Four years ago, UCLA’s medical center was ranked as an honor-roll hospital by U.S. News and World Report—but our patients would seldom “refer us to a friend.” We skillfully performed today’s health care miracles: organ transplants, complex neurosurgical repairs, and saved the lives of those ravaged by trauma. Why wouldn’t those under our care tell their friends to come to UCLA? Were we so enamored of technical expertise that we neglected to listen to our patients and their families?
Over the last 4 years, we have worked to transform ourselves, and today we rank among the very best hospitals in the nation on patient satisfaction scores. This turnaround began with a steadfast commitment by our leadership to see that every patient entering our doors would receive the same care we would want for our own families. With our support, staff developed a set of six communications behaviors that we now refer to as CICARE (pronounced “See-ICare”):
- Connect with the patient or family member using “Mr.,” “Ms.,” or their preferred name.
- Introduce yourself and your role.
- Communicate what you are going to do, how it will affect the patient, and other needed information.
- Ask for and anticipate patient and/or family needs, questions, or concerns.
- Respond to patient and/or family questions and requests with immediacy.
- Exit courteously, explaining what will come next or when you will return.
Some would call this innovation, but in reality, it is just getting back to basics. We believe that we significantly improved our patient satisfaction scores by putting the “face of the patient” into every decision we make at UCLA. As a result, we have also found other quality measures improving. For example, readmission rates decreased as we enhanced communication with our patients and families.
CICARE was followed by many innovations and some missteps as we sought to ensure that every patient was cared for with the highest level of compassion, dignity, respect, and privacy, while receiving safe and high-quality care. We changed from an institution where the unwritten message was “Aren’t you lucky you get to see us?” to one in which our mission, “Healing humankind one patient at a time, by alleviating suffering, promoting health, and delivering acts of kindness,” was reflected in every patient’s experience.
What would happen if the concepts of alleviating suffering, promoting health, and delivering acts of kindness were scaled throughout our complex national health care delivery system? Clearly, there are pockets where such acts are already taking place, and some may be doing an even better job than we are. But, on the whole, we doubt that our collective patient population would describe the current U.S. health care system as kind, focused on prevention, or palliative.
This small example of our work at UCLA shows that clear and singularly focused leadership, combined with staff engagement around a compelling purpose, were the ingredients needed for change. The Institute of Medicine’s mission is to serve as adviser to the nation to improve health. We believe that instilling a sense of compassion and respect in our health care delivery system will go a long way to improving the health of our nation.