Patients First is not Patient-Centered
If there is a loss of cabin pressure, the panels above your seat will open, and oxygen masks will dropdown. If this happens, place the mask over your nose and mouth, and adjust it as necessary. Be sure to adjust your own mask before helping others.
If you have been on a commercial flight anytime in recent memory, you have heard these words. After becoming a father, I can still remember the first time I listened to a flight attendant say to adjust my mask before helping others. For me, the “others” were my wife and daughter. I remember thinking, no way! I am going to save my family first. I’m going to put them first! But was that the right feeling? Nope! I recently saw a video where a researcher investigated what would happen if a plane’s cabin lost pressure and he wasn’t able to get his oxygen mask on. When the aircraft was depressurized, he quickly experienced hypoxia-like symptoms (weakness, disorientation, and inability to save himself). If I spent the time to help my family first, I will promptly experience the same symptoms and eventually pass out. Then what? What if I hadn’t gotten my daughter’s mask on correctly. Now we are both in trouble. The premise is pretty simple. I have to take care of myself first to make sure I am well enough to care for others.
The same is true for us in healthcare. Depending on the study you look at, nearly half (or more) of nurses are experiencing either one or more of the following: a high degree of emotional exhaustion, compassion fatigue, moral injury, and moral distress. These things are often grouped together into a word known as burnout (I personally hate the term burnout, but that’s for another blog post). To put it simply, our caregivers are suffering. Even amid this rampant caregiver suffering, I can’t count the number of times I have heard the words Patients First. I understand the context and reasoning behind this saying. It’s saying the decisions we are making as caregivers and healthcare organizations should put the patient at the center of our choices. But does putting Patients First mean we are being patient-centered? Does putting something first mean we put it at the center of our decisions and vice-versa? I would contend it does not.
I am going to say something that may shock many caregivers and leaders. Before you stop reading, please read through the whole post. OK, here it is. Putting patients first is not being patient-centered. Please allow me to expound on this thought.
Unfortunately, there are instances where patients suffer because we’re not caring for the caregivers; is that patient-centered? The research is pretty well-defined that the epidemic of caregiver suffering significantly impacts (in a negative way) quality, safety, patient experience, turnover, work effort (ya know, the things we use as a measure of success). Some caregivers come to work with overwhelming compassion fatigue and/or moral injury that don’t feel supported by an institution designed to care for people. Many of these caregivers are in survival mode, running on absolute empty; something no amount of pizza is going to fix (if you know, you know).
Now, please do not be under the misconception that this is due to COVID. COVID has absolutely exacerbated an already existing issue. But COVID did something else. It highlighted what can happen if we care for, support, and lift up our caregivers. What happens when we are patient-centered while putting Caregivers first? What happens if we put the patient at the center of our work and care for our caregivers. Please don’t think I am about to oversimplify the complex factors that contribute to caregiver suffering. Remember in April/May/June, all the talk about healthcare heroes? During “early COVID,” our caregivers experienced a time where much of the administrative stuff (not necessarily all bad) was removed, and they were allowed to just take care of patients. Communities and executives rightly celebrated them as the heroes they have always been. Caregivers experienced unprecedented support from the community and the healthcare organizations where they work. Caregivers had incredible amounts of communication, and people were frequently checking in on them. Was this “Patients first”? Nope. Was it patient-centered? Absolutely. Even though this pandemic caused tremendous stress, early research has shown that caregivers are overall more “engaged” (less suffering). Because healthcare leaders were putting humans first and caring for caregivers so they could care for patients. It was patient-centered, but Caregivers first. It was incredible to see the safe, high quality, compassionated-connected care these caregivers were (and continue) providing.
The reality is, if you as a caregiver want to put your patient first, you must put yourself first. If you’re going to put your patient first, you must put your fellow caregivers first. If healthcare leaders genuinely want to put patients first and empower the delivery of safe, high-quality, compassionate-connected care, they must put their caregivers first. In a typical shift (however you can define “typical” in healthcare), a caregiver is pouring themselves out into other human beings for anywhere from eight to sixteen hours per day. They are pouring themselves out, and if they are empty, there is nothing left to give. Go to your kitchen and grab an empty cup. Now, turn that cup upside down and pour the contents into another cup. You can’t, right? There is nothing in the first cup to pour out because it is empty. As caregivers, we are the same way. If you come to work empty, you can’t pour anything out into another human being. You have to refuel, recharge, refill yourself, taking care of yourself before you can care for another.
It is past time in healthcare that we rethink the words Patient First. Proclaiming Patients First is one-way healthcare organizations tell the public they don’t put profits above safety, quality, and experience. But is Patients First the right mindset? Rethinking the Patients First terminology does not abdicate our responsibility to those we exist to serve to be patient-centered. We should strive to be patient-centered and put Caregivers First. Human suffering does not become OK just because someone is being paid to be at work. The reduction of human suffering and the provision of safe, high-quality, human-centered care should guide every decision in healthcare. Being patient-centered and putting Caregivers First guides decisions to improve the quality of life for caregivers and patients together. Being patient-centered and putting Caregivers First affirms the importance of caring for caregivers while also being laser-focused on providing safe, high-quality, compassionate-connected care. We can do both of these at the same time. It’s not a binary choice. We can and should put our Caregivers First so that we can be patient-centered.
To my healthcare peers, never forget to put your oxygen mask on first. If you’re in an organization that doesn’t care if you have an oxygen mask, run! Because we need YOU. Not your job role, not your job title; we need YOU. Our patients and your peers need YOU. You can’t take care of others, reducing suffering while providing safe, high-quality, compassionate-connected care if you don’t first take the time to put your mask on first. How are you refueling, recharging, refilling yourself?
Let’s stop putting patients first. Put them at the center of every decision we make, and put our Caregivers First. We must be unwavering in our promise to being patient-centered. We must also be relentless in our promise to put our Caregivers First. This is more than a slogan. It is a movement and mentality that delivers on the mission of patient-centered care. If we don’t have caregivers to care for patients in their time of need, is that patient-centered? As we care for our caregivers as they care for our patients, healthcare in America can be radically safer and more compassionate. And listen, this isn’t just a “play on words” either. Words matter.
As a brilliant physician colleague, Dr. Lisa Uherick, puts it, Healthy People Heal People. In other words, people who have their oxygen mask on can care for others.
