July 2005 Newsletter

Patient Rights: From Rhetoric to Reality

How well do employees in your hospital bring the language of Patient Rights to life? Every hospital has a Patient Bill of Rights. Although employees probably know this document exists, they may not be practicing either the letter or the spirit of this document. You can use the ideas in this article to help staff make the jump from Patient Rights as rhetoric, to Patient Rights as a reality.

There are several barriers to fully implementing patient rights:

Employees don’t know the rights your hospital is guaranteeing to patients.

Employees don’t take patient rights seriously, and don’t think their managers/administrators do, either.

Employees (and management staff) don’t know that CMS and JCAHO require that certain patient rights be followed as a condition of reimbursement or accreditation. (See the link provided here to CMS website for more information. Choose section 482.13)

People don’t think about how their actions are related to patient rights.

Guaranteeing that a patient’s rights are met is not only a regulatory requirement, it is a strong driver of patient satisfaction, and thus impacts your bottom line. The following are just a few examples of patient rights that are mandated by CMS Conditions of Participation. We discuss a few ways those rights may or may not be fully operationalized in your facility.

The Right to Respect and Dignity

Violations of this right typically occur when an employee is having a stressful day, and/or feels the patient is “difficult” in some way. Examples include laughing at a patient’s behavior or appearance, mocking the patient in some way, sighing or eye-rolling when the patient asks for something, or dismissing the patient’s personal beliefs about healthcare if they do not correspond to our own. While most employees, if asked, would say these behaviors are inappropriate, they still occur in many settings.

The Right to Refuse Treatment

Most healthcare professionals know patients have this right. Yet in our work with hospitals we have heard stories about nurses holding a patient’s arm and insisting a phlebotomist draw blood over the patient’s objections. We have heard of patients being told they “cannot be discharged” unless they submit to a test or procedure. More subtly, how do employees or physicians react when a patient questions or refuses treatment? Do they use scare tactics to convince the patient to comply? Do they intimidate the patient either with words or body language? Do they make the patient feel stupid? All of these behaviors represent violations of the patient’s right to refuse treatment.

The Right to Pain Management

How well does your staff handle this? Do they fail to act when a patient tells them their pain level is a #7, for example, but doesn’t “look” like s/he are in pain? Are they quick to characterize as “drug-seeking” any patient who asks for a pain medicine by name? Are there humane protocols for handling a suspected addict? Do people realize that even addicts sometimes do experience actual pain related to an illness or injury?

The Right to Access to Care

Most employees are familiar with the EMTALA rules prohibiting refusal of emergency treatment to patients, and most hospitals fully comply with those rules. A less obvious form of violating this right is when staff delay providing non-urgent care to patients they feel are less “worthy.” For instance, does anyone ever place a lower priority on caring for a homeless person than is clinically warranted, on the grounds that “He’s lucky to be in here with a roof over his head. He can wait a while.” Any time people delay giving care to a patient based on the patient’s race, disability, lifestyle, behavior, or other non-clinical variable, it is a violation of the spirit of the patient’s right to access.

We suggest you use your own hospital’s Bill of Rights as a starting point to discuss these types of issues. Encourage staff to identify situations where fully complying with a patient’s rights is difficult, and then determine what support they need to become compliant.

We would like to share your questions or concerns about patient rights in future issues of this newsletter. Please write us at awoodw3369@aol.com with your comments. We will not use your name or hospital name without your permission.

A. Woodward & Associates is available to help you assess your organization’s level of understanding and compliance with patient rights, or to help with staff education on this topic. Contact us at 216-631-1852 or awoodw3369@aol.com for more information or assistance.

Upcoming Speaking Engagements

Anita Woodward, MBA, CHE, will be speaking in the following locations in the next few months. Please stop by to visit, and let her know how we can make our e-newsletter more useful to you.

September 15 - 16, Ohio Society of Healthcare Consumer Advocacy, Fall Conference, held at the Cherry Valley Lodge, Newark, OH. For more information, contact Paula Almendinger at OHA, 614-221-7614, Lee Gibbs, OSHCA Program Chair, at 216-692-7888. Anita will provide an update on CMS, JCAHO and HCAPS.
November 4, Alabama Society of Healthcare Consumer Advocacy, Fall Conference. For more information, contact Sharon Beal-Fowler, President at 205-592-1989 or sharon.beal-fowler@bhsala.com.

Real Life Customer Service Case

The following situation really occurred. Consider using it as a case for quick discussions in staff meetings.

An elderly Hispanic woman was brought to the ER by her grown son and other family members. She spoke almost no English. Although she seemed in pain, based on vital signs and the son’s report of what brought her there, the situation did not seem to be immediately life-threatening. The nursing staff and the ER physician communicated with the woman by using her bi-lingual son as an interpreter throughout her visit.

Does staff at your hospital regularly use family members as interpreters?

Is using a family member a good idea? What are some problems with this practice?

Could the use of family members to interpret constitute a violation of HIPAA standards? What about the right to privacy? Finally, what about the rights to information and to make an informed consent?

What resources are available for hospital staff to use for patients with Limited English-speaking Proficiency (LEP)? What about patients with other communication difficulties? Do staff members know how to access these resources?

We all grow when we learn from each other!

Let us know if you find this newsletter helpful. If you have a case study you would like us to include, or if there are certain topics you would like to see addressed, please tell us by sending an email to awoodw3369@aol.com, or by calling 216-631-1852.

About This Newsletter

This newsletter is published for clients and colleagues of A. Woodward & Associates, and for others who are interested in customer service, employee relations, and organizational communication, especially in healthcare organizations.

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