The Key to Creating Patient Trust: Extravagant Hospitality

"The interface between people may be as important as the mechanical interface around tissues." - Paul Brand, MD, orthopedic surgeon and pioneer in the field of pedorthics, Veterans Journal of Rehabilitation , 1983. Much pedorthic, orthotic, and prosthetic education is spent on managing the mechanical interface around tissue. What energizes the professional, however, is often the trusting relationship with patients that leads to compliance, improved mobility, and a better quality of life. What frustrates and fatigues professionals is when a connection with the patient cannot be established. To create the premier O&P and/or pedorthic facility, practitioners must go beyond having a high level of technical expertise. Experience from some of the more successful facilities suggests that a high level of relationship skills and extravagant hospitality in combination with exceptional technical skills creates patient trust and helps overcome patient resistance. Providing patients with a caring and hospitable environment is not so much a matter of what we know as it is a matter of our skills in human interactions and how we treat others. This brings us to our concept of "Extravagant Hospitality." Providing extravagant hospitality includes four skills: (1) positive attention, (2) generous listening, (3) authenticity, and (4) acceptance. Positive Attention By showing positive attention to all who enter your practice, you begin to create a safe and caring space for patients so they may let down their defenses, dissipating skepticism and concerns. Create a welcoming environment from the moment the patient makes the initial contact with any of your staff. When you notice people and greet them in a friendly manner, they begin to sense your caring. You can tell people you care or post your mission statement on the wall, but it is not as convincing as showing them that you care. The first step and the quickest access to building rapport and breaking down resistance is the positive attention that is given to the patient by all your staff. These skills include: (1) being present in the moment and not letting your attention wander; (2) establishing eye contact; (3) expressing warmth and friendliness through your facial expression and meaningful gestures; (4) phrasing conversations positively; (5) and letting people know your name and using the patient's name. For example, a patient walks into your facility. Scenario A: A staff person may or may not look up at the patient, does not smile, and asks rather pointedly, "Do you have an appointment?" The question is almost an accusation, suggesting, "If you don't, you'll have to wait or come back another time." In addition, it focuses the attention on the staff member's own convenience in the moment. Contrast this with Scenario B . A staff person notices a patient entering the facility and turns her full attention from what she was doing to establish eye contact with the patient. She then greets the patient with a friendly smile and says, "Good afternoon; my name is Deborah. How can I help you today?" Perhaps you set appointments, and it is 1PM, and you see by your book that Mr. Rosen is due in for an appointment. Your staff person says, "Good afternoon; my name is Deborah. You must be Mr. Rosen here for your 1 o'clock appointment. We're happy to see you. Please have a seat. We will be with you shortly." Although a poor initial impression can be overcome, the goal of extravagant hospitality is to make the patient feel comfortable, welcome, and happy that he chose you for his professional right from the start. Especially important is the use of people's names, as this single factor serves to give people a sense of being known for their uniqueness and value. With added hospitality, the feeling builds to the point that they look forward to their visits and being in the presence of your warm, welcoming staff. Interruptions should be kept to a minimum or handled courteously in a way that is respectful. Excuse yourself from the conversation with your patient, put your full attention on the person that needs your help, and then return graciously to your client, apologizing for the interruption and encouraging him to continue talking. Generous Listening Most people believe they are good listeners, yet new research suggests we interrupt the person we are talking with every 17 seconds. Likely, in a professional environment we have developed a good ear for letting the patient tell his story. But, could we do even better? Here we are talking about full, active listening with all of our attention on the patient and what he is saying. From our listening, we formulate meaningful questions to deepen our understanding of the patient's desires and needs and help establish realistic and measurable outcomes. This is where the patient begins to feel understood--and greater trust is established. Because our minds are so busy interpreting, analyzing, and planning a solution for our patients as they present their problems, even the most experienced professional may find his attention wandering at times. That's normal. As soon as you notice, re-focus. Also, after helping people for many years, we start to act like, "Oh, I've heard this story before," and forget that the person in front of us is unique and deserves our complete attention as he shares his very personal story and complaints. Professionals may have noticed that people blossom in miraculous ways when they feel fully seen and heard. It is as if their self-esteem improves and a weight is lifted off their shoulders. They so appreciate a good listener that they start to like and feel comfortable with the person listening. In addition, listening is a key to instant rapport. When we listen to others, they are more apt to listen to us. A practitioner is also an important patient educator. Listening thus encourages compliance. Listening includes the ability to be still and silent and to be comfortable not talking. Often we are so eager to let a person know we understand that we end up interrupting, breaking the silence with great regularity. Our intrusions into their speaking, however, only serve to distance us from the patient. Our patients are vulnerable as they come to us with disease and discomfort. Often grief and worry accompany their condition. They actually may need to go through a healing process as they reveal their history little by little. Extravagant hospitality supports healing. Sometimes healing happens the first time someone shares and receives the support and listening of the practitioner; sometimes it takes longer. But eventually, the wound is bound to heal in an accepting and supportive environment where listening is given priority. When patients heal, they reclaim a part of themselves that they didn't have before. Authenticity Magic occurs for both the practitioner and the patient when professionals approach their interactions with patients from passion and commitment. Meeting people passionate about their profession, who enjoy serving people, is always an uplifting experience. Letting people sincerely know this is what you love to do can turn an individual's distrust into admiration. Authenticity has been called one of the most effective leadership tools, because in an age of cynicism and distrust, it is one of the few things that inspire people to action. What we say doesn't count for much if people don't believe us. The absence of authenticity affects all our relationships and prevents the very connectedness that we all yearn for as human beings. Practitioners want patients to appreciate their training, knowledge, and expertise. Steer clear of appearing arrogant or overconfident, which will distance you from your patient. Do this by using words the patient understands and by presenting options and educating the patient in an unhurried manner. Honor each patient's questions; they provide a critical opportunity for gaining compliance. Acceptance The extraordinary journey to becoming our real selves provides a freedom to be with people--human beings just like ourselves--and freedom to express and appreciate who we are with all our imperfections, while still accomplishing the job of helping people. If we can be relaxed enough to stand in all our greatness and all our vulnerability, then our patients will also feel comfortable with their greatness and weaknesses. Accepting others starts with accepting yourself. Now, the question here is: "Can you love and accept your grumpy, complaining patient and provide extravagant hospitality as much as you can to the friendly, likeable, compliant patient that you thoroughly enjoy serving?" This is perhaps the practitioner's greatest challenge. Can you consistently exert a calming and accepting disposition with this person? If so, you are extraordinary in your professionalism and truly understand what it is to provide extravagant hospitality. Trust and Compliance Trust and compliance come from incorporating finely tuned relationship skills and this model of extravagant hospitality. People have a basic need to be fully seen and heard and to be accepted for who they are. People also yearn for connection. In addition to offering technical expertise, practitioners who provide positive attention and generous listening, accept their patients, and bring their genuine self to the appointment provide what people want most. It is not only acceptable, but also good business to acknowledge our humanity. Toni Gitles is a professional speaker, consultant, and writer who has spent over 30 years in the healthcare industry. She is the author of numerous articles and co-author of the anthology, Happiness is a Decision of the Heart. Contact her at www.tonigitles.com and tgitles@cfl .rr.com Harriet Cavanah Dart is a certified pedorthist for Scheck & Siress Advanced Orthotics & Prosthetics in Bannockburn and Arlington Heights, Illinois. In 2002, she was awarded the Seymour Lefton Award, PFA's most prestigious honor, and was included among the "Prominent Women in O&P" by O&P Almanac, March 2003. She is president of the Pedorthic Footwear Foundation. Contact her at harriet.dart@scheckandsiress.com

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