going, but demands for my time at the bedside precluded me from making the calls I felt sure would make a world of difference to my patients. This compulsion for a systematic feedback loop to my patients followed me into my work as the manager of a nurse call center.
In 1989, I was managing a nurse call center that handled 120,000 calls per year. My team of registered nurses was armed with protocols for triaging caller concerns about everything from infant teething to chest pain. The typical inbound calls were initiated by a customer with specific needs—usually symptom-based concerns—but other calls concerned physician referrals and registrations. It was not uncommon to have patients contact our call center with questions about their recent discharge instructions, medications, or follow-up appointments. It dawned on me that we had the perfect set up to manage not only the inbound requests for information, but to make outbound calls to our recent discharges as well. Hence, our follow-up service was born. Within weeks, we were up and running making follow-up calls to patients discharged from the hospital’s inpatient units as well as those treated and released from the emergency department. Back then, we didn’t have the sophisticated computer technology that exists today, but we were driven by the same goals many of us have today:
•Validating patients’ comprehension of and adherence to discharge instructions
•Assisting in answering questions and securing follow-up appointments to maintain compliance
•Maintaining a warm connection between patients and the organization
What made sense then still does and will continue to make sense in the future. Patients come in contact with hospitals and other healthcare organizations when they are feeling vulnerable, frightened, and confused. They are often hurting physically and emotionally. And, despite our best efforts at education and thorough discharge instructions, their time with us is not the optimal “teachable moment.” They often leave the hospital or clinic only to find themselves wondering about next steps. Now that the Centers for Medicare & Medicaid Services (CMS) are placing greater accountability on hospitals to prevent unnecessary readmissions, hospitals are scrambling to do whatever they can to ensure patients leaving the hospital maintain a connection to medical professionals and timely advice. Value-based purchasing has created a burning platform for hospitals to decrease readmissions and improve patient satisfaction.
Improving the patient experience has always been a central theme in my career, whether it was at the bedside, in leadership positions, or in my consulting role. I’ve always felt that, regardless of the nature of the healthcare encounter, consumers should leave every encounter feeling more knowledgeable about their conditions and more comfortable in taking the necessary next steps than they did before. If we as an industry are going to create a truly patient-centered experience, we must embrace follow-up efforts as an integral part of the total experience. But success will not happen by chance—it must be created by design.
The following chapters will provide rationale as well as tools and examples of successful approaches you can take in weaving follow-up calls into your care and patient experience game plan. When it comes to follow-up calls, it’s no longer just a nice thing to do for your patients—it’s necessary. So let’s get started now.
Chapter 1
Why Create a Post-discharge Call Program?
Wanting to go home from the hospital and being fully prepared to go home from the hospital are two very different states of mind. The first acknowledges—and rightfully so—that the average patient wants to spend the least amount of time possible in a hospital. The second implies that the patient feels confident and is fully equipped to take the reins in the next stage of his recovery process. Patients may feel highly motivated to leave, but are they really prepared?
In many ways, medical care has become so complex that patients often go home from the hospital with what can be described as a “loss of direction” about what to do, where to go, and whose advice they’re supposed to be following. Many times, patients receive discharge instructions while still in pain or under the influence of medication, neither of which are considered ideal teaching situations. When you add to a patient’s fear and worry about not being qualified to manage her own care or—worse yet—her false confidence that being sent home means no further treatment is necessary, you have the recipe for a potentially dissatisfied patient.
This book is designed to help you understand the patient perspective, including some of the emotional aspects concerning how patients deal with discharge and what might be going through their minds as they transition home. This book then explores steps you can take to manage patients’ experiences, especially as they transition back to the home environment.
The following chapters will discuss why it’s important to make post-discharge (PD) calls part of your strategy to enhance the patient experience and improve clinical outcomes. Chapters will also provide details on how to structure a PD call program, addressing everything from sample scripts to pros and cons of various models for implementation.
Moving your organization from encounter centered to patient centered is a big step, and, before getting started, it's important to understand the rationale behind the effort.
Reason #1—Improve the patient experience (and, ultimately, patient satisfaction)
There are many reasons why organizations have embraced PD calls. The primary drivers are to improve the patient experience by maintaining a connection, supporting clinical objectives, and providing additional customer service opportunities. If you think about it, we are trained as customers to anticipate follow-up communication from service centers after our car has been worked on or from veterinary staff to check on our beloved pets. Why shouldn't we expect that someone involving human lives would want to know how we are doing after we've left their professional care?
Providers send out patient satisfaction surveys by mail, but nothing says “We're here for you” like a live conversation with someone showing concern within those first couple of days after discharge. Discharged patients want to feel somebody still cares enough to pick up the phone and call while maintaining a link back to their trusted caregivers within your organization. It brings a whole new meaning to the concept of providers making house calls.
Understand the Patient’s Frame of Mind
To help healthcare leaders and caregivers get into the mindset of their patients, I often use an exercise that I call the “Think Back” exercise. It’s simple and one that I encourage you to use in your own department or organization.
Exercise #1—Think Back
Setup: Make sure everyone has the Think Back worksheet and a writing utensil. Have a flip chart and markers ready for yourself.
Ask everyone in the room to close their eyes for a moment while you say the following: “Think back to a time when you were ill. It could be as simple as a bad cold or as complicated as a surgery or recovering from an injury. How did you feel?” Give the group about one minute to reflect internally.
Then, ask them to open their eyes and write down responses on their worksheet.
After they have recorded their responses, ask them to complete the second portion of the form; say the following: “Now that you have identified how you felt at the time, what did you need?”
Once again, give the group a moment to reflect and record responses on their worksheets.
Wrap Up: Once everyone has written down their responses,
