Deborah Crossan

Why messenger, re-enforcement and a touch of ego matter for timely hospital discharges

March 16, 2017

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My dad ‘the heart patient’ case study

Why messenger, re-enforcement and a touch of ego matter for timely hospital discharges: my dad ‘the heart patient’ case study.

As one of iMPOWER’s MINDSPACE Champions, I am always on the lookout for examples of behavioural science in action and was very pleased to see it in the NHS’s care of my dad.

In September 2016, he had a heart valve replacement and coronary bypass operation at England’s leading hospital for heart surgery. The operation was successful, as was his recovery. Aiding this were several key factors – whether he and the hospital staff were aware of them or not – which greatly assisted the speed of, and his commitment to, recovery.

In the recent budget an additional £1billion was allocated for improving delayed transfer of care (DTOC). Could learning about and applying behavioural science – such as outlined here – in a more structured way be an appropriate use for some of this funding?

1.       Establishing initial relationships (the Messenger)

As you would expect before any major operation, my Dad’s surgeon’s registrar came to see him, while nurses took him through the pre-theatre process. These initial interactions were highly important. Trust was quickly established and in behavioural science terms they exhibited their ‘authority’; authority established by their expertise which was re-enforced by the hospital staff being specialists in heart and lung surgery.

2.         Rapid focus on strengths

The operation lasted four hours, while my Dad was under anaesthetic for at least ten hours. The day after his operation we went to visit him in intensive care and were astounded to find him sitting up in a chair, drinking tea and able to talk. It also happened to be his birthday, so we had a slightly surreal giving of birthday cards surrounded by other intensive care patients!

Dad himself was surprised to be out of bed so quickly. This rapid encouragement of strengths and ‘labelling’ of positive behaviours by the hospital staff was a catalyst for his successful recovery. Let us not forget that they had the ‘authority’ to say, ‘We think you are strong enough to get out of bed this morning’ (12 hours after surgery) and ‘So that is exactly what you are going to do!’.

3.       Messenger, re-enforcement and a touch of ego

There were a couple of ‘messengers’ who made a real difference to his speedy recovery. Firstly, a visit by the registrar he had met the previous day. He commented on the success of the operation which triggered an immediate sense positivity. The second key visitor was after he had been moved to the ward. She was one of the senior nurses he had met during pre-op. The nurse commented on how well he was looking and what great progress he was making. She also visited on multiple occasions re-enforcing positive messages.

These might sound like small acts but to someone who has never gone through surgery of this magnitude and has no idea what ‘good recovery’ looks like, the message and the messenger were very powerful.

4.       Environment

My Dad was very fortunate to have a bed by a window, from which he could look out over trees and see the sun shine. He was also lucky to be in an unusually shaped room which meant that he had no-one on either side of him and only two other beds in the room. The natural light meant that he could do what he enjoys, read the paper and complete crosswords, again supporting him to be able to do what is ‘normal’ and what he would want to continue to do once home. Obviously it would be impossible for all hospitals to be designed in such a way but we do know that high ceilings and natural light lead to better creativity and positivity. Also, the overall atmosphere on the ward was calm and unhurried. How can design like this be introduced into hospitals in the future?

5.    Similar others

After a couple of months of recovery dad joined an exercise class solely for recovering heart patients, led by physios from the hospital.  Here, he was surrounded by ‘similar others’, people like him with whom he could compare experiences, but also people who were nearing the end of the programme by whom he could be inspired. Once again very powerful messengers but also a way to establish the new ‘norm’.

Many of the behavioural science examples I have cited may seem small and to some obvious. However, these small acts have a powerful effect on how someone feels, the progress they make and the confidence they gain for going home and continuing the positive trajectory. Their collective power should not be underestimated.

Dad was certainly very pleased with the care he received and provided positive feedback to the hospital and more recently to his surgeon – a fantastic NHS story.

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