Sally, a married 54-year-old mother of two teenage girls, just returned from her mammogram follow-up appointment with a troubled look on her face. “What’s the matter?” asked her husband of 25 years. “Again, something showed up, so I have to go for another mammogram and some additional tests,” she responded. This second round of examinations had confirmed abnormal results in her breast tissue. As a result, she was referred by her primary care physician, a nice woman about her age whom she has seen for about 15 years, to a specialist at a local hospital. Although Sally thankfully had never been there before, she knew it had a good reputation for women’s health issues.
Her appointment was scheduled for one week later. In the meantime, Sally performed searches on the internet about breast cancer, treatment possibilities, outcome rates, and learned a bit about which hospitals were best. For the first time in her life, she actually stopped looking for information before she had all the answers she was seeking – perhaps because she couldn’t stand to read any more about it.
When the day of her appointment arrived, her husband Henry took the day off from work to go with her. Sally was comforted that she would have someone close to her for emotional support, but had kept a lot of her feelings inside. She wasn’t sure what her first two tests meant, what to expect, or even exactly where to go. She had been given a map of the hospital, and was allowing enough time to find her way, but with so much information to process over the past week or so, Sally had a hard time keeping everything straight.
After parking their car in the well-lit parking garage, Sally and Henry made their way into the atrium of the hospital. Soothing piano music was being played in the far corner, past the sculpture by the water fall. She quickly scanned the area for signs, and noticed an art gallery along a long wall that led to the gift shops and café. She also saw that each hallway was color-coded, and quickly determined that finding her way wouldn’t be so tough after all.
Sally opened a folder to reconfirm information about which hallway to take first. As she paused to get set, she started thinking about what was happening. What if I have breast cancer? What will my daughters think? Will they get it someday too? What will my prognosis be? She quickly nipped all this negative thinking in the bud, even if it didn’t diffuse the pit she felt in her stomach. No, Sally decided, she wasn’t going to give in to the pessimistic voices in her head. She was going to focus on remaining calm, asking questions, and learning more about the events of the day. “Henry,” she started, “we need to follow the red line on the wall to the Women’s Health unit.” Henry nodded. Sally then turned, put her arm through Henry’s, and took a long stride forward. She was on her way.
This case is illustrative of what patients go through every day. It is characteristic not only of patients with breast cancer, but of various patients with many health conditions who are facing uncertainty regarding their condition and future. When faced with unknown risks, it is typical for patients to react emotionally, then to get to work to make sense of their statuses and options. When Sally disengages from the internet search, it is illustrative of the potential impact of negative emotions. Yet when Sally musters the emotional energy needed to move forward, it is a resource she deploys to re-engage, to participate in her circumstances.
This refreshed emotional state, called positivity, is the condition of positive emotions’ relative strength over that of negative emotions (Fredrickson, Barbara L. (2001), “The Role of Positive Emotions in Positive Psychology: The Broaden-and-Build Theory of Positive Emotions,” American Psychologist, 56 (3), 218-26.). Positivity has been linked with increased functioning of bodily systems, improved health outcomes, brain and immune function (Davidson et al. 2003), and even longevity (Fredrickson & Losada 2005). Most relevant to patient behaviors, positivity expands considered actions and activities, including creative problem-solving behaviors (Isen, Daubman, & Nowicki 1987).
This perspective is in contrast with traditional beliefs regarding patients’ emotional states, which instead focus on the inhibition of positive patient behaviors due to paralysis from anxiety and fear. Recent research has confirmed positivity’s constructive effects among patients facing stressful, anxiety-producing, and uncertain health care encounters, and found that as patients become more positive, they participate more (Gallan, Burke Jarvis, Brown & Bitner (2013) “Customer Positivity and Participation in Services: An Empirical Test in a Health Care Context,” The Journal of the Academy of Marketing Science). Most interestingly, as positive patients participated more, they viewed their providers as more technically proficient, and were more satisfied with their care. Additional research has shown that addressing patient fears can raise critical patient metrics [HCAHPS] (see http://www.healthleadersmedia.com/page-1/MAR-271458/Easing-Patient-Fears-Can-Raise-HCAHPS-Scores).
Amazing what a change of emotional state can do!
So what can health care administrators, managers, designers, and practitioners do to enable patients to best deal with their emotional states? How can patients be helped to overcome negative emotions such that they are empowered to exert increased levels of participation? We can consider implementing the following suggestions:
- Design physical spaces to enhance emotional security. As an example, the health services innovation class at Parsons the New School for Design created new environments for patients at Memorial Sloan-Kettering Cancer Center in New York that accounted for patients’ and families’ emotional states and thereby facilitated more productive interactions and behaviors (see http://www.slideshare.net/sgdean/grow-an-herb-garden-system). Reinventing existing spaces can be relatively inexpensive and may provide exceptional returns. You may recall that Sally entered an engaging and welcoming space, and it set the stage for her to transform her emotional state.
- Engage patients proactively to set a stage of positivity. As an example, Mayo Clinic collects information from patients upon entering their facility regarding the patient’s disposition, emotional state, any information the patient may have collected, and questions the patient would like to have answered. This pre-encounter process provides front-line employees with important information that may be used to highlight and reinforce reasons for patients to remain positive about their situations. It also may prompt patients to be prepared to actively engage in their diagnosis, procedures, and treatment. To be most effective, it is imperative to have health educators consult with patients prior to physician consultation, to assist patients in addressing emotional issues in addition to identifying questions and concerns that then lead to increased participation levels. Sally had sufficient information to navigate the facility upon entering. An additional step would be to ask her to bring a list of questions or comments to share.
- Allow sufficient time and space during health care consultations for patients to explore and explain their emotions. Providing patients with sufficient time and personal space along with co-creating a specific plan of action are effective methods of enabling patients to transform uncertainty–and even fear–into favorable attitudes and expanded behaviors. That is, in the context of patient–provider communication, anxiety-producing discussions can lead to positive behavioral change when details of patient actions are provided, and when barriers to action are lowered or even eliminated. Moreover, participation is enhanced when information is accompanied by explanation customized to the specific client, and when customer knowledge is recognized and rewarded (Eldh, Ekman, & Ehnfors (2006), Nursing Ethics). During the visit with her physician, Sally should be encouraged to bring our her list of questions and comments, and to think (and feel) through what’s still unclear or bothersome.
My hope is that the health care industry continues to engage its providers in its core mission: to transform patient lives. The era of patient empowerment is quickly emerging, and its impact on the health care field already is profound. It is imperative, therefore, for health care administrators to find new ways to partner with, and bring out the best in, their patients.
I welcome your comments. Good luck!