The Unexpected Experience – You can’t make this stuff up…

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When I phoned home from California I was greeted with this question from my 7-year old: “Mommy I hurt my arm and I can’t move it so I can’t brush my teeth. Daddy is getting me Tylenol but since you teach doctors do you know what to do?”

I appreciate the confidence she had in me but truly was wondering what the heck she thinks I tell the doctors we coach! My kids know I’m not a nurse and that I don’t know much about clinical things. In fact, my injured child’s older sister has been known to describe my work this way: “My Mom works with doctors – she’s not as cool as the doctors but she just gets to follow them around a lot….”

I told her heat and ice (Or is it ice and heat? Or one or the other?!) and suggested that she prop it up, take the Tylenol, and try to rest. All the while though, my Mom-gut was telling me that she needed to go in and be seen by an actual clinician. Admittedly though, that’s easy to say when you’re the parent out-of-town for work and the one at home has three to care for. So, I said a little prayer and went to sleep.

The next morning, I woke up and called home to check and see how she was doing. My eldest (10 years old at the time) answered the phone and said “So, did you hear about her arm?” And I said that yes, I’d talked to her last evening, and my oldest said, “Oh, so you heard all about the Emergency Room?”


That’s the last thing a Mom, a thousand miles away no less, wants to hear!

My eldest proceeded to tell me the story of how when my injured daughter couldn’t sleep, my husband finally decided it was a good idea to take her to the ED – this was at about midnight and he had to trek all three kids out of bed and off to the Emergency Room.

My daughter continued to relay to me her version of the ED journey through her eyes from 12-3:30 a.m.… and it was humorous, fascinating, and profound. (Although I did have to cut her off at one point and ask “So, is her arm broken or what?!”)

In this series, we’ve been talking a lot about the Unexpected Experience for patients and families in the ED. We’ve discussed successful flow and explored some of the key strengths, inconsistencies, and opportunities we witness in our coaching with staff in EDs across the country. I’m sharing my family’s story, not because they are my kids and I think they are adorable, but because I believe children give us such great clarity and their perspectives are often profound.

The reflections by my three kids on their Unexpected Experience provide a great summary of the key aspects we’ve discussed in this series. Here’s what I learned from their experience:

  • Everyone’s a doctor My kids had no differentiation of who was who. “Mom, we saw lots of doctors but it took a LONG time and everything moved very slowly.” As they told me about the various people that cared for them – they referred to all of them as “doctors.” They knew their names but they didn’t distinguish roles; everyone was a doctor.

Take away: Introductions – names and roles – are important!

  • No one talked to each other – “Mom, they kept asking us the same questions over and over and if they would just read each other’s notes, they would know what we told the last ‘doctor’!”

Take away: Eliminate the redundancy as much as possible and narrate the care team connections.

  • They didn’t respect our privacy – “So Mom, one time, [my 4-year-old son] was trying to get [my middle daughter- the patient] to laugh to distract her and he was being really silly. And the “doctor” knocked but they didn’t wait for us to say ‘come in.’ They just barged right into our room and [my 4-year-old son] was super embarrassed and felt really ashamed that they walked in and saw him being so silly!”

Take away: Knocking and pausing before just entering the room, communicates courtesy, respect, and privacy.

  • Not everyone sat down – Apparently one “doctor” (whom I determined was a nurse) was tall and adjusted the computer in the room so he could stand and see it at his height. Then, when “Dr. B” came in he’d have to adjust the computer down and he sat at the stool to talk to them. “But, Mom it was so stupid because this took like so much time for each of them to constantly adjust and reposition the computer – I mean, just sit down and leave the computer in one spot already!”

Take away: Sitting down is important no matter what your role.

  • “Faces” are a fun way to evaluate pain – “So, when we got there, she was like 4 faces – do you know the faces that tell you how much pain you’re in? Well, she was first like 4 faces and then she was like 5 faces.” (When I later talked to my daughter the actual patient, she told me she was at 9 faces!) Regardless, they were cool and useful!

Take away: Pain is important to patients. Using your care boards and other tools to help assess and reassess this can help patients talk about it.

  • They didn’t ask open-ended questions “MOM! Like everyone who came in the room asked us ‘Do you have any questions?’ NO ONE asked us ‘What questions do you have?’ It was SO annoying, I mean don’t they know that that’s a really bad way to get our input?” A coach/mother couldn’t be more proud.

Take away: Use open-ended questions – remember the A&W!

  • They explained things in a way that was understood When I finally cut her off from her coaching debrief and asked the burning question about the outcome, I found out that my eldest daughter knew quite a bit about my middle daughter’s diagnosis, treatment, and next steps. She told me “Oh, yeah, she has a fracture in her growth plate – we have a picture of it we can text to you (visual aid). So, they will have to wait and see how much pain she’s in and follow up with an orthopedist in the next week. If it still hurts they will put a cast on it but meanwhile she has a splint. We can still come and meet you in California but she can’t get the splint wet….”

Take away: Using non-medical language, visual aids and pictures can help patients and families better understand what’s happening to them.

As my daughter continued to debrief their overnight in the ED, I finally asked her if I could send her my coaching evaluation tool and ask her to complete it based on her observations! But seriously, if this experience showed me one thing, it’s that the key care practices that we’ve discussed in this series are evident and observed by patients every day. This story showed me that these key practices can even be identified and articulated by some of our youngest healthcare consumers!

And if you’re keeping track, we did end up with an appointment with a pediatric orthopedist and a cast was eventually (and unfortunately) necessary.

Next time we’ll take one final look at the Unexpected Experience in the ED and offer a key resource to you for your improvement efforts in this area!

Janiece Gray

I began my career as a social worker and later, with my Master of Health Administration (MHA), directed operations at Allina Health in Minnesota. I later directed patient experience at Allina. My background and experience give me strengths in approaching healthcare opportunities and challenges through a systems lens – with unique strengths, challenges and activation points. My experience is also informed by leadership roles leading performance improvement in patient-centered care and patient experience departments. Working in the client role with healthcare consulting firms inspired me to address some unmet needs in the industry, and to co-found DTA Healthcare Solutions. I have a Lean Six Sigma Black Belt, and find that the discipline of practice translates to healthcare work very well.

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