The Caring Equation: Is There Anything Else I Can Do For You Today?

Paul Levy is a former hospital CEO who writes at “Not Running A Hospital.” This piece was first there on May 16, 2012, titled “Caring = f(Σ4.5seconds x constant)

Dr. Susan Shaw, a critical care doctor in Saskatoon, decided to conduct a clinical trial.  For this one, though, she used the Lean PDSA cycle:  Plan, Do, Study, Act.  It required no IRB approval and could be replicated by any doctor out there.

What was this?  She was inspired by Liz Crocker’s talk at the provincial Health Care Quality Summit a few months ago, and also by a story told by Bonnie Brossart.  She wondered how much time it would add to her work day, and what would be the results, if she asked each patient a question.

Her summary of the trial was recently posted:

Plan: For one week, at the end of each bedside round, ask the patient and/or the family “Is there anything else I can do for you today?”

Do: Do and describe what happened. I chose the following measures: how much time asking and answering the question took, how many yes’s how many no’s and what additional questions and requests were asked.

Study: Analyze the results and determine what you learned.

Act: Adapt, adopt, or abandon the change based on what you learned. Then complete the cycle testing out another small change.

Here is a description of the protocol employed:

I didn’t use any fancy data collection tools. Just a pen and a piece of paper that I carried in my back pocket, along with some additional attention paid to the clock on the wall. And I wrote down the answers to my question, which I asked 87 times over the course of one week.

And, finally, the results:

What did I discover?  Asking “Is there anything else I can do for you today?” added an average of 4.5 seconds to the length of the time I spent rounding with each patient

Asking this important question did not slow me or my team down. I did not get asked any difficult or awkward questions. I felt like I made a stronger connection with the patients and families in the ICU. And I liked that this simple question provided a sense of closure to the round while signaling to the patient and family that we truly were interested in helping and supporting them.

I also smiled a big smile when I overheard two of the four residents working with me that week asking the same question of nurses, patients, and families when they were working at the patient’s bedside.