How To Vastly Improve The Experience and Outcomes of Hospitalized Patients
Managing the User Experience of a Traumatic Life Event
I’m writing this to express my opinion that our medical establishment needs to pay more attention to the mental state of patients, as it is at least half of the recovery process. It is not enough to operate, medicate, monitor and repair a person’s physical being, at there we are missing a grand opportunity to advance healthcare. I’m a software designer. Today one of the big initiatives in that industry is the realization that it is not enough to make a full featured program or that you have a logical interface. Now, the big push is on the User experience, the UX. Our doctors and hospitals would do well to learn from the softies the principles and subtle but significant ways the mind reacts to its environment and challenges from without.
Three weeks ago, I underwent a rather surprise open heart surgery. I knew I had a heart murmur from early childhood, but the doctors always said I was in apparent good health and that we’d just keep and eye on it. I’m now 67 years old and still in otherwise good health.
Several months ago, I began to experience a slow decline in my stamina and strength. I wanted to sleep often, sometimes three or four tines a day. After a series of attempts he concluded that it could be my heart, so he ordered an ECG and saved my life. Turns out I had a AAA, Ascending Aortic Aneurism and a bad heart valve that was barely opening. I was scheduled for open heart surgery.
Our city’s St. Luke’s Health System is one of the best and I have to say how impressed I was with their precision, thoroughness, cross-checking and deep professionalism. Everything they did medically as first rate, they made no errors that I know of and, when I had a stroke immediately post-op, a special team swept in to quantify, relieve and clear the clog causing the stroke. I recovered almost completely from it, a fact that my surgeon called “amazing” from the complete left-side debilitation I was in.
All went well medically during my surgery and in the weeks since. I’m still at home recovering and will be for at least a couple more weeks, slowly regaining strength, improving my breathing, balance and vision through intense physical therapy. I said medically it went well. Mentally was another story.
I’ve been hospitalized seven times in my life for mostly minor surgeries and accidents and each time I noticed that I soon developed a nasty depression, which I’m sure is normal as the body devotes maximum resources toward repairing itself, leaving perhaps a deficit of energy for general brain functions. Also, you’re being treated with a barrage of drugs whose side effects, especially in combination are not easy to predict. Some people react opposite the predicted way. The last two times I was hospitalized over several days, 10 days this last time, and that is where the real trouble started.
I began to have random, ill-defined hallucinations. Smells became much more intense, first the linen smelled like cleaning solvent, then I for a breakfast tray covered with a plastic cover that smelled like fish, dead fish, and thereafter I could not get that smell out of my head. It impacted my already-impaired appetite. Then I began to dream about the fish, a big cat fish with a massive head, rising out of a river and trying to draw me closer. I couldn’t shake it; indeed, it was home foe several days before it finally began to abate. By the time I was finally released I was all but begging them to let me go home, to get away from all the negative and powerful mental collateral of that hospital.
IMPROVING THE PATIENT EXPERIENCE
I’m certainly no expert other than have experienced some of the negative effects of body trauma and hospitalization. My suggestions should serve as a small contribution, a starting point for actual experts in these fields to step up, coordinate efforts and develop a first draft plan to focus on what the hospitalized patient is undergoing, their reactions and ways to mitigate and improve that experience.
I believe that tending to the patients state of mind could yield significant improvements in recovery rate and the percentage of successful outcomes. So, here are my suggestions, in no order.
1. Preparing for the hospital
There is no way to be completely prepared for you hospital stay unless you have Been there, Done That. And, if you have BTDT you are mot likely quite resistant to ever doing it again, especially for any length f time. I never want to go under the knife again and will aggressively seek other options first.
My surgeon is one of the most impressive people I have ever met. He did more to prepare me for it when we met a few days prior to my operation. “You’ll go through two days of hell and six weeks of misery”. Three weeks along, I’d say he nailed it. But people should also be warned of the possibility of paranoia, depression, hallucinations and how to ask for help. Just saying that those things are common does little to relieve the patient of a deeply troubling state of mind.
The bed you will be in is likely designed more from the perspective of the medical team, allowing them easy access to you and safely confining you. They don’t forewarn you that many people experience the beds as having poor lumbar support, resulting in a nagging backache.
You should not expect more than a pill from the nursing team either since they are really swamped and cant take time to rub your back or use a vibrator massage on you, even if you bring it. That backache will occupy more and more of your mind. Even if family member step in and try to help and even if the nurse gives you a Tylenol, the bed is not built for restful sleep and you will be continuously re-injured as long as you sleep in it.
Of course, it won’t take long before someone tells you that the recliner next to the bed, if there is one, is actually more comfortable to sleep in, assuming the medics permit. But, most of them are constructed of sharp-edged wood with thin padding and plastic or fabric over that. Some of them have hard wood arms. The sharp edges of those boards cut into your legs, feet and elbows until you defend yourself with pillows and blankets. Even then, it is also probably not designed to decent lumbar support and your aching back will continue to nag. Its hard to get a good night’s sleep in a hospital, never mind the beeping and frequent vitals checks.
MY RECOMMENDATIONS FOR HOSPITALS
Rather than getting into any pretense of Cost/Benefit analysis about whether improving the patient’s state of mind will result in shorter stays, less reluctant returns and overall Better Outcomes, lets assume there is a fair case to be made for it. If these really are good ideas the insurance companies will likely get on board. Many policies already cover some alternative therapies like acupuncture and hypnosis, but the policy holder may not be aware. Insurance actuaries are not fools.
Demand better beds — the one I was in supposedly was packed with sensors and cost $15k. It didn’t hold a candle to my $800 Sleep number bed.
Try napping in a recliner before you order 200 of them.
Implement massage therapy, aroma therapy and color therapy. Fragrances and music are very powerful energies than can uplift or depress with equal ease. https://elemental.medium.com/the-science-of-aromatherapy-753717d5a4b3
Pay attention to air quality. Fresh air can be a breath of fresh air. Get the patient out in the courtyard or under the portico once a day to get air and sun. If you clean your linens in industrial solvent, make sure they get rinsed thoroughly.
Ensure that the cafeteria thoroughly cleans the dishes. Not just for germs but odors too. Last night’s catfish dinner can be someone else’s breakfast nausea. Consider hard plastic dishware instead of the softer stuff that can absorb odors. Remember too, odors are particulate.
Some people would benefit from traditional religious support, but others might appreciate some alternative spiritual engagement.
The TV probably gets 150 channels, of which the majority are mind-numbing crap. Treat the patient’s TV as an extension of the elevated Patient Experience. Put things in it that Engage the idled mind. Content that stimulates interest and takes them away from their misery for a while. Indeed, the television could be a basis for some of the therapies like Music and Spiritual programming. Documentaries, History, Science, Technology all have so many interesting stories to tell. I would, at the same time minimize News and Mainstream Entertainment because, after all, we are trying to improve their state of mind. Pay attention to the TV.
My hospital room was nicely appointed, especially with inset medical technology. The remainder was treated with a Gray and Toad Green wallpaper, for some reason. Much has been discovered by the softies related to color combinations and how they affect people. Hospitals would be wise to access this wealth of study to provide an overriding impressionism of mood, stimulus and well-being to the suffering patient.
Encourage patient and their families to bring in outside food since it will almost always be better than what’s on offer in the cafeteria. Coffee too. Few things can lift your mood like a plate of your most favorite food and treats, medics permitting, of course.
MY RECOMMENDATIONS FOR THE SOON-TO-BE PATIENT
Read up on what to expect. Most hospitals of doctors have tip sheets. Know what you can and cannot do (like bring in your own coffeemaker or back massager).
If you have any kind of chiropractic issues, schedule a visit or two before you go in to the hospital. It could make the difference between several days of inconvenience or misery. Likewise, haircut, nails, etc. since you may not be going out again for a few weeks.
Ask to inspect a clean patient room. Sniff a lot, esp the bedding. Ask if you can bring your own memory foam pad or bedding if the standard stuff does not meet your minimums.
Enlist the help of family in case you need someone to advocate for you. This can be very important if you slide down that long dark corridor of depression and hallucinations or will be under powerful drugs.
Everyone’s different but I hate hospitals and avoid them like the plague. Many friends and family wanted to come visit me and turned them all away. I was imply not feeling like visitors, I’d rather sleep.
I told everyone, No Visitors Please for the first several weeks. If you want someone to visit, you can call them. And, unless it is a real serious situation, I think it is abusive to ask someone to stay with you. They will not be able to get very comfortable, they’ll want to go home, clean up and sleep in their own bed.
Post-op and on release, don’t hesitate to ask what each med is for and if they have been checked, as a group, for negative interactions. Understand the likely side effects. Doctors must practice Defensive Medicine to ensure that they don’t get accused of negligence for not prescribing Pill X on the outside chance you develop Dengue Fever or whatever. I went home with over a dozen prescriptions and soon came to realize that I was never going to crawl higher than the nap of my carpet if I kept doing that. I asked my pharmacist to check for interactions and one pill greatly amplified the effect of two other pills causing a strong sedative side effect. You are the person most responsible for you so use your head, watch out for yourself and good luck.
Doctors and hospital, heed my call and hue. Investing real thought and some money into uplifting the Patient Experience will pay off in better outcomes, less reluctant returns and happier referrals.