Perhaps the quote stuck because the context of the quote was a situation involving an individual’s ego negatively impacting a situation. The quest for being better did not seem to be particularly driven by quality as much as a personal ego to chalk up personal wins through an organization.  It is possible in our drive for being the best we leave some bodies in the road. It’s possible. Sometimes change does need to be exponential or transformational in nature to achieve a goal. But sometimes, improvements can be incremental and over time, these small rapid improvements create significant change in our daily, routine interactions with our patients, families and colleagues. They can transform the patient/provider moment into a collaborative, trusting relationship.

Last week, a friend of mine gave me a lovely lavender plant as a hostess gift. I was truly touched by her thoughtfulness. I love lavender and the moments of brief pleasure I receive rubbing my fingers along the leaves, capturing some of the fragrance and remembering my mother who enjoyed the herb as a personal favorite too. But my friend took an ordinary lavender plant and made it special or an “extra” ordinary plant. Not too much, just popping in one simple metallic wire with a few rainbow stars to make the plant more festive. Maybe she took a few minutes to locate something at home to “pretty up” the gift. Not overwhelming, not a “wow”, an “OMG” or an “a-m-a-z-i-n-g” just a little something to say “I took a few extra moments for you.”

Our service cultures are built upon creating the “WOW!”, the “A-MA- ZING” and the “FIVE STAR” service. Perhaps we can get bogged down a bit with thinking we have to hyper-extend or overextend ourselves to create that “wow” experience when perhaps we can create exponential patient memories by each of us taking the ordinary moment and making them “extra” ordinary. Perhaps being “extra” ordinary is as simple as gently “prettying up” an ordinary interaction or encounter.

We may experience potentially ordinary moments many times during the day; delivering meal trays, filling water pitchers, straightening a room, taking vital signs, just “checking” on a patient, passing a colleague in the hallway, being on the elevator with a family member, answering the phone, making a bed, helping a co-worker, or simply answering a question – all opportunities of ordinary moments to make a small change, a small improvement, a small connection through compassionate interactions to be “extra” ordinary.

As the service bar continues to rise, and it will, and we may find ourselves losing personal energy in hyper-extending our level of service.  Compassion is relieving suffering by attending to the essential ordinary, a small act of kindness, listening authentically and adding a brief moment of connection showing you truly care.

Who are your individuals on a daily basis who, in their gentleness and thoughtfulness, move the ordinary to the “extra” ordinary from accruals of little touches of care?

As much I loved these methods in my prior experience of making sure patient care work is done, processes are standardized and I have applied some piece of evidence-based practice related to the care, I was always and still am searching for the better mouse trap of patient communication. My pulmonary rehab programs relied heavily on patient satisfaction – they needed to love the staff, love the program, feel a connection and go back to their physician feeling this was the best thing they’d ever done for themselves.  As some call it, make them “raving fans.” And they were our fans.

We had every kind of assessment useful to measure outcomes – walking distance, VO2 max, rate of perceived exertion, quality of life, locus of control, readmission rates, length of stay date – you name it, we probably tried to figure out a way to collect it. Some of our patients were less than enthusiastic, cautious about the program, and perhaps downright belligerent about being in the program. As with many other types of rehab, with tenderness and care, we could generally bring the most difficult patient to enjoy the sessions and gain from the experience. We not only had to show we were technically competent, most important, we had to show we cared and yes, loved them.

Throughout the time in the program, we had an opportunity to find how at least one thing that was very important to the patient – outside of walking longer, breathing better or having more energy or less pain. We could find out what was really important that represented who they were as a person, not just a patient. One wanted us to know he was part of the US forces that liberated the Dachau prison camp. Another used woodworking as a hobby. Another experienced the tragedy of watching her husband lose grip on the tree they were both clinging to for life during a severe flood and saw him float down the torrid stream and out of her life.

This information was more than just irrelevant anecodotes. This was valuable information about the patient on who they were as a person, their values and their personal motivation. As a team, these bits of information helped us value and respect our patients even more as we helped them in their journey of the healing process.

As you make your daily rounds today and ask what you can do to make them more comfortable, as you build trust with your patient or the patient’s family, rather than ask, “Is there anything else I can do?” perhaps pose the question, “What is one special thing you would like for me to know (or would/feel comfortable sharing) about yourself that could help me better care for you or know you better as a person?”

Last Sunday, I had some extra quality outdoor time for Bobo. As we played in the grass, a lovely woman walked by on the sidewalk with her plastic bag of groceries.  She was dressed in what appeared to be an abaya and hijab. Her face was radiant and she greeted me with a most generous, glowing smile. We talked a bit about cats and she told me she had three cats too. As we continued with our cat conversation, we both agreed that there are ups and downs with caring for them. Indoor cats are safe but may not be able to enjoy their natural environment of the outdoors. Outdoor cats don’t need a litter box so owners might save some money but the cats may not be as safe.

At some point we introduced ourselves. Marci continued that caring for cats is like everything else in life. Life is not perfect. There are ups and downs, good and bad, give and take. When she left Iran, she gave up much. But in coming to the US, she has learned so much about our culture.  She misses her family terribly but in return, she has developed a true love for America and is most thankful she had the opportunity to live here with her husband and raise her children.

We continued with our discussion that even when we think we win at something, someone is really giving something up, however small. In this giving up, we perhaps lose a little something of ourselves, sometimes painful, sometimes not so painful.  But this experience of actively giving or losing can open us up to being filled up by something or someone else if we open our hearts. Sometimes we have to give out or give up to receive from others.

In customer service training sessions, we discuss the Law of Reciprocity and its role in service orientation. We may give to receive. Sometimes the gift we receive back is an internal feeling of satisfaction and emotional warmth – a sense of connecting to the human race from helping others.  By demonstrating compassion, we serve others by relieving suffering. We may want to relieve suffering for many reasons – a response to our personal sense of empathy, our righteousness (sense of the right thing to do), and perhaps, because we have a sense that to receive, we give.

Facilitating discussions and discerning the “why” and “how” of service orientation is as important as the writing of a good script, an acronym and setting service expectations and consequences.  For some, service orientation is natural. For others, it can be more challenging and a continual learning process. Life does get in the way, things do happen, conflict does occur and we must re-evaluate and reset our internal compassion compass from time to time.

I may never see Marci again. But I am thankful a stranger took a personal moment to share, to discern and to help me reset my compassion compass.

Many of us have witnessed changes in the last 40 years to improve cultural diversity and sensitivity in  the workplace. In many organizations, training is provided to learn about other cultures, obtain a baseline of knowledge and gain a general acceptance of differences.

As we move from just accepting our differences to acknowledging and embracing our differences, we build our own cultural competency. Cultural competence emphasizes the idea of effectively operating in different cultural contexts and altering practices to reach different cultural groups. We learn new patterns of behavior and we apply them to the appropriate setting.  Sometimes we are successful, sometimes we make mistakes. But rather than just accept, we continue to attempt to reach out and truly connect.

In the healthcare setting, healthcare providers, come from a position of power. Healthcare providers can have power over the healing process including medications, activities of daily living, meals, family, and pain.  But how do we reduce the power imbalance to obtain the therapeutic alliance, the bond of trust that allows us to learn from the patient and family, improve communication, compliance and outcomes? How do we reduce or eliminate possible cultural power imbalances between each other that may inhibit the team delivery of compassionate, quality care?

As defined by Tervalon and Murray – Garcia, Cultural Humility is the lifelong commitment to self-evaluation and self-critique to develop beneficial and non-paternalistic relationships.  Each of us is a unique intersection of various aspects of culture. There may be norms but there are variations of the norm, therefore a checklist of required elements identified with a culture will not create a culturally competent individual.

Through humility, we accept our humanity and relate to others free of pride, power and arrogance. Through humility, we accept that is impossible to learn all cultures, we cannot know everything but we become familiar, that knowledge of culture does not create mastery and standardization of practices and that perceived mastery can lead to miscommunication or mismanagement of care.

We do not live in a culture-free world. Every day we are exposed to variations of culture in our families,  our friends, co-workers and patients. Our very humanity continually involves and is influenced by other cultures including our clothing, food, entertainment, and healthcare among other domains of life.

What can we do each day to approach life with love, an open heart to create connections built on a foundation of cultural humility, caring and respect?

Ask questions in a humble, safe manner

Seek Self-Awareness

Suspend Judgment

Express kindness and compassion

Support a safe and welcoming environment

Start where the patient is at

Many healthcare organizations are currently focusing on hiring for care, concern and compassion, especially now that the CMS is targeting patient satisfaction as a key quality indicator related to reimbursement. I know we all want to bring in those individuals with true service orientation and heartfelt empathy. Above and beyond reimbursement, our patients and families deserve respect, care, concern and compassion.

Although I am a firm believer that compassion and empathy can be learned and hard-wired, I do understand that everyone experiences varying degrees of empathy. For some individuals, the learning curve for moving empathy to a compassionate response is much higher.

Healthcare organizations do not always have the means and capacity to start developing empathy from scratch with new hires, regardless if they are direct or non-direct care positions, therefore, compassion and empathy are essential and must be evaluated in the interview process. Once we have empathy and compassion on board in the organization, we can support the patient experience with service scripts and use personal empathy and compassion to build a connection with the patient.

So how do we explore compassion in an interview?

Certainly candidates can tell us good, detailed stories in response to a behavioral interview question,  but is the story authentic?  Does the story come from the heart? We have to determine that we are not just receiving a highly crafted story, but better, have they and can they demonstrate compassion even with the going gets tough.  As you move through the interview, do you see and feel the compassion and caring from the candidate?  Do they not only know what compassion is, but is it represented in their body language and their response to behavioral, situational and demonstrative interview questions?  Do they know how to connect with a patient through appropriate touch? For some positions, we may take the time to have candidates demonstrate a specific technical skill. Should we not do the same for something as critical as care and compassion?

You can readily teach a service script to a new employee and coach to hard-wire it into daily patient interactions. It can be much harder to teach them the innate internal warmth and satisfaction, the altruism of helping others. We must evaluate not just what is said, but how the words are supported through tone of voice, cadence, facial expressions, compassion “sounds”, body language and touch.

For a sample list of interview questions to explore compassion and empathy during your structured, interview process, please click here for a free download “10 Questions to Explore Compassion and Empathy in an Interview.”

“Courage is almost a contradiction in terms. It means a strong desire to live taking the form of readiness to die.”  

GK Chesterton

There’s a reason the universe sent me this quote even though I did not subscribe to the sender. It got me thinking about the types of situations in life when we need a bit of courage or even perhaps a lot of courage. Courage to get up every day after a loved one dies. Courage to share disagreement in a fruitful manner. Courage to be compassionate.

Yes I do believe sometimes it does take courage to be compassionate. We are greeted everyday with opportunities to demonstrate compassion. But sometimes we make excuses why we cannot be compassionate at that moment.  A small inner voice may say, “someone else will help” or “they don’t deserve compassion”, “I don’t have the time”, or  “others will ridicule me.”   We may need courage to slow down, be in the moment, be selfless and show compassion. We may need courage to be compassionate without criticism or judgment. And courage to be compassionate when we really don’t feel like it.

We may not think twice about being courageous and demonstrating compassion when it is truly a life or death situation. Perhaps the true courage to be compassionate is when we can easily turn our head, walk away, and ignore another’s suffering.

Customers have high expectations of excellence and sometimes we forget, especially during the holiday season, that there is a human being on the other side of the counter who wants to get her/his shopping done and spend time with their family just as much we do. Hmm, is it a consumer right to be rude, gnarly, impatient and difficult? Is it a patient right to be rude to the front office staff? How can we participate in instead of just receive great service?

For just one holiday moment, as a consumer, let’s give the spiritual gift of patience to the customer service representative who may have been on their feet for the last six hours, bagging merchandise and passing out change and receipts to a hundred faceless customers. Bring a gentle smile to the frowning medical representative who may be on his or her last nerve of seasonal illnesses flanked by holiday crazy. Take a moment and share a word of encouragement and a sincere, heartfelt, Merry Christmas, Happy Holidays or whatever greeting of loving kindness you choose to the service associates, regardless of the industry, who are working hard to help us through this holiday season. Be the gift.

One of our primary focuses on improving the patient experience has been providing tips and tools to script and standardize the dialogue and interaction between the caregiver and the patient. Therefore, we can script our way through registration, room admission, hourly rounding as well as daily tasks to care for the patient. It could be possible to regurgitate a script without ever looking at a patient and showing care, concern, empathy, kindness and encouragement through even a facial expression.

In one of my recent workshop discussions about being “in the moment” with a patient, one of the attendees shared what worked for her was being attentive enough to identify and recall the color of a patient’s eyes.  This focused activity helped her slow down and insure the patient saw the love in her face.

There are many barriers to practicing compassion in the workplace. Technology, time, push for efficiencies, communication styles, professional distance and power and organizational culture can all play a part in preventing compassionate interactions.

Can your staff define compassion?

Does your staff know the difference between compassion and service?

How do you “hard-wire” your brain for  empathy?

Do your patient interactions tend to be task – driven or focused on comfort?

How does the absence of compassion impact the perception of care and concern?

What can you do to be in the compassionate moment with the patient – to show the care, love, and concern you have for their well-being and comfort through the healing process?

Yes, being compassionate seems so easy at times – especially when you can visually see the person in pain and suffering. When the pain scale is obviously a 9.5 on a scale of 1 – 10. When we see videos of natural disasters such as our fires in Texas and floods in the Northeast. Extending compassion becomes much more difficult when we begin to wonder if a person deserves our compassion – that in some way they have not earned our compassion and thus we hold back on acts of kindness.

Compassion is not a reward. Yes, sometimes we have to triage our compassion for those that are suffering more, as in emergency situations. Healthcare providers must quickly analyze who receives treatment first, but ideally, no one goes without a compassionate connection. But, perhaps we don’t always see the emotional or physical pain scale measure of 1-7. Those pains of life that can make us uncomfortable yet we carry them, hide them, and show our best self so no one sees our suffering. Yet we do suffer. Each us. In different ways and measures. No one is a true zero always.

So just for today, let’s ask ourselves:

Do I find myself withholding compassion to others?

If so, why do I withhold compassion?

Am I comfortable extending compassion to those that I cannot see are in pain?

Does someone have to be a physical pain for me to feel compassion?

How can I open my heart to the invisible pain?

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Practical tips and encouragement for caregivers of terminally ill loved ones.

No matter what your knowledge base, caring for a parent with a terminal condition is a solemn, courageous, loving yet chaotic journey. Caring for two parents who are on separate paths to eternity can be doubly painful. Managing the End…Bridging the Beginning is a caregiver’s guide based on the author’s own family experience with caring for her mother during the last year of her life and her father’s rapid decline after a 10 year battle with his own chronic condition.

Weaving a soulful and heartfelt story and offering over 90 practical tips and words of encouragement, Lisa draws not only from her experience caring for both parents but also her professional experience to support the caregiver in experiencing life’s natural journey of the dying process, grieving and rejoining life as what she joyfully calls “a leave-behind.”

Subjects addressed in the book include:

• Practicing “TCOY”
• Managing difficult conversations with the loved one
• Proactively managing work responsibilities
• Practical tips for managing estate matters
• Tips for family and friends of caregivers who are supporting the experience.

Through sharing her story, Lisa hopes to bring encouragement to caregivers, guidance for a peaceful end, comfort during grief, and strength for a new beginning.

This book is sold by BookLocker.