Hospice Pro Tip: Be Courteous

“Really big people are, above everything else, courteous, considerate and generous – not just to some people in some circumstances – but to everyone all the time.” – Thomas J. Watson

Courtesy is the hospice outcome that matters

I recently spoke with a doctor who works in a hospital and complained about the HCAHPS – the hospital CAHPS survey. He felt that asking people questions like, ‘were you treated with courtesy and with respect’ are unreasonable and unfair.

The doctor’s point is that he treats dozens or more patients a day and his focus has to be on outcomes. The hospital should judge his performance based on patient outcomes, not emotional criteria that are subject to a range of factors affecting the patient or their family. People, he explained, can have many of emotional issues, especially when they’re in the hospital, they feel out of control. They don’t understand how overworked their healthcare providers are and how much time is spent behind the scenes working on their case. While I might only speak with the patient briefly, there is a lot of time and effort spent on their case that they’re not aware of. Therefore, “I should only be judged on outcomes.”

We can agree to disagree on whether hospitalists should be judged on outcomes alone or if survey questions about courtesy and respect have a place. However, in hospice, the outcome is almost always death.

Hospice professionals can’t rely on saying, a patient came to me with a problem and I cured the problem and that’s what’s most important. By definition, hospice is not curative. Even the core healthcare aspect of hospice, ‘treating pain’ is typically temporary or fluctuating and not an outcome in the same sense as treating an illness. Further, CAHPS surveys are not even completed by those whose pain was treated. CAHPS surveys are completed by the informal primary caregiver, the person who was most involved in the hospice experience, for whom temporary pain relief may not count as an overriding positive outcome.

In hospice, treating patients and their families with courtesy and respect are the key factors in respondent’s overall view of how well the hospice agency provided care.

4 Tips for Improving Courtesy & Respect in Hospice Care

Tip #1. Go Slow

You might be in a rush, running late from the last patient, documentation piling up, whatever it might be, when you feel rushed, stressed, or anxious, no matter how well you think you hide it those feelings come out.

• Take a moment before entering the patient’s home or room and take a few deep breaths. Close your eyes and count to ten. Visualize the patient and the environment you’re about to enter. Anything to simply slow down and reorient your focus on the task at hand without carrying the stress.
• Knock on the door to the patient’s room and wait to be told to come in. If you don’t hear a response, knock again, open the door a crack and announce who you are and ask if you can come in. “Hi, it’s Nurse Jackie from Hospice Agency. May I come in?” Wait a moment and then enter.

Tip #2. Get Informed

Nothing shows a patient and their families that you value & respect them like knowing the details.

Be prepared before you enter the room. Take a moment to review the patient’s information. Know their name. Know relevant family information. Review the chart. Be aware of what has been happening with the patient. Check if there are open care plans.

Ask relevant questions. Don’t ask questions that could have been answered by glancing at the chart.

Trust & respect are diminished when a patient or family member is being asked a questions because you’re not current with the information in the chart.

Tip #3. Non-Verbal Communication

People won’t remember most of what was said during a hospice visit. They will remember how you made them feel. Body language is one of the critical factors in creating feelings during interactions with patients and families.

• Take your time.
• Look professional: Organized, dressed appropriately, & prepared
• Make eye contact
• Smile
• Don’t cross your arms or put your hands in your pockets
• Sit during conversation. Nod in acknowledgment and show other signs of active listening

Cultural pitfalls to be aware of: Cross-gender touching such as shaking hands or hugging: In many cultures, men touching women or women touching men is forbidden. If you don’t know, ask before holding out your hand or jumping into a quick hug.

Hand signs: symbols like the thumbs up, or ‘okay’ and many others can mean different things in different cultures.

Tip #4. Verbal Communication

It’s not just about what you say, but it’s about how you say it.

Utilizing the tips on slowing down, being knowledgeable, and aware of your non-verbal communication, here are some ideas on what to say to enhance the feelings of courteousness & respect.

• Talk about things not related to their illness: Hospice professionals are not quick-draw hospitalists going from curtain to curtain in an ER. You may see the same patient and family multiple times a few over weeks, months, and sometimes even longer. It is expected that you get to know the patient and family in ways that are holistic and not simply defined by their chart number and illness. Ask about the family, events, previous experiences such as work and travel. Showing an interest in patients and their family as human beings is a fundamental piece of courtesy & respect.
• Address the patient & family members by Mr./Mrs./Ms unless specifically told to use a first name or nickname. Don’t use well-meaning terms such as ‘honey’ which can be taken as childish or demeaning.
• Proactively review open care plans: Don’t wait for an official care plan meeting or a complaint about something from the patient that touches on an open care plan.  If you know open care plans exist, let’s say for nutrition & pain, mention that these care plans are in place and ask the patient and family members about them.
• Ask open ended questions: Instead of asking, ‘do you need any help with pain today’, try something like, ‘tell me about your pain today.’ Open ended questions lead to more thoughtful conversations where patients and families feel they can express themselves & be heard – key elements of inspiring feelings of courtesy & respect.

Remember, trust is built in drops and lost in buckets. Interactions that may seem small & insignificant to you, may become the focal point for a family & patient going through the emotional roller-coaster of hospice. Make sure that all your actions are building trust.

Like any skill, exhibiting courtesy & respect can be learned and improved upon with practice and effort. Incorporating these tips will help develop these skills and create better results for your patients, their families, and clinicians. Practicing these skills will deliver positive returns for everything from referrals to testimonials, reviews, & CAHPS scores.

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