I recently had the pleasure of speaking to Lorraine Dickey, M.D., the CEO of The Narrative Initiative. Her innovative training program is designed to help healthcare professionals remain resilient while optimizing communication between providers and patients through telling stories. After listening to what her company does, I thought this would be a transformative program to implement in the home care industry.
This isn’t a cure to home care’s workforce problems, but it functions as a tool to help you solve problems that are due to perception: What does “quality care” mean to you as a home care administrator versus a new caregiver that you just hired? Do you have that kind of alignment and common understanding?
Healthcare providers — especially physicians — are taught to listen for data and numbers. This is true in home care as well; the numbers we look at are revenue-driven rather than outcome-driven or satisfaction-driven. This shift is starting with the use of value-based care in home healthcare settings, but home care agencies have a long road ahead in terms of data collection. But what does the right “data” look like?
Right ‘data’ for gathering home care stories
When we visit the doctor in pain, their response is usually “On a scale of 1 to 10, how would you rate your pain?” With The Narrative Initiative programming, a caregiver would instead ask, “What does pain mean to you? And “how does it affect you?” Clients talk in terms of stories. They don’t go to the hospital simply because they’re in pain, they go to the hospital because they can’t complete their activities of daily living (ADLs). Unless you take the time to listen to what’s hurting and how it hurts, the care provided will not align with the client’s expectations.
This goes in line with home care inquiry calls. When a distressed adult daughter is calling for services for a parent, they may express frustration. Why aren’t we taking the time to unpack that frustration and understand the complete scope of their frustration? It’s not necessarily all related to the need to find care for their parent; it could be stress with a child, marital issues, financial issues and more. We need to take the time to learn what these words mean in someone else’s context, and not our own.
As I was listening to Dickey explain the process of active listening, picking out certain words, and extrapolating storytelling information — qualitative data — it brought up a story in my head from a previous client of mine. He explained to me that he lived in excruciating pain. I spoke to our office manager and we talked about bringing in a local hospice or home healthcare agency for a pain management program. When we brought this up to the client, I remember him clearly saying, “I need to live in pain. Without pain, I don’t want to exist.”
This client’s perception of pain differed from mine. We’ve all been trained to fix rather than to manage; this is one of the fundamental flaws of our sick care system. If we brought in hospice (or something like it) to manage this client’s pain, it may have fit the traditional definition of quality care, however, this client would’ve declined and suffered more than he did when he was in pain. If he was surveyed, he would’ve scored us poorly in that instance, because we would’ve ignored what he wanted.
Gold versus platinum
Dickey pointed out the important distinction between the golden rule and the platinum rule. The golden rule is simply to treat others the way you’d want to be treated. The platinum rule is to treat people the way they want to be treated. The Narrative Initiative’s mission isn’t solely centered around interactions with patients, it’s also designed to minimize workforce burnout and dissatisfaction through resilience.
They call it: write, read and reflect. When caregivers are in a room full of their peers, they’re surrounded by people who understand their struggles. While this programming does not serve as therapy, it contrastingly functions as a tool to manage complex problems. Caregivers would be given the opportunity to write about positive and negative interactions they’ve had, read their responses out loud, and receive actualization and validation from their peers. This isn’t a cure, rather, it’s an opportunity to share and feel heard. This requires active listening, not correction or hearing for numbers.
One point that Dickey made that I think many will reflect on is this: “What does comfort look like to you? This could mean being on-call less often for your office staff. As an agency owner, comfort to you might look like steady revenue growth. For your caregivers, this could mean making a wage that allows them to cover daycare costs without taking on a second job.
There is no silver bullet for caregiver recruitment and retention issues, but if you give your caregivers the tools to feel heard and listened to, as well as to listen and hear their clients, you’ll find yourself in a much better place in your home care business.
Jennifer Lagemann is a former family caregiver, as well as a former professional caregiver and administrator at home care agencies. She works as a writer and researcher, helping care providers to create patient- and family-friendly websites, articles and marketing literature.
