American Association for Physician Leadership

Problem Solving

The “Mother Test”: Encouraging Outstanding Patient Care

Robert C. Goldszer, MD, MBA

November 8, 2019


Abstract:

Healthcare organizations strive to provide high-quality, high-value, reliable care. How do they know they are doing the right thing for their patients?




One week during teaching rounds, I asked my residents and students these questions: How do you know you are doing the right thing for your patients? What thoughts or policies guide you when you work with your teams of physicians, trainees, nurses, and others on the care team?

They looked at me a bit quizzically and then offered some good responses: “Patients get better and go home.” “Patients and families seem happy.” “Abnormalities related to diseases seem to improve.” “Nurses seem happy and seem to understand our plans, and students give us good evaluations.”

We talked about the many people we work with and serve in our community, about quality measures, about the fact that physicians and hospitals are graded on specific metrics of how we care for our patients with myocardial infarction, congestive heart failure, and pneumonia. We talked about metrics such as length of stay, mortality, hospital-acquired conditions, hospital-acquired infections, and readmissions.

We agreed that the value in healthcare is measured as Value = Outcome + Experience/Cost. We discussed how our care can truly add value and be provided in a high-quality, highly reliable manner wherein all patients receive only the required care at the right time.(1)

Our systems of care have improved in many ways. Checklists help us remember the order of activities to achieve ideal outcomes.(2) Computerized systems of orders and documentation help eliminate errors.(3) Barcode scanning decreases errors related to medications.(4) Along with these systems for improvement, we provide a constant reminder: Always keep the patient at the center of analysis and planning.

Two strategies are helpful for implementing patient-centered improvements: 1) apply the “mother test” and 2) recognize those who use it.

The Mother Test

How would you like your mother to be treated if she came into the hospital? This is the “mother test,” an extension of the golden rule: “Do unto others as you would have done to you.” It’s a simple yet important consideration when making decisions about patient care — and about how we communicate with patients, families, and each other. By keeping this rule central in our choices, we remember to do the right thing.

The value of this concept is that it is simple. There is no cost, and no app or computer analysis is necessary. It can be used any time in any place and often with instant feedback in the form of a “thank you” from the patient and/or family. Table 1 summarizes the benefits of the mother test.

Of course, applying this test can be easier said than done. There may be conflicts with colleagues on the patient care team or maybe even with supervisors. Maybe you don’t have the proper equipment or enough knowledge. You may even run into problems with patients and their families.

Here are some thoughts to consider as you strive to treat every patient as you’d like your mother to be treated:

  • Are enough of the right people on the team? All organizations need to be value-oriented and efficient to be successful. Physician leaders should evaluate the people on the care team and ensure they understand the goals and plans for each patient, which will take extra time at the bedside but almost always save time and decrease the number of phone calls. I try to talk with the nurse and care manager daily and ensure all consultants understand the plan for each day.

  • Physician leaders should provide excellent supervision. They must teach and demonstrate the behaviors they expect as the team interacts with the patients. At the start of each teaching rotation or change in residents and students, the team should “huddle” to ensure everyone has the same expectations for patient care, behaviors, communications, and professionalism.

  • Equipment may present challenges to providing care. Physician leaders should anticipate problems and review equipment prior to all procedures. If they are not familiar with a piece of equipment, they should receive the proper training and ensure team members do as well.

  • Because all patients and families are unique, it may be difficult to anticipate their varied needs. In keeping with what students learn in their first year of medical school, it’s important to ask patients open-ended questions: What do they understand? Do they have any questions? What are their expectations? Their responses will help the care team clearly understand the patient’s and family’s viewpoint and concerns. At the end of a patient encounter, a meeting, or a team discussion, pause for 10 seconds to allow the patient, family, or team to reflect on the discussion and ask questions.

Giving Credit Where Credit Is Due

To demonstrate the value of those who put the patient first, perform well, and achieve high standards of quality and service, it’s important to recognize them. This can be done immediately with a thank you and when appropriate, by sharing with the team.

At Mount Sinai Medical Center in Miami Beach, through our Resident of the Year program, we celebrate excellence and build respect and collegiality among teams by having nurses acknowledge the most outstanding residents each year.

Nurses from various units select the residents who they believe provide the best quality care, patient service, and team communication. They recognize residents who were sensitive to patient and family cultural restrictions such as diets, languages, religious habits, and travel schedules. Others are recognized for being compassionate with patients, families, nurses, or colleagues. We recognize two residents for clinical excellence and two for professionalism. Table 2 outlines the criteria for selection.

To determine the award recipients, nurse leaders solicit names of residents from each unit. Residents who are mentioned repeatedly or who display outstanding concern for patient care are noted. The awards are presented at an annual event, which is attended by all of the residents as well as much of the teaching faculty, senior nurses, and hospital leadership. Each selected resident receives an award plaque, a cash card, and a letter for their curriculum vitae.

These awards help achieve several goals. The nursing leadership appreciates the opportunity to recognize other team members and residents are encouraged to compete for excellence and recognition. An added benefit is that of making all members of the team more aware of the goals and standards for acknowledgment and the importance of effective teamwork. This provides a framework for future quality behaviors and practices.

Doing the Right Thing

To achieve the goal of doing the right thing for our patients it is important to give future physicians guidelines to determine whether their patients are receiving reliable, quality care. Teaching them to apply the mother test will help them make the best decisions for their patients. Recognizing those future physicians will inspire them to continue to make improvements.

The author and his family report no conflicts of interest with any aspect of this work or manuscript. There is no funding source related to this work or manuscript.

References

  1. Chassin MR, Loeb JM. The Ongoing Quality Improvement Journey: Next Stop High Reliability. Health Affairs. 2011;30(4):559-68.

  2. Gawande A. The Checklist Manifesto. New York: Henry Holt and Company; 2009.

  3. Goldszer RC, Ratzan K, Csete M, et al. Impact of Order Set Use on Outcome of Patients with Sepsis. Applied Informatics. 2017;4:2-6.

  4. Seibert, HH, Maddox RR, Flynn EA, William CK. Effect of Barcode Technology with Electronic Medication Administration Record on Medication Accuracy Rates. Am J Health Syst Pharm. 2014;71(3):209-18.


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