Monday, December 30, 2013
I just read this great article Michael Solomon: miracle-cure-driving-patient-satisfaction-for-hospital-and-healthcare-customers/ . And I agree with everything Michael says, I also recognize the real barriers to changing culture. As of now hospitals are trying to change and change rapidly from a clinician-centric delivery model to a patient-centered model. Hospitals are trying to standardize and decrease costs, while at the same time, deliver individualized patient centered care. So much of this change in how we relate to patients is really occurring in the interactions between clinician and patient and the culture of the organization. The challenge that leaders face today is that training clinicians to communicate better is not done with a power point or a sign. It isn't taught with online modules or posters. Changing is going to take real investment. One just needs to look at the evidence and research on the matter. Communication skills are learned through a process of role modeling and coaching with feedback. Other especially effective methods include the use of video feedback with coaching. The coach/educator has to have very good skills at observation, questioning and guiding people to their own realizations. It is a delicate dance between understanding each person's unique relational style and language and professional communication. Another innovative method that I have found to be very effective is the use of patients as teachers. Asking patients to volunteer as "patients" for teaching communication skills. (It takes a special person to volunteer for this "patient" role in that they should have some experience in teaching and learning.) This fun way to teach communication skills involves asking clinicians to engage in a communication activity and receive feedback from the patient's perspective. When clinicians have this opportunity to see themselves through the patient's eyes, it can be very impact-full. Making it real this way is relevant, in that these patient actors are likely to pick up on medical terminology and assumptions about health literacy. The next level of improving communications with clinicians and patients is going to take a commitment to evaluating systems and infrastructure, and determining what forces in hospital culture and systems deter clinicians from taking adequate time and energy to sit down with patients. Identify organizational forces that deter clinicians from sitting down with patients and drive rushing through discharge and education. I love the idea of introducing nursing's caring theory to an organizations nursing model of care. This helps to reinforce the patient centered models inside the education and culture of nursing within an organization. Evaluate what needs to change and push for new incentives for patient-centered care. Once clinicians see the outcomes of their energies through feedback about readmission and population health, culture change will take off. According to Kotter, the change process involves dedicating meaningful time and education resources to effective training and marketing the new ideas. I believe hospitals are on the edge of a real paradigm shift. I cant wait to see what happens!
Monday, November 25, 2013
Simulation can be very magical, as many nurse educators have discovered. The speed of behavior change that is. If done correctly and following the best principles of evidenced based teaching and learning practice. However if done incorrectly, the damage to learner self confidence and cognitive scaffolding is enormous.
I was recently in the audience listening to an educator share their experiences with teaching through simulation. I was shocked and saddened to hear their practice techniques. It was clear they had never truly learned about how to teach with simulation from a knowledgeable source.
This teacher was throwing the learners into the hot seat without any prior presentation of content and role modeling. Essentially it was what simulationists call "hitting below the belt". This is where you throw learners into a scenario for which they have not been given preparation that could help them be successful. Experiential learning the old way. Its the 'sink or swim" mentality for teaching and learning. Unfortunately, this tactic is as outdated as it is inefficient and damaging. It is critically important when taking on the art of simulation that educators learn about what simulation is and isn't. It is important to read about how to approach and facilitate simulation learning. Most importantly, respect and care for the learners who trust you to teach them. When learners go into a simulation scenario unprepared for the situation, and perform to what their life experiences have granted them so far, this does nothing to grow their knowledge. This instead may cause them to question their past and delay their receptiveness to new knowledge. Suddenly they make mistakes and perform poorly in a situation that they were not prepared for. Afterwards you ask them, "what were you thinking? What went well? What didn't go so well?" Anxiety and shame may block the learning moment. What should they say? "I should have known to do X, or I should have known not to do Y?" Well of course this is the end result. You cant blame them for not knowing. But the learner doesn't know this. The learner only knows they didn't perform well.
The art of simulation is about experiential learning. Simulation experiences should be guided, and positive. Learners should feel that they are practicing a new skill. Learners should "know" what to do and in simulation, have a chance to "do" what they know to do.
Simulation is magic. But only if facilitated by a knowledgeable educator who values evidenced based practice. Beware of those old school simulationists. They know not what they do.