Being hospitalized for any reason is never a fun time, but there are some instances where it can be a harrowing experience. This is especially true for psychiatric patients, who are already in a crisis even before being plunged into the hospital atmosphere, which can overwhelm them. This disconnect between patients and hospital staff has long been an issue. Today’s guest shares some insights on her work to improve this relationship.
About Our Guest
Since 2017, Gretchen L. Ramsey, MPS has been the Director of Patient Experience at Geisinger Holy Spirit Hospital in Camp Hill, Pennsylvania. In this capacity, she coaches and mentors providers, nurses, and non-clinicians who have patient contact in order to improve their ability to achieve higher levels of patient satisfaction.
PATIENT EXPERIENCE SHOW TRANSCRIPT
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales, and today Vince and I will be talking to Gretchen L. Ramsey who is the director of patient experience at Geisinger Holy Spirit in Camp Hill, Pennsylvania. In this capacity, as she says, she teaches people how to be nice to one another. Gretchen welcome to the show.
Gretchen L. Ramsey: Thanks, Gabe. I am so excited to be here. Hi Vince.
Vincent M. Wales: Hi there. I’m very intrigued by this teaches people how to be nice to one another, because I think that’s a big failing in our society as a whole.
Gretchen L. Ramsey: Absolutely absolutely. You know I had to develop an elevator speech because director of patient experience sounds a lot like the director of hospitality and a lot of ways it is very much the same. But in other aspects it much different and it is a opportunity to teach and train and to coach physicians and frontline staff how to recognize their own behaviors but then also recognize the behavior of a patient or a family member who just may not be having the best day and how to interact with them with a positive outcome as the ultimate goal.
Gabe Howard: I think that it’s very interesting speaking just as patient versus medical staff because those are two very very different experiences. One person, the patient, is, you know, sick and scared and out of their element and the other person, the medical staff, is at work. This is their normal. So if there was ever going to be like a misunderstanding I think that is just the perfect recipe for that to happen. Has that been your experience? Is that what you’re kind of working to solve?
Gretchen L. Ramsey: It is, Gabe, and I appreciate that astute observation particularly because not only is there just one sick person but there are multiple sick people coming in one after the other after the other or a dad or a mom bringing in a sick child with maybe multiple kids. So it’s not even a situation where you have a one at a time and Okay now I’m done and I can move to the next one you might have a line of three or four people. We have our front line, what we call our patient access rep, checking people in and they’re the front face of the organization. And so if they are not educated and trained properly on how to negotiate those interactions, then oftentimes what we see is the rest of the visit is what we call sort of managed down. So, before they even get back into that room, that first impression that they’ve had, if it has not been a positive one, will really impact the overall interaction that they have with his or her physician.
Vincent M. Wales: I think one of the most common areas where this is going to be the case is in the emergency room when the doctors there are not necessarily trained in how to deal with psychiatric patients. And I know that several years ago the Hospital Corporation of America collaborated with NAMI and they put together a training video called Competent Caring: When Mental Illness Becomes a Traumatic Event, because a lot of the people who get into an emergency room when they’re having a psychotic episode or something, you can’t treat them the same way that you would a normal patient. It just won’t work very well. And so it was a really really good video that they did and showed how easy it is to do things wrong with a psych patient.
Gretchen L. Ramsey: I’m glad you brought that up because specifically at Geisinger Holy Spirit, we recognize that too and so we picked up that same cue and very simply so our hospital administrator team decided to in fact build congruent to the reception area of the emergency department a completely separate intake area for those patients coming in the front door that presented in crisis, whether it was voluntary or involuntary. Because what we were seeing is so you know I have two humans that I’ve created and hopefully I’m doing a relatively decent job. One is 15 and one is ten and a half, and when I would take either one of them in, oftentimes you know it’d be late at night, you’re not feeling well, but you’re watching a person who is in mental crisis also walk in. And so in addition to trying to help your child, or your loved one, feel a little bit better and try to comfort them you also had somebody that was sitting right beside them that was in mental health crisis. So what we did is we built a separate intake area for those patients and we built it with the idea of being a bit more compassionate, a bit more inquisitive about what level they may be presenting at. And then we trained our really fantastic emergency department staff to be able to handle that and really be empathetic about the patient and the family members of the patient who may or may not be with them at that time.
Gabe Howard: I really like what you said there about how you’ve got a person in crisis and they’re impacting the people who aren’t in crisis. And the example that you used is you know you with your tiny humans right in the emergency room and because you felt uncomfortable and you felt uncomfortable and therefore you were worried about your child and what we’ve seen in psychiatric care is that burden almost always falls on the person who’s there for psychiatric care. You know, why don’t you calm down? You know, you’re scaring people, stop? You know we hear this time and time again and it just becomes this feedback loop. You’re in the emergency room because you can’t calm down because you’re presumably not in your right mind during crises. And then the people are yelling at you that you’re making people nervous or they’re afraid of violence and you need to control your behavior. You’re in the emergency room because you can’t control your behavior. And everybody thinks that is the reasonable thing, and it falls apart really quick because of everybody’s basic misunderstanding of what mental health crisis looks like. So now the person who’s sick has two problems. The problem they showed up at the emergency room for, and this problem of trying to make people comfortable while they’re sick and it sounds like your hospital is working to prevent that and educate people so that the end of the day the psychiatric patient has a much better chance of having a better outcome. Is that correct?
Gretchen L. Ramsey: Yeah absolutely. That’s really our main goal and as I’m probably sure you won’t be surprised to know that psychiatric inpatient unit in local hospital they are at capacity and so.
Gabe Howard: They lose money hand over fist. Not only are they filled up but they’re not even loss leaders. That’s I’ve heard somebody say well, it’s a loss leader. No it’s not, the psychiatric patient doesn’t come in to buy the pop and then leave with potato chips. It’s just loss all the way around and this makes people upset.
Gretchen L. Ramsey: It does. So that’s it. And you have to find ways all around this? And oftentimes you know what will happen is and recently I was actually walking out to my car which I walk in front of the emergency department every day to do and just happened to be leaving and it was a beautiful fall day and there was a family that was standing there and all of a sudden I just saw that young woman drop and she started to hang on to one of the concrete barriers that we have in front of the emergency department. And she just wasn’t going to get up. And you know long story short she worked in a nursing home and had never taken a vacation, hadn’t taken a vacation in six years.
Vincent M. Wales: Oh my God.
Gretchen L. Ramsey: Very young woman, very motivated and her mom and dad would say that, it’s her mom and dad were standing there. They had brought her in because she was just so exhausted and just so immediately evident that they were exhausted and she was exhausted and it turned into a bit of an incident with multiple people there. And as soon as the police are showing up you can see that she is agitated but our staff at Geisinger Holy Spirit, both in the emergency department, and in behavioral health crisis department just came out and surrounded her and it was a scary thing but it was also a very beautiful thing to watch. Particularly as the director of patient experience to watch staff be able to engage with a patient who is so deeply in crisis. And is just physically at the brink of physical exhaustion and cannot and is not capable of making a proper decision. But just to wrap around that patient that’s just something that you know when we talk about what motivates me to come back to work tomorrow. That’s the thing. And I think about that quite a bit and actually followed up with that family and that young woman is doing very very well. But I think at the moment of watching that her family was watching that too. So and they weren’t in even though they were in crisis. They’re going to remember that compassionate care that our team provided I think at Holy Spirit, and I think again that’s really what motivates me to come back every day.
Gabe Howard: That’s wonderful. Thank you.
Vincent M. Wales: So how does the work itself affect you? This kind of work has to be difficult on the patient experience professional too, right?
Gretchen L. Ramsey: It is.
Gabe Howard: Because you’re in charge of everybody. You get the complaints from both sides.
Gretchen L. Ramsey: Right. So I often say we’re a Catholic hospital and I keep telling people you know wine is the blood of Christ. It’s in the Bible people. And if we could just have some dispensaries around the hospital, I think it would really help everybody just all the way around. But in addition to a good glass of the blood of Christ when I get home, one of the things that really strikes me in my everyday work is you know when we’re looking at people the first question I have for them now is where are they on their Maslow’s hierarchy of need? You know when we think of the physiological need of food, water, and rest that’s really where I sort of I come back to my own pyramid because I realized that I can’t stay up until eleven thirty or five o’clock either on social media or watch my favorite baseball game. And so you know that later at night. We really need really good rest because that mental recharge that I think we all need and then really what I’ve started to do in the morning quite frankly gentlemen is I feel like at the moment my eyes open up people are asking me questions. So my tiny humans are constantly asking me something or my husband, who is fantastic, is constantly asking me something but I realize that that’s the trigger because I’m constantly solving problems. And so I need about an hour before I really get into my day. So I’ve really started taking that as getting up about an hour before I really need to get ready and just to do some silent reflection to do some devotional reading and just to reflect on the day before and the current day ahead just to get a mental checklist prepared so that I can be more successful and I’ve seen a great amount of success with that. Maybe a little bit more than two or three glasses of the blood of Christ. Thanks for asking.
Gabe Howard: We’re gonna step away to hear from our sponsor. We’ll be right back.
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Vincent M. Wales: Welcome back everyone. We are talking with Gretchen Ramsey about how to improve the patient experience.
Gabe Howard: I love that you brought up Maslow’s hierarchy of need and for those who don’t know just a real quick synopsis of that is, it’s this idea that people need more than one thing in order to be well. Specifically in psychology or mental health circles it’s all fine and well to have somebody have you know the correct medications or to have somebody be able to see a psychiatrist or a medical doctor and get the care that they need psychiatrically, but of course if they don’t have food or they’re homeless or they don’t feel safe, the medical care is only going to go so far and that’s a really bad explanation. You should probably Google it. But in general it’s just explaining that people need more than one thing and one of the things that you described is one of the things that people really really need that we’re really poor at giving ourselves is self care. Because we think that self care is actually pronounced selfish care. If you’re worried about yourself, you’re therefore not worried about your spouse, your tiny humans, your friends, your job, and therefore you’re lazy. But of course we’ve learned that if you don’t take care of yourself, you don’t have the internal fortitude to help others, so you tend to help them more poorly. Now am I explaining that correctly?
Gretchen L. Ramsey: No, Gabe, I think you really you know are on to there is something that it’s not only can you not function properly, you can’t again negotiate those situations you know come back to that idea of how many people are in front of you. You can’t take care of yourself. There’s no way that you’re going to be able to really give patients the vibrant experience that makes them feel like we are glad that they are here. And it’s a privilege to be able to take care of them. One of the things that I really started to hone in on is when I am working with staff, it’s a lot of behavior modification. So it’s first step of it is really just to educate them on the survey instrument that we use to give to the patients. And I would say it’s an open book test, that we’re giving you the test and I’m going to help you study. I’m going to give you the answers but what happens is oftentimes you realize that somebody’s pyramid the staff person. You know we think so oftentimes maybe it’s the patients who are coming in the door that may not have clothing and food and shelter. What I quickly realized as I worked the first few months on in this capacity, is it’s not just the patients, it’s our staff. It’s really our staff. I had a situation not that long ago where I was working in one of our family medicine clinics and somebody pulled me aside and said You know I think so-and-so may have gotten evicted. And I said why? And there was evidence that perhaps the staff person was living inside the clinic with her two tiny humans. And so it immediately snapped something in my brain to think here I am coaching this staff person, and if she had a tendency to be very quick with the patient, she would hang up if the patient was the patient for disagreeing and then all of a sudden I thought to myself It is no wonder, if she is worried about food insecurity shelter and where are we on that Maslow pyramid? So that’s my new approach. Interestingly enough to coaching and training and educating staff regardless of whether they are maybe an entry level patient experience representative or if they are a physician because a lot of times then you on the other end of the spectrum a physician who may be very stable at the bottom of that pyramid with their physiological needs being met now may be in the center of that pyramid where there may be some esteem issues or maybe they are striving to feel loved and connected in community with one another in some way. And that’s a barrier oftentimes to a patient experience because if they’re too friendly, then we know what can happen, and patients can get the wrong idea. And if they’re inactive, then I always say you know with the patients we’ve got to unlock that empathy box. So it’s a really interesting concept that I have been very focused in on and it has I think helped me become a stronger professional in terms of let’s figure out where they are. And then we can figure out how to coach educate and train them.
Vincent M. Wales: I just want to mention real quick that this sort of thing does not apply just to professionals. If you are an in-home caregiver for a loved one, for example, you also have to take care of your own needs before you can effectively maintain your relationship with them.
Gretchen L. Ramsey: And that’s a great point.
Vincent M. Wales: Well so what I would like to know is what’s the most challenging part for you of this job?
Gretchen L. Ramsey: I think it’s figuring out where they are. I think it’s figuring out where the individual or the staff member is on that pyramid. So you know I could be talking to a physician who has had 20 plus years of education and try to dissect it and figure out OK how can I help him or her the best? Because usually when they see me show up, they know that there is something amiss. But right now I think that’s the most challenging part of my job is just trying to figure out the best way to give staff and the best techniques for de-escalation of sometimes very vitriolic patients. And we could be talking about a staff person who just graduated from high school or you know we could be talking about maybe it’s a medical assistant who has had 18 months of post-secondary education. But how do we safely and effectively train them to de-escalate patients, when you both know oftentimes, it takes years and years and years of education to be able to do that properly and the people who do have the privilege to work with our other mental health patients and our patients who’ve gone to school for a very long time. So how do I condense that training right now? In today’s society and give that to the frontline staff? I think that’s one of the most challenging things that I’m currently faced with.
Gabe Howard: One of the things when you’re sort of describing your job and like the actual nuts and bolts of your job it sort of reminds me of human resources like they’re just trying to get management and employees to get along and to make sure that everybody follows the rules and that there’s no laws broken. Is your job kind of human resources? I mean I think a lot of people understand the role of human resources and you know maybe a lot of our audience doesn’t understand, you know, your role. I mean teaching people how to be nice. That sounds all great and everything. But isn’t that what human resources does? Teaches everybody to be nice? Can you kind of compare and contrast that a little?
Gretchen L. Ramsey: Yeah, that’s a great point and I think that the patient experience, the role of patient experience is you know it was born of the concept of the Center for Medicaid and Medicare Services starting that survey instrument in the early 2000s and then going public with that reporting the findings from that first instrument in 2008. So I think the patient experience department, depending on what hospital or organization you’re talking about, may right reside in the human resource space that also might reside in the clinical space. But a lot of times that is what it is. I have a very close relationship with our human resources team. They have great relationships with our staff, but a lot of times I do have to collaborate with them just to say you know where are we with this person’s performance improvement and what is it that we can do to better help it and train and educate them? Additionally, working with our organizational development group and that’s our group of trainers that offer systematic training throughout the year on different subjects. A lot of times I’m going in and giving bits and pieces of those training. But I’m realizing the whole department could benefit and listen to and hear. So it is very human resources. You know it is a lot of behavior modification and management. But the bottom line is my job is really just to make sure that the staff understand how their interactions are being perceived by the patient. We know that that may not always be the case. When our surveys go out if they go if a patient is randomly selected to receive a survey by paper it would be about two weeks after the interaction. So they’ll get that paper survey in the mail. But if they are randomly selected to get the electronic version they’ll get it within the first 24 to 48 hours. So you can imagine which one tends to be more favorable. The ones that come in via the Internet are the ones that really tend to be a little bit more volatile because the experience is fresh in their mind. The more favorable ones happen to be the paper ones because a lot of times when you’re writing comments you actually have to take a good old fashioned pen, and you have to hand write those comments. If you want to give somebody a compliment, or if you want to really make a suggestion for improvement, or you have something negative to say, you have to write that out. So it’s my job as sort of in the middle of all of those spaces and I think that’s just what makes that type of work interesting because it’s not necessarily defined in one bucket or another but clinical or human resource or organizational development it kind of spans those chasm.
Gabe Howard: Thank you. Thank you for explaining that. We really appreciate it.
Gretchen L. Ramsey: Yeah. No problem.
Vincent M. Wales: So, Gretchen, where do you see this experience going? Do you see it evolving into bigger and better things? What’s on the horizon?
Gretchen L. Ramsey: Thanks for asking me that, Vince. I myself I really think that it is really heading down more of a psychological path that right now I think that if you would look up a job description for a patient experience director, many of them would require a nursing degree. They’re looking for that registered nurse or an R.N. because the idea is clinicians can train clinicians. I actually happen to have a non-clinical background. With our leadership team at Geisinger Holy Spirit thought was a good fit because now I have the lens of a patient. I really see this profession going from a place where they require, you know, in many cases, where they do require an R.N. and I can see it evolving to where they would actually require a degree in psychology because it truly is at the end of the day about getting people to change that behavior and break that cycle into something from a negative to a positive. I think in a recent podcast you interviewed Dr. Judd Brewster and I heard him call addiction, how did he say that? I think he described it as “the continued use despite adverse consequences.”
Vincent M. Wales: He’s right.
Gabe Howard: Yes.
Gretchen L. Ramsey: You say you know when you ask about the human resource space, I think that’s one of the challenges is if a person is treating a patient the same way and it’s having a negative impact and we can’t do anything to change that behavior. Then that really just becomes, OK, I’m at the end of my rope and I’m not sure what’s next. Oftentimes I find myself thinking, boy if I had a background in psychology perhaps this maybe this would have been more beneficial and to the point where I’ve even considered if I would ever go back to get a PhD. Which I think then I’d need a lot of blood of Christ if I have to figure something out because of my tiny humans. That it would probably be a PhD in psychology because I really see that’s what I believe is going to be the future of the director of patient experience.
Gabe Howard: That’s wonderful. Gretchen, thank you so much for being on the show. We really appreciate having you and it just shows you that we have a lot of work to do in the fact that this is new. I imagine the medical staff has been complaining about patients and patients have been complaining about medical staff for decades and this is a relatively new thing where we’re trying to bridge that gap and get everybody on the same page. I think what you’re doing is admirable and wonderful and I hope it spreads across the country and the world.
Vincent M. Wales: Definitely.
Gretchen L. Ramsey: Well thank you, and thank you for your great work to to get this topic out in a fun and easy to understand and digest it. It’s great as a professional to have those resources on you and your 30 minute commute. It’s nice to listen to something else than just talk radio.
Gabe Howard: This is perfect. You know if your commute ever goes to 35 minutes you’re gonna be in trouble. But if it ever drops to 20 you just make sure you drive the same route and you’ll be fine.
Gretchen L. Ramsey: Every time, yep.
Gabe Howard: All right. Thank you, Gretchen, and thank you everyone for tuning in, and remember you can get one week of free, convenient, affordable, private online counselling anytime anywhere just by visiting BetterHelp.com/PsychCentral. See everyone next week.
Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].
About The Psych Central Show Podcast Hosts
Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.
Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.