Emotional Intelligence and the Patient Experience

Michael Sacopulos: Susan, I know your experience is in helping healthcare entities with the interplay of leadership and emotional intelligence. How do you describe emotional intelligence?

Susan Childs: Emotional intelligence is being mindful of one’s own actions and responses—and the relationship management with others. And we all have it. It is being aware of each person’s individuality and demeanor and how to manage that process with the most positive results, in any situation.

I usually describe two competencies, personal and social. The personal is an internal competency and being cognizant of your individual emotions and managing your behavior and tendencies. For example, a person’s “personal” competency may be traits like stubbornness, or tenacity, or “standing up for the little guy,” or being a “morning person.” The social competency is an external focus, being aware of others and managing those external relationships. We have to know what motivates us, as well as what social cues (or even specific people) can set us off.

Emotional intelligence is your basic instincts kicking in but managing your behavior in the most positive direction.

We are aware of this in our work setting when we become territorial, angry, excited, or happy. There are times when it can be most challenging. For example, there may be a time when a patient is screaming at you. It is hard not to take that personally, but it’s not a personal attack. You just happen to be the person there. That’s where the emotional intelligence kicks in.

Here’s another example. Physicians have to convince patients to comply with medication prescriptions. But what if the patient refuses? The physician has to pivot, to understand the basis of the noncompliance. Emotional intelligence is approaching the patient on their level—it is about going where the person is.

Think about how many interactions you have like that in a day, how you appear to others. One confirming statement, that exhibits your level of emotional intelligence, from you could either make a person’s day, or ruin it. An emotionally intelligent individual has to be responsible for that.

MS: Very interesting. Can emotional intelligence be taught or developed? I’m hoping that it’s not like height or eye color, just kind of baked into our DNA. Is there hope to help people improve in this area?

SC: Yes, I believe we can continue developing our awareness. It Is referred to as brain plasticity, and plasticity creates a chain reaction. Remember when your mother used to tell you to “count to 10” before you react? When information enters the brain, it impacts the emotional part of your brain before it registers in the cognitive portion of the brain. We take in the info, think about it, and then react. If we can have plasticity and think about our responses before we actually respond, it makes our reaction more informed. In making these behavioral changes, we are more apt to build new pathways, establish new patterns. This is when it becomes more of a habit, and contributes to improving the emotional intelligence. Once this becomes habit, we see good results and good rewards. The result in the reward.

Think of a scenario in a healthcare practice. The manager announces to the staff, “We’re not collecting enough,” or, “We’re not seeing enough patients,” or “Doctors, you’re taking too long with each patient.” No explanations, nothing there for the staff to participate in.

With an increased emotional intelligence, the manager may try this instead: “Let’s work towards some raises for the staff and collect more on the 90 days plus balances. I’d like to help you. What do you need to be confident about requesting more money?” In this scenario, the staff may work harder because the possible result will benefit them. People are devoted to their jobs, but everyone wants to know, “What is in it for me?” In managing people, we should be able to clearly explain why a change is needed. Transparency is a great place to start, listening to and responding in a positive way. The goal here is to reward rather than have repercussions.

MS: Can you give me a specific instance where you went into a healthcare practice and how you assisted the individuals with their emotional intelligence? What was your process?

SC: Healthcare is an industry like no other. Emotional intelligence is always in play and part of every project because we are in the business of caring for people. That includes a specialized empathy for patients, staff members, and doctors. In healthcare there is a sense that everyone is in this together.

So how do we build emotional intelligence into our policies and procedures? Practices opening up early and staying later is a great example of tuning into the needs of patients. Timing of nursing callbacks and responding to patient queries can be strategic. Another area is in financial policies and revenue cycle attention. As we define payment agreements, perhaps we don’t need to be as stringent as 1, 2, 3. In working with people, it may be an evaluation of how much they can afford and the timing of their payments that help to put together a successful plan.

When asking a staff member to perform a task, such as placing a referral, general courtesy is in order. Respect matters always. Every nuance matters. That’s where emotional intelligence works.

Here’s a specific instance that you asked about. I was called in to consult in a practice. The initial complaint was, “We don’t know exactly what is going on, but something is very wrong here. Something is amiss.” Well, it turned out that the administrator who engaged me was the obstacle. It was tapping into my own emotional intelligence that helped me conduct a personnel and duties audit that showed what was amiss. The administrator was unaware the entire office was ready to walk. Emotional intelligence allowed me to tune in to her world to realize what we were facing. We had a leadership meeting to discuss each person’s role in the practice. We changed around a few duties, reprioritized some tasks, and set up ways for the staff members to support each other. At the end of the process, the administrator actually requested a change in her own position. We worked through that, as well. Now, everyone is happier and working toward a similar goal. The patients, however, never noticed anything amiss. The team continued to provide seamless care.

MS: Very impressive. Do you think that emotional intelligence should be tested or a criteria for Human Resources when hiring staff?

SC: Yes, I believe so. Organizations are starting to test for emotional intelligence, especially for those with direct patient care. Working in medical records may not be as much of an issue as working the front desk or front-line nursing.

When working with emotional intelligence, we can work with people’s characteristics and use that to our benefit. I had an employee that I thought would be great at the front desk, and she ended up being amazing in medical records. If somebody loves to chat it up, put them at the front desk to extend that friendliness while greeting patients. For those naturally good at money discussion, place them at check-in. Everyone has their natural tendencies, and that’s the key. Most of us are most comfortable in a role that we can naturally fulfill. This is where the emotional intelligence comes in.

MS: Susan, let’s shift gears a bit and look at the patient experience. How has the patient experience evolved over the time you’ve been involved in healthcare, let’s say the last 20 years?

SC: My father told me when I first worked at a medical practice, “People will always be sick and they will always need certain things.”

Unfortunately, I’m now seeing a more relaxed and less personalized approach. For the most basic of patient experiences, appointment times are shorter. Physicals used to be an hour and follow-up appointments were 15 minutes. Some offices now have a 5-minute office visit.

Patients often check in with a kiosk or device rather than a live person. While it may be easier and safer, we also forfeit that personal greeting and interaction, “Hello and welcome to our practice.” You may literally walk into a building, pull a number like at a deli counter, and that’s not right. There should be a human involved in every level of care possible.

It may help with patient flow, and it saves in labor, but not with customer service, so you make it up in other ways. If there is a long line of receptionists, they can always say, “This receptionist is available for the next person checking in.” Try a more human approach . . . and we are in the business of caring for humans!

The patient portal can be your best friend. Think about the ongoing conversation with the patient—and using the portal every step of the way. Registering the appointment, getting lab work, obtaining vitals during the visit, and then the patient being seen in the exam room. In reality, patients only spend 10% of the time face-to-face with the physician. With so many office processes set up to protect the physician’s time, it is important to make that physician connection to the patient at every connection of care. For example, nurses may answer questions submitted via the portal, but we want the patient to know that the physician is involved with the answers. So we mention their name in the message. “Dr. Childs is glad you are feeling better and . . .”

A major and most unwelcome change is the patient’s increased financial responsibility. We have gone from small copays to 40% of patients with high deductibles in the thousands of dollars. Emotional intelligence is clearly now in play. The front desk is asking for larger payments sooner. It takes a certain finesse to be able to request money from a sick patient in the most productive way. The EI enters where we reach out to patients with information on the website—that and other venues addressing their unspoken concerns. Patients are proud. We reach out letting them know we are available to help establish a payment plan.

Telemedicine is the most wonderful and convenient patient-oriented offering! Underserved and/or reduced-access-to-care populations can be seen online! There are studies that this service supports improved health, and compliancy improves. This is truly meeting a patient “where they are.”

MS: You’ve delineated some major changes in the last 20 years, and it seems to me that perhaps it’s not just healthcare providers and practices that are changing, but patients as well, their expectations. Do you see that?

SC: Yes, here’s an example. I’ve seen a rise of requests, from practices, for someone to work with staff on how to best handle upset patients. As the level of premiums rise, so does the level of patient expectation, and I’ve found that to be very true. Realizing that healthcare is at the forefront of politics these days, patients are already experiencing reduced access and the rising cost of healthcare. There is a lot of fear.

There is also a change in the relationship of (dis)trust between patients and their insurance—fear that the visit or procedure will not be covered. Insurances and local healthcare groups are narrowing networks, severely reducing choice, which may not be a patient’s preference of care.

We will see where this next phase carries us. I do hope the patient speaks up to avoid take-a-number healthcare. It is our role to anticipate a patient’s needs with our offerings . . . finishing their sentence for them. If not, patients are now consumers and will be looking for other practices.

MS: Interesting. It seems to me that patients’ altering expectations are directly tied to their previous experience, for better or worse. I think that that’s true, and certainly more the demanding nature, and perhaps that’s a direct result of the diminished patient–physician relationships that we see.

SC: Yes, remember that only 10% of the visit is spent with the physician. Patients want more. The most important and human aspects of patient care should be conserved and protected with newer technologies. It’s the conversation with your physician, eye-to-eye contact and accessibility, a receptionist greeting you with a smile, and the nurse playing a comforting role. These actions and approaches can easily be folded into your everyday care policies and procedures.

MS: One thing that has changed the landscape for physicians practicing over the past few decades: electronic health records. I recently read a study that said 40% of physicians believe that these systems improve the quality of care. Disappointingly, 44% believe that it has decreased or diminished the quality of care. How do you view technology vis-a-vis the patient experience? Has technology removed or diminished the art of medicine?

SC: Yes. The EMR has reduced the personalization. Other technologies such as test results and access via a portal are much welcomed. One thing I hear often is, “The physician is behind the computer and I don’t know what’s going on” . . . and then the fear escalates. Most patients will tell you they just want eye-to-eye contact. We are dealing with the most basic feelings, and that’s why emotional intelligence is so important.

Working with physicians, we look for ways to reduce worry by rephrasing responses. For example, “I’m ordering a lab test and asking Jenny if she can get you in next week.” or, “I am looking at the lab . . . are you able to come in next week?” or, “I’m looking at your last results.” Explaining what and why we are doing things and of course eye contact makes a world of difference.

The one thing I would reiterate for every physician—it’s a real pain and nobody wants to do it, but it pays beautifully—go back and please update your templates. This is something we end up working around. Your practice changes, your patients change, and your questions change. Your templates can save you so much time. Personalizing providers’ templates is OK! You are paying a fortune for a system. Let it work for you.

I work with a dermatologist who is amazing. He shaves off seconds up to a minute and by the end of the day he has more than 30 minutes extra time, and you can do a lot in 30 minutes.

MS: Those are some excellent tips. Susan, you’ve assisted healthcare entities around the country with physician–administrator collaboration. What are some of the misconceptions harbored on both sides of that equation?

SC: There are misconceptions, and the best thing we can do is break them. Because they will continue until you do so. I like to have a group effort so people see what others are really doing. You can change roles and cross-train for a shared understating of roles.

For example, clinical staff can challenge the front desk on why it takes a patient so long to get roomed in the back in an exam room. We have fun with team building and role playing. A physician plays the receptionist, and the receptionist is in another room as the patient. The physician has to book the appointment, and of course the front desk person has a lot of fun bringing up every line and reason: “What was that recipe at the PTA the other night?” We go through every complicating scenario. After the appointment is finally made, “Oh wait, I can’t do that. We have to change it” . . . and then we all see why it takes so long. It is a lot of fun, people respect it. We can always improve things.

MS: That seems like a very good strategy to combat misconceptions on both sides. When I was preparing, you were nice enough to give some feedback about administrators and whether or not they had a clinical background. At a certain level that may happen and other levels maybe not. Can you talk about clinical experience with administrators, how that either benefits or does not benefit a practice?

SC: Yes, and sometimes physicians will be their own manager as well, which may not be the best idea because they should be focusing on the patient care and have staff handle the rest. With administrators, I love working with those that have a clinical background. It is a wonderful gift because they can see things from both business and clinical perspectives. I would highly implore managers to see and feel more of the clinical side, to shadow nurses or physicians. It’s really knowing your staff, patients, and doctors. That’s the gift.

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