Renewed Perspective Comes from the Heart
There’s nothing like a random epiphany to put things into perspective when you least expect it. I was fortunate enough to witness such an epiphany when I was asked to be a speaker at the annual Center for Medicare and Medicaid Services (CMS) Regional Office Stakeholders’ Conference. The conference brought together groups from CMS, survey agencies, quality improvement organizations, End Stage Renal Disease (ESRD) networks, ombudsman programs, and representatives from hospitals, nursing homes, and home health associations. The theme of the conference was “Transitions of Care and Patient Safety,” with an aim toward improving the quality of care that is delivered in health care systems.
Having taught various programs and topics for close to two decades, I recalled one of the Eden Alternative ® philosophies involving cultural shifts within organizations: You can’t move people to action unless you first move them with emotion; the heart always comes before the head. It is from this springboard that I crafted my intensive about improving quality of care, and how I have always tried to create operational and cultural shifts within organizations.
As I began my program, the room became charged with palpable energy, participant insight, and enthusiasm as we spoke about and the group took part in providing wonderful examples of what creates a meaningful life, a sense of purpose, and why geography does not change who we are as people.
This progressed into the renewed perspective that no matter where people receive care, we cannot expect individuals to change who they are merely because they have patronized our businesses temporarily as a patient, or permanently as a resident.
Think of it this way: in our often futile attempts to instill conformity, we get consumer pushback, as force will always be met with force, or what we like to label as non-compliance. Rather, we need to create environs that allow individuality and expression, while meeting the various regulations; a relationship of symbiosis, not totalitarianism. This also means including those (or their responsible parties) that are on the receiving end of the services we provide to be a part of the conversation when we come up against a roadblock -- knowledge is power. It was clear that the attendees readily understood, and could relate to, the mantra of the intensive: Renewed perspective comes from the heart. To really understand a situation, it is best to view it from the other’s perspective while being empathic in seeking first to understand. And while this all makes logical sense, it is, at the very root of genuine human caring, the way that all human beings deserve to be treated, regardless of conditions or frailty matrices.
With that in mind, I want to share with you the heartfelt story of Mrs. A, a nurse administrator who attended the conference, and the random epiphany that she experienced that enabled her to put things into a renewed perspective:
“A few months back my 76 year old mother endured an unfortunate left shoulder injury requiring surgery. Prior to her injury she was very independent (and all that implies…chuckles), drove, volunteered, and was very active socially and physically. A widow for the last 10 years, she has not allowed her grief to keep her from doing what she loves; helping others. After purchasing a few items at a grocery store for an ill neighbor, she was rushing in inclement weather, lost her footing, and fell in the parking lot. Prior to her discharge, my family and I rearranged our schedules so that there was someone to stay with her during her recovery, and I was the one in charge of ensuring she had home care services in place to avoid having to place her into a facility to convalesce.
We were in for quite a ride in having to navigate the various systems, appointments, insurance coverage processes, and therapy needs. The irony for me was that this was a system I thought I knew well as a 25 year veteran of the ‘business’. My family and I quickly became overwhelmed and on the whole did not find staff to be very kind or helpful. As a result I found myself thrust into the role of a fierce advocate as the following scenarios played out over a very long 6 week period: Therapists would tell my mom that she could do (x) if she would “just try harder” or “put her mind to it.” Nurse after nurse would talk to me or my siblings about what was going on with my mother while completely ignoring her. Staff wouldn’t show and we would have to call the agency only to be told that they were, “Running late and should be there within the hour. If they’re not there then please call us back.” They couldn’t call to let us know the staff member was running late? And my favorite: during an exercise my mom complained of pain and the therapist said, “Try and push through it,” at which point I felt compelled to intervene. I was later advised during our ‘private’ exchange that at this point in her recovery, she should not be in this much pain, and this person felt that it was a form of manipulation so that she wouldn’t have to do the work.
I called the agency that day and requested that the therapist not be permitted to continue on the case. What would have happened if I wasn’t a witness to these things? How would she have felt if day after day this was how she was treated? What was later discovered is that my mom hadn’t taken her usual analgesic prior to therapy. We would usually remind her, but she had been so good about it, that I didn’t remind her that day; then I felt horrible, but the sad thing was, not one person, including me, thought to ask or think of that possibility.
Overall, the staff treated our mom as though she was invisible, and her utterances fell on deaf ears; she was in fact dismissed as being a cantankerous, non-compliant patient. I can’t say that I blame her; under the circumstances, I would have done the same. Then I felt ashamed, really ashamed, because I know I’ve been that nurse who has felt that way about a patient I was caring for. I’ve also had staff that reported to me indicating they were exasperated over a particular patient that, “Just wouldn’t listen…” and they were looking for advice on what else they could do because, “nothing was working…”
Now as I sit here today, I wonder what we were missing, or how we could have functioned more as a caring resource and not responded with a canned bag of regurgitated rules, policies or biased opinions. Your talk today made me remember why I got into healthcare to begin with: To make a real difference in the lives of people every day, to know that their lives are better in some way because of the assistance I provided, the directives I shared, or the encouragement I gave to them or a member of their family. Somewhere along my career, I got lost in all the politics and regulations and forgot about the person.
With my mother’s recent situation, your message today has really hit home for me. I was no longer acting in the role of employee but the consumer. I can't imagine her (my mother) being in an environment, or God forbid living in a place, where she is made to feel dismissed, has limited choice, unfulfilled days, meaningless activity, and a mundane existence. It just isn't acceptable, it shouldn’t be allowed, and frankly, I'm emotionally distraught thinking about just how badly the system is broken. We have to do better! We can do better!
Thank you for reminding me of what I am made of, where I come from, and why I chose the career that I did. This has been the single most enjoyable intensive of my adult life because it has reminded me about not only being a better care provider, or as you have appropriately recoined it, care partner, but also about being a better human being. I hope your message serves as a constant reminder to all those that attended about why we need to be so passionate about person-directed/centered care. I hope they all go back to their respective organizations and begin to work on how to make things better for the consumer as well as the staff.”
Mrs. A, through connecting with her own humanity, and thinking back upon her own recent experiences of being on the other end of what she had been providing for decades, experienced her epiphany when she made sense of the realization that no matter where we are, we all want to be seen and heard, to be valued and respected, and to be able to be our authentic selves in spite of our condition(s). What I’ve explained to so many over the course of the last several decades is that there is no such thing as non-compliance. This statement was usually met with weird facial expressions, raised eyebrows, scowls, or a distinct look of disagreement. As someone who has spent years working as a nurse and healthcare administrator, I too shared those views and expressions, but what I’ve come to realize is that what we are really experiencing are people trying like hell to execute choice and self-expression when they feel that they have been ignored, dismissed, or don’t understand why they can or cannot (insert issue here).
Dr. Wayne Dyer beautifully captured that how we choose to see situations, or the world depends upon the lens we are looking through. “When you change the way you look at things, the things you look at change.”
What lens are you seeing things through?
With spring upon us, I am reminded of why it is my favorite time of year. Spring symbolizes growth and a renewed sense of beauty as new life unfolds from a long winter’s dormancy. It teaches us that we too are continually evolving, and growing as individuals. Spring forward into your renewed perspectives; those life lessons are all around us when we open or hearts to receive them.
Every day you have an opportunity to make someone else’s day a bit brighter, their week a bit more optimistic, or their worldview a bit more filled with faith that goodness still exists all around us. Work to regularly plant tiny seeds of benevolence which can have a huge impact, even if you never have the opportunity to bear witness to their growth. This doesn’t need to be monetarily driven; it can be a kind word, the gift of your time, or a compliment. You’ll be amazed at how a random act of kindness from one individual positively impacts the lives of others, a region, a city, a state, a nation!
