Greeting a visitor at security, retrieving a patient in the emergency room, discharging a new mother — every moment, even the most mundane, can be imbued with the sacred.
"Spotlighting," an initiative at St. Joseph Health System of Orange, Calif., gives caregivers new tools to show their compassion, honor patient dignity and foster an environment in which patients feel safe and nurtured. The result — "Sacred Encounters" — is not just good customer service; it's an expression of the system's mission and values in its service to the whole person, body, mind and spirit.
"There are profound encounters, and there are mundane encounters, but they all have the potential to be sacred encounters," said Jeff Thies, vice president of St. Joseph Health System's Leadership Institute. "This focus is as important to us as improving the quality of care we provide and enhancing the quality of life of the community we serve."
But what exactly is the sacred? That was the first question leaders had to answer before developing the Sacred Encounters initiative some five years ago. Sixteen key concepts emerged after a text-mining analysis of system documents on the subject. Dignity, connection, care and compassion rose to the top in surveys of patients, staff and community members.
"We understand the sacred is bigger and broader than these words, but we believe that we can increase the likelihood of a sacred encounter taking place if they are present," said Thies. "And if we don't have these in place, there is a good chance a sacred encounter won't happen."
Intentional, authentic exchanges
To put the concept into action, St. Joseph teamed up with IDEO, a global design firm specializing in "human factors." IDEO interviewed patients to discover which moments were the most memorable during their hospital stays. From those conversations, St. Joseph decided to focus on three moments: admission, bed time and discharge.
Since then, departments at four system hospitals have convened small groups of seven or so frontline caregivers to look closely at every aspect of those experiences, determine the tone they want to establish and then explore what caregivers can do and say to foster a sacred encounter. This is called "scene building," and the process varies from department to department. For instance, one labor and delivery team decided to take a photograph of families as they leave with their new babies; another kept a card on a mother's chart for everyone who had contact with the family to sign. The "scene" is tested on patients in a process called prototyping, refined and then rolled out unit-wide.
"The idea is create, engage, reflect," said Thies. "There is consistency of process, but it's creatively implemented on a local level. It's not like we're running a call center, and beginning tomorrow everybody talks like this. The thoughts and the gestures are not scripted. They are not meant to be programmed in a rigid way. They are tools that allow the caregiver to reach out. If it is not authentic, the patients wouldn't respond to it."
Basic human touch
Sr. Jayne Helmlinger, CSJ, St. Joseph executive vice president of mission integration, is the force behind spotlighting. She is amazed by the innovative ways different departments have brought the human touch back into the high-tech world of medicine.
"It's real basic things," said Sr. Helmlinger. "Because you get so caught up in the actual giving of care, you can lose the ability to look at things from the patient's perspective. For instance, in the prenatal exam room there was no chair for dad. That's not very welcoming. The idea was to look at every aspect of that room to see ways we could make a difference."
Facilitator Elisa Tagaloa at St. Joseph's St. Jude Medical Center in Fullerton, Calif., is charged with leading units through the spotlighting process, which typically lasts two weeks. Perhaps the most challenging unit, she said, was the busy emergency department.
"People think of waiting rooms as these huge holding tanks where everyone is a number, not a person," said Tagaloa. "They yell out your name, and everyone looks up at you."
The design team came up with an alternative — when patients first arrive, the admission nurse jots down what they are wearing. That way nurses can find patients and escort them back to an exam room.
"Taking that extra step to find that person and address them in a quiet voice does not take a lot of time, but it honors that person's dignity at a time when they may be in pain and afraid," said Tagaloa.
Honoring patient and self
Tagaloa, who started at St. Jude 24 years ago, considers spotlighting one of the most thrilling opportunities of her tenure.
"I never thought of myself as a creative person, but it's been really exciting to discover ways to connect with patients in a meaningful way," said Tagaloa. "You realize there are so many moments during the day to honor the patient."
Focus groups and surveys show patients have responded to the initiative, and it is being rolled out throughout the system. Staff members also have embraced spotlighting.
"What I've noticed is that it taps back into why they became a nurse or a tech," said Sr. Helmlinger. "Having that opportunity to be reflective really rejuvenates them. You wouldn't see that energy and passion if you said, 'Okay let's work on getting our customer service numbers up.'"
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