patient. Gloria had recently had methadone added for pain management and was reluctant to tell Jane what her pain level was. Jane sat on the bed next to Gloria, held her hand, and told her, “You know you don’t have to be in pain. We can do other things.”

Gloria admitted that she was having constant pain, but was afraid of feeling “foggy” and missing any part of her family being around her in her last days. Her daughter was visiting, and as Jane ended the visit, the daughter had a lot of questions; she was in the process of moving in to help Gloria’s husband, who was the other primary caregiver. Jane received new physician orders for comfort and suggested other non-pharmaceutical options as well. Gloria had a sauna in her basement and was going to try using it, and the daughter was going to try and teach her breathing exercises.

The importance of strong communication between staff and caregivers/patients

Later, I used Gloria’s daughter as my teaching point with Jane. Could Jane have spent a little more time better explaining the pain medications or other options to Gloria and her daughter? Given Gloria’s hesitation to share her pain level, what else had she had trepidation about sharing with the hospice team?

These conversations cannot always happen in one visit, but what was Jane’s plan to follow up and reinforce that overall education? Was she going to call or visit later in the week and see what was working for Gloria? Did Gloria and her caregivers know Jane’s plan for follow-up?

Using CAHPS Surveys to focus on patient care

Nurses often serve as case managers and help steer the ship for patient care. They can also set the tone for a patient or caregiver’s experience with your agency, and there are a few questions they can answer in a different manner that will also change the way a caregiver later responds to a CAHPS survey. CAHPS places a focus on the following:

  • Whether pain medications were taught to patients and caregivers in an easy-to-understand way, including:
    • Side effects and what to do if the patient has any adverse or unwanted effects
      • Sleepiness is specifically mentioned in the survey as an example of a side effect
    • When to give pain medication
      • Focus on how to give PRN medications, appropriate scenarios or pain levels
      • Providing scheduled check-box calendars may be helpful in this process for a tangible tool
    • What to do if pain medication is ineffective, and how to get help from the hospice team to resolve the pain
  • Training for patients and caregivers on what to do for trouble breathing
  • Training for patients and caregivers on what to do for anxiety, restlessness, agitation, or sadness
    • Remember to be specific to instruct as to what each medication’s purpose is
    • Use survey language such as “sadness” instead of “depression” for consistency and later recognizability for the caregiver filling out a CAHPS survey

Have every employee, not just nurses, read the following questions written from the perspective of a patient or caregiver.

Why your staff needs to be mindful of the CAHPS Survey

If Gloria had passed a few days later and her daughter ended up being the one to fill out that CAHPS survey, would it be positively completed? Staff performance is not rated on returned surveys, but they can certainly be great indicators of the quality that agencies strive to achieve.

Jane, who had tried so hard to avoid our joint visit, later thanked me for going with her and giving that education to her. Support your staff by engaging with them as you educate and foster the qualitative growth that is judged by the CAHPS survey. Teach them to be mindful of the survey and use the same language when teaching family members.

To ensure all of your patients and their caregivers receive the best experience, review common educational questions with your employees and set standards for how they should respond. You can use this handout we created. This can function as a resource for patients and caregivers as well; anticipate their questions and concerns and give them the answers upfront.

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