RSSAuthor Archive for Wendy Leebov

Wendy Leebov

Wendy Leebov is a passionate advocate for creating healing environments for patients, families and the entire healthcare team. A mission-driven expert, Leebov provides outcomes-based consulting services, culture change strategies with healthcare organizations, training and tools for enhancing the patient and employee experience. With more than 30 years of experience and skills in communication, training design and delivery, she is known for making hard skills accessible and motivating people to stretch and apply skills which set them apart. Author of 12 books for healthcare, Wendy has produced two groundbreaking video-based skill building systems that educate and empower all staff to deliver the exceptional patient experience consistently by excelling at caring communication. Wendy writes a free monthly e-newsletter - HeartBeat on the Quality Patient Experience - packed with concrete tips and tools for managers who champion the great patient and employee experience. Visit Wendy’s website for more great tips and tools.

Are you and your team on automatic pilot?

By Wendy Leebov, PhD

A couple of weeks ago, I was running a workshop on The Language of Caring and how to communicate in a way that builds trust and partnership with patients and families. As we worked our way through the seven skills, we reached the part where we examined what I consider to be one of the most important skills for patient-centered communication: “explaining positive intent.” This involves telling the patient (or other customer) how what you’re doing is for their sake. Often, we just engage in our activities with the patient without much explanation. We’re on automatic pilot and not thinking about how the patient or family member perceives what we’re doing. When we do explain, the explanation typically focuses on the activity: “Here’s what I’m doing.” Rarely, do we go beyond saying what we’re doing and articulate the benefit to the person with or on whom we’re doing it.

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Commanding respect from disrespectful physicians

by Wendy Leebov, Ed.D.

“I work days and try to have everything ready when the doctors come in (labs in charts, vitals done, etc.). But they are immediately demanding everything at once, not giving me a minute to collect my thoughts and focus on the patient in question. Then, they treat me like I’m stupid when I don’t give the answers almost before they ask the question!”

Alan Rosenstein did a revealing study about nurse-physician relationships.

A few findings that struck me:

  • More than 92% of nurses had witnessed disrespectful and/or disruptive behavior by physicians.  The most common behaviors cited include yelling, raising the voice, condescension, berating colleagues, berating patients, and use of abusive language.
  • Common generalizations about abusive behavior on the part of physicians make it seem as if most physicians are “abusive.”   However, in Rosenstein’s study, nurses clarify that very few physicians are abusive. The vast majority are not. I think that’s VERY important to remember.

Still, the instances of abuse stick in the craw of not only the people on the receiving end, but also on people who witness it.  So, it’s important to address this behavior, so that it doesn’t erode morale, teamwork and patient outcomes. Of course, that’s not so easy, because many caregivers feel intimidated about speaking up to stop respectful or abusive behavior because of fear of retaliation, lack of assertiveness, and/or a sense of hopelessness that the person’s behavior will ever change.

What to Do?

There’s a lot an organization can do, and should do, such as:

  • Commit to and make explicit a code of conduct and link it to your vision, values and standards. Highlight the impact of teamwork, collaboration and communication on quality, patient satisfaction, risk reduction, safety, and outcomes.
  • Zero tolerance. Institute and enforce a zero tolerance policy about coworker disrespect.
  • Adopt a “respect” signal. Decide on something anyone can say when they witness inappropriate behavior—a signal that means “You have crossed the line.”  Stopped in their tracks, many people become more aware of their behavior and more accountable for it.  My favorite signals:

o     “Time out.”

o     “How about a cup of coffee?”

  • Physician-nurse rounding.  Have physicians and nurses round on patients together and provide training to support effective communication during these rounds.
  • Provide personal coaches for individuals who behave in an outrageous way.
  • Adopt-a-Doc: Have nurses each adopt a physician with whom they will deliberately build a positive relationship and for whom they will act as an advocate.
  • Provide assertiveness training for nurses! This is critical!
  • Discussion forums: Provide forums in which physicians and nurses talk to each other!

BUT, while the organization can work to reduce abusive or disrespectful behavior between nurses and physicians and among colleagues in general, in my view it is essential that the individual who perceives the behavior takes responsibility to address and handle it effectively, one situation and one person at a time.

What can the individual do?

In one of my roles years ago, I was in a position to field physician frustrations every day.  My friends called me the LIVER of the organization, because so many toxins flowed through me.  In my early years, in the face of a hostile physician, I would get defensive or cower.  Both approaches seemed to increase the behavior I was hoping to eliminate.  Then, after spending about $5 million on therapy, I learned other MUCH more effective techniques, and I have had a less stressful life ever since, because these techniques WORK.

Tips from my experience:

  • Alter your own inner monologue. These are the statements you say to yourself.  Look within:  What do you say to yourself when someone is abusive to you?  “This jerk!  How awful!  Poor me!  I hate this!  I don’t deserve this!”  If your inner talk makes you angrier or more defensive, change it.  You CAN decide to think something different, such as, “This is not about me,”  “I deserve respect,” “I don’t have to react,”  “I can stay calm and help this person,”  “I can take the high road here.”
  • Don’t respond in kind. It’s human nature to want to strike back when attacked.  Resist.  Handle the inappropriate behavior respectfully.  Stay on the high road, since this will make you most effective and also enable you to feel good about yourself at the end of the day.  CALMLY SAY, “What is happening is not okay.”
  • Give direct feedback without anger.  “I saw you do this….” or, “I don’t appreciate your tone,”  “I would appreciate your keeping your voice down,”  “When you belittle me in front of our patients, I resent it and it makes it hard for me to support you.”
  • When someone is verbally attacking, instead of getting defensive, make explicit your positive intent. Instead of saying, “WHOA!  Hold it a minute” say, “You know, I really want to help you.”  Then if they persist, say that over and over in a sincere tone, “As I said, I really DO want to help you.” And then wait until they have vented enough to allow them to calm down and address the facts of the situation with you.
  • Use the caring broken record.  In the face of persistent disrespect, repeat your bottom line message each time with caring.  “I hear how frustrated you are, and I really want to support you,”  “I realize you’re under extreme pressure, and I really do want to provide the support you need,”  “I’m sorry this isn’t what you wanted.  I really do want to help.”
  • If the abuse continues, remove yourself from the situation. “I’m hanging up now.  Please call me back when you’re ready to talk with me in a respectful way about this.  I really do want to help you.”
  • “There you go again.” If you’ve addressed the behavior over and over and it still hasn’t changed, when it happens next, say very calmly, “There you go again.  I want to discuss this with you when we can both be respectful.”  And do that EVERY time it happens again.

And with your TEAM:

Talk about the elephant in the room. Work together with your team to identify great ways to respond to the disrespectful or inappropriate behavior you handle most often.  I’ve provided a worksheet to guide your discussions.  You can be sure you’re not alone.  So, the activity will help everybody.

Healthcare environments are inherently stressful and it’s upsetting to think about the times when colleagues add to this stress instead of relieving it.  To be effective and to do your part in altering an atmosphere of disrespect, it takes courage and caring — backbone and heart.

For helpful resources about handling disrespectful behavior, click here.

“No decisions about me without me!”

By Wendy Leebov, Ed.D.

Harvey Picker, founder of the Picker Institute, coined this phrase many years ago.  In my view, it articulates so simply and powerfully the key principle driving patient and family-centered care.

It’s exciting to see the epidemic of commitment to patient and family-centered care! The words ‘patient-centered,’ ‘engagement,’ and ‘partnership’ are everywhere, as are bulleted lists of key principles, factors, and dimensions.

Since I’m very concrete, to better understand and embrace these concepts I’ve been reflecting on personal experiences that make these concepts come alive.  In some of these experiences, these concepts were glaringly missing and the impact was profound and disturbing. In other instances, these principles were in full bloom and the impact was profound and gratifying.

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Can empathy be learned?

Of course.  That’s how people become empathetic in the first place.  Children are not naturally empathetic.  They are largely self-centered beings whose main focus is on getting their own needs met at all costs.  Much of “growing up” has to do with moving from a role of taking, to one of also giving, of learning to set our own thoughts, feelings, and needs aside sometimes, so we can make space for those of other people.  This ability, of course, is the key to feeling and expressing empathy.

But what if a person did not learn these skills as they grew up?  What if expressing empathy doesn’t come naturally to them?  Are they then hopeless?  Of course not.  If they want to learn to be empathetic, more often than not, they can.

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In-room computing: 5 tips to enhance patient-caregiver communication

When hospitals and medical groups transition to an electronic health record (EHR), many caregivers view the computer as interfering with, not helping communication with patients. I spent a big chunk of time reviewing the myriad studies about the relationship between bedside and in-office computer use and patient satisfaction. Based on all I’ve read, I’m convinced that EHR systems at the bedside and in medical offices can greatly enhance the patient experience of care and satisfaction.

Years ago (in the 90s), in-room computer use by caregivers was indeed a barrier to communication. Caregivers weren’t used to it and many resisted it. The systems were much less user-friendly, so caregivers struggled to access and enter information as the impatient consumer looked on.  Also, far fewer consumers used computers themselves, so few patients realized the benefits of the computer for their care.

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Enhance the patient experience: Four pointers on nonverbal communication

I’ve been doing a lot of communication skill training recently and I’m repeatedly impressed by the impact that nonverbal dynamics have between staff and customers on rapport, trust, and mutual respect.

I’ve been privileged to observe many people’s nonverbal behavior as they try their hand at various everyday scenarios. And here’s what I see:

  • Some people say the right thing, but their nonverbal behavior doesn’t support what they’re saying
  • Some staff respond to the content of what their customer is saying, even when the customer’s nonverbal behaviors communicate a completely different message
  • When asked to help each other communicate better, most people focus on “what you can say that might be better,” not on opportunities to communicate better nonverbally

These observations have prompted me to think more about how to make nonverbal communication work for us as we strive to create great patient/customer experiences.

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Eight Ways to Drive the Complaining Patient and Family Member Nuts

One of my favorite activities is facilitating patient and family focus groups. What I love about focus groups is that I always learn something!

I’ve consistently found that patients and families are very sensitive to how they are treated when they complain and very articulate about the experience. If there’s one thing I’ve learned well it is “What drives the complaining patient and family member nuts?”

Listed here are the highlights. Consider sharing this list with staff throughout your organization so that people avoid some of the pitfalls of dealing with complaints.

1. It drives patients and families nuts when we get defensive. If we take complaints personally and say things like “I only work here” or “It’s not my fault”, we make matters worse. We need to keep calm, stay objective, and avoid judging, acting superior or making excuses.

2. It drives customers nuts when we coldly cite “policy” as our reason why we can’t do what the customer wants. Statements like “I’m sorry, but that’s the way we do things here” or “It’s our policy” infuriate patients and families, because it seems we care more about protecting ourselves than serving their needs. We need to somehow give them at least one option in line with policy or find ways to bend rules when we know we’re acting in the patient’s and organization’s best interest. And when the rule can’t be bent, we can at least listen intently and, with sincere regret and caring, explain how the rule exists for the sake of the patient. Why is there no smoking? Not because “it’s our policy.” Instead, “For the health and safety of all of our patients and staff, there’s no smoking.” [more]

The Maddeningly Difficult Patient

The maddeningly difficult patient presents a maddeningly difficult challenge —almost daily.

Oops. I said “difficult patient” and I vowed never to use that term. I think it’s much more constructive to talk about “difficult situations” and the “difficult-for-me patient”. The fact is, because patients and families are so anxious during healthcare experiences and so out of their element, many people do not behave at their best. They are not inherently difficult. The situation is difficult for them. (Click here to read more about “The Difficult-for-me Patient”)

Yet, since challenging patients and families produce so much stress for service providers, I am constantly trying to learn about ways to help. Recently, at a large medical group, I ran a focus group with nurses, billing reps, registrars, phlebotomists and others known for dealing with difficult situations well. [more]

Celebrating Nurses’ Caring: Meaningful Activities for Nurses’ Week

I would like to introduce Wendy Leebov, Ed.D., who is a new monthly contributor to the blog! She will be posting a variety of articles to help educate and empower staff. She comes to the Leaders’ Lounge with more than 30 years experience in communication, training design, and delivery. Welcome, Wendy, to the Leaders’ Lounge!

Every year in May, as Nurses Week approaches, I stop and reflect about the gifts of caring that nurses deliver to patients and families day in and day out. These gifts are remarkable.

While nurses’ acts of caring deserve recognition year-round, there are so many ways to use Nurses Week to express our appreciation and support. Here are favorites from my experience as chief human resources officer at the Albert Einstein Healthcare Network where I worked before leaving to become a full-time consultant (fanatic) on the patient experience. [more]