How to make the most of limited time to address your most difficult challenges
One of the most valuable tools is also one of the most basic: time. Learn insider tips on using time wisely to set your patients up for sustainable success.
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Time, that most basic of commodities, is the most important and all-encompassing tool you have when you’re treating patients with COPD. There’s no question that successfully treating a range of unique individuals struggling with complex chronic conditions demands a significant time commitment. But for most providers, time is precious and scarce. That’s why today’s leading care teams employ smart strategies to make the most of their limited time. They spend it well—actively observing, listening, empowering, making sure their patients understand them, and making sure they understand their patients. This upfront time investment is pivotal to targeting care and reducing COPD readmissions down the road. Read on to see how you can start applying these strategies today.
Any relationship of any kind needs time.”
Roberto Benzo, MD, MSc
Motivational-Based Health Coach
Contributors
Chikita Mann, MSN, RN, CCM Disability RN
Case Manager Supervisor Genex Services, LLC for the State of Georgia
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager Department of Respiratory Care at UC Davis Medical Center
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Roberto Benzo, MD, MSc
Motivational Based Health Coaching
Vernon Pertelle, RRT
President and CEO StratiHealth Management Consultant for ACOs
Make the most of: time spent observing
It’s easy to take the little things for granted. For example, mastering the use of inhalers may seem like a relatively easy task. But taking the time to observe often reveals otherwise. A recent study found that “incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years.”1 A similar situation can arise when durable medical equipment companies arrange to simply drop off oxygen canisters or other devices at patients’ homes, with inadequate consideration given to follow-up and education.
Well, I think that one of the things we found with our PCRC project was that we had our teams going out to the homes. We saw more oxygen canisters in corners with clothes on top of them than we can shake a stick at. We also saw CPAP devices that were being used as hangers too. So I think that there's a lot of technology that patients resist and then the question becomes, why do they resist it?
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
We really assess the patient to find out what they've tried in the past and what didn't work for them and why. Sometimes they're on a great medication regimen, but they're saying it's not working. And then we watch them take their inhaler and we see that they weren't shown the proper way to do it.”
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCal Davis
Krystal Craddock adds, “We make sure that when we are ordering something for our patients, we're choosing the best company that’s really going to take care of them, go out to their homes and do the education. Oxygen therapy is important, and the patient needs to understand how to use it and why to use it.”
Make the most of: time spent listening
There are any number of reasons why lack of adherence is a challenge with COPD patients. But there’s only one way to find out what’s holding a patient back: to listen and truly understand what’s going on in that patient’s life, and in that patient’s head.
Better listening techniques
Remember that hearing and listening aren’t the same thing. True listening is about trying to understand the other person’s values, thoughts, and attitudes.2
Tips for healthcare professionals who want to enhance their listening IQ:
Watch your nonverbal cues and body language. Make eye contact, sit down with the patient, and don’t cross your arms.
Pay attention to the patient’s nonverbal cues as well. Be sure to notice if they appear to be in pain, or show any signs of anxiety.
Do not multitask. If you need to write something down, let the patient know you’ll be taking notes to assure you accurately reflect what they’re saying.
Wait until the patient is finished speaking to respond. Don’t interrupt or speak over the patient.
Use appropriate touch if the patient seems upset. This conveys empathy to the patient and family members, and builds trust.
Ask clarifying questions. This not only ensures you understand the full picture, but also lets your patients know you are interested and are listening carefully.
I mentioned earlier about time to spend with those patients. I'm lucky at my health system to be allowed the time to get and spend an hour at the bedside with my patient during the day, which is huge, because you want to build a rapport with that patient. Our hospitalists are busy, running around, seeing so many different patients admitted for so many different things. And they really work well with us and really depend on us now to be able to give their patients our time, to learn about their disease, and their home life, and their social situation, and their abilities—what can they do, can they take care of themselves at home, are they able to get transportation to pulmonary rehab. And so, with our patients in that spectrum of hospitalizations, we do have teams devoted to helping care for that whole patient.
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCal Davis
Make the most of: time spent empowering
People with COPD often feel overwhelmed and powerless. They may even be inclined to give up. To succeed, care teams must spend the time needed to engage patients in their own care.
Let's face it, COPD is a disease where to a certain degree, the patient may feel like, ‘I've lost control of my life.’ Let's find a way to give them back control. Once we start to do that, I promise you, we're going to see results that are out of this world.”
Chikita Mann, MSN, RN, CCM
Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Motivational interviewing is a technique that uses four guiding principles (represented by the acronym RULE) to enhance patient motivation and help empower patients to change their behaviors3:
Resist the righting reflex
Understand the patient’s own motivations
Listen with empathy
Empower the patient
I am so in awe of the power of motivational interviewing to make a difference in the lives of these patients. I've seen so much transformation with patients that are charged with these self-management burdens, overcoming them just by having the power of tapping into their own value sets.”
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
By taking the time to empower your patients, you gain back significant time in fostering their ability to self-manage and remain healthy at home.
People are resourceful. If we give them the opportunity, they know what works and what didn't work in the past. People are experts in their own life, like us. So, patients are not different than anybody else. So, you give the opportunity to really bring up the situations that people have in their life, and how they can address it, what worked before? What didn't work before? What is the next step? It creates a very rich conversation and very important decisions, and people feel reassured that somebody cares. And so, I think patient engagement is critical. It’s a missing piece sometimes in the decision making. So we need, of course, a proper treatment, we need a proper professional, but we need the patient.
Roberto Benzo, MD, MSc
Motivational-Based Health Coach
Make the most of: time spent making sure patients understand you
Health literacy varies greatly from patient to patient, and patients are often overwhelmed, confused, and/or distracted when they’re given instructions. It’s crucial that care teams devote enough time to making sure patients understand the information and instructions they’re given. To fuel COPD readmissions reduction, care teams should also plan to spend sufficient time with patients after they’re discharged.
But the bottom line is if we can develop protocols that can support the ability of those home health skilled professionals to go into the home, they do have the time and the ability to help better educate, continue the education, so that the empowerment occurs, the engagement occurs. And it’s not just the patient, it’s the family members. It’s the spouse, it’s the aunt, it’s the cousin, it’s the dog in some cases, you know. You need to make sure that their dog, whether they’re providing that emotional support to help with that quality of life, is not also causing harm.
Vernon Pertelle, RRT
President and CEO StratiHealth
The discharge process is so critical with the COPD patient. You can't do it within five minutes. You can't do it within 10 minutes. It has to begin the moment that they step in the door. I think one of the things that we're going to have to step our game up in is truly assessing their health literacy. Have them regurgitate back to us: ‘Yes, I understood how to take this medication. I understood the BID is twice a day.’"
Chikita Mann, MSN, RN, CCM
Disability RN Case Manager Supervisor Genex Services, LLC for the State of Georgia
Make the most of: time spent observing
It’s easy to take the little things for granted. For example, mastering the use of inhalers may seem like a relatively easy task. But taking the time to observe often reveals otherwise. A recent study found that “incorrect inhaler technique is unacceptably frequent and has not improved over the past 40 years.”1 A similar situation can arise when durable medical equipment companies arrange to simply drop off oxygen canisters or other devices at patients’ homes, with inadequate consideration given to follow-up and education.
We really assess the patient to find out what they've tried in the past and what didn't work for them and why. Sometimes they're on a great medication regimen, but they're saying it's not working. And then we watch them take their inhaler and we see that they weren't shown the proper way to do it.”
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCal Davis
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Further reading
COPD insider
References 1. Sanchis J, Gich I, Pedersen S; Aerosol Drug Management Team (ADMIT). Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time? Chest. 2016 Aug;150(2):394-406. doi:10.1016/j.chest.2016.03.041. Epub 2016 Apr 7. 2. Dwinal L. Coaching Minute: Why It's Important to Listen to Patients. https://www.studergroup.com/resources/articles-and-industry-updates/insights/august-2017/coaching-minute-listening-to-patients 3. Hall K, Gibbie T, Lubman D. RACGP. Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. 2012 Sep;41(9):660-667.
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