Healthcare Emotional Intelligence: Its Role in Patient Outcomes and Organizational Success

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There is a renewed interest in healthcare, in the role of Emotional Intelligence — a set of behavioral competencies, distinct from traditional IQ, that impact performance. There is also a growing body of evidence that individual behaviors, including EQ, influence patient outcomes and organizational success. What is EQ? How does it apply to healthcare? How do we use it to improve performance?

Everyone is striving to provide patient-centered care. Operational strategies like Lean or Six-Sigma help in designing new, patient-centered care models. Information systems make clinical and financial data more useful and enhance efficiency. These strategies and technologies are widely available, but not every organization is successful.

Patient-centered care is not just about new care delivery models. It is, to a large degree, about relationships and interactions between providers and patients and among administrators, physicians, nurses and staff. With this realization, healthcare is exploring how we can apply the concept of Emotional Intelligence.

Emotional Intelligence – What is It?
In the 1930s, psychological research identified “social intelligence” skills, distinct from traditional intelligence, that impact work performance. By the 1980s, research showed that overall performance was often the result of interpersonal, rather than technical, skills. By the 1990s, the term “Emotional Intelligence” was widely discussed in business circles. A definition that includes about two dozen social and emotional abilities linked to successful performance in the workplace. These abilities can be grouped into five core areas: • Self awareness • Self regulation • Self motivation • Social awareness • Social skills

Interest in the concept took off with Dan Goleman’s 1995 book “Emotional Intelligence.” Harvard Business Review printed an article on EQ in 1998. It was the most widely read article in its 40-year history. The concept continues to have widespread support in the business world but healthcare has been slow to apply EQ concepts.

Behaviors and outcomes
Efforts to improve quality of care will always begin with research and training on new diagnostic and treatment approaches. There is a growing body of evidence, however, that individual behaviors significantly influence outcomes and warrant more attention.

For instance, relatively simple protocols can virtually eliminate certain hospital- acquired infections. Some hospitals, though, adopt these protocols but are unsuccessful. Why? John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, commented on the dilemma: “For the process to work, each individual has to make a commitment to perform each step each time, and have the courage to correct their colleague when they see an error has been made.” Success requires staff members who see the value of new procedures, and a culture of communication, collaboration and adaptability.

In fact, we are learning that behaviors like empathy and compassion actually impact patient outcomes. For instance, physician empathy improves patient satisfaction and adherence to treatment, and correlates with fewer medical errors. Empathetic physicians are better at managing chronic conditions like diabetes. Higher levels of communication and collaboration mean better outcomes in shock-trauma units. Inappropriate behavior by nurses and physicians is not only disruptive to the work environment but, more importantly, these behaviors can harm patients.

EQ in healthcare
What about the broader concept of EQ? Recent research reveals that EQ might be offered as an explanation for why some practitioners and organizations are better at delivering patient-centered care. EQ has been shown to positively contribute to the physician-patient relationship, increased empathy, teamwork, communication, stress management, organizational commitment, physician and nurse career satisfaction, and effective leadership. Several dozen nursing research studies demonstrate a correlation between EQ and performance of nurses, retention, stress adaptation, organizational citizenship and selected positive patient clinical outcomes.

There is also evidence that EQ can be improved with training. If a provider has a better understanding of his or her behavioral propensities, he or she can adopt specific behaviors that will improve interactions with patients and colleagues.

Healthcare emotional intelligence
Working with a group of physician leaders at a progressive healthcare system, we heard the following: “We appreciate the connection between EQ and patient care and physician career success, but when we took an EQ assessment, we found the results to be interesting but weren’t sure what to do with the information.” Traditional EQ measurement tools do not provide practical recommendations for adopting patient-centric behaviors.

Part of the problem is that the concept of EQ — how it is defined, measured and used — has not been looked at within the unique context of healthcare. Physicians, for instance, may score high on traditional measures of EQ, but other behavioral traits can prevent them from displaying the highly collaborative or patient-centered behaviors we’d expect.

From Select International’s experience working with healthcare organizations, we’ve developed an innovative behavioral construct to patientcentered care. Whether a physician or nurse scores high or low in any of these areas is less important than their ability to understand their behavioral make-up and adapt accordingly. The construct includes four core areas:

1. Compassion — How compassion is measured, and how the results presented, are important. We’ve seen outstanding clinicians who don’t score on the high side of the compassion scale. For compassion to be useful, it must result in positive action. Even highly factual (vs. feeling) individuals can connect with patients and coworkers if they are aware and able to convey that they are trying to understand the other’s emotional state.

2. Awareness — The ability to understand a situation and either focus on the details or the big picture, as appropriate, is invaluable to creating a patient-centric culture and to successfully collaborating and working in teams.

3. Regulation — The ability to moderate emotions is critical to the ability to problem solve under stress and to maintain productive, professional relationships and behaviors. Those at either end of the spectrum can function well if they are aware of their natural reactions. Those who are highly excitable may be at a greater risk for impulsive negative remarks or actions (e.g., physician disruptive behavior). Those who are hyper-controlled, however, are often perceived as distant and uncaring.

4. Emotional Intelligence. Or, your level of “social focus.” Are you so focused on the task at hand that you fail to read the needs of patients and colleagues, or are you easily able to read others’ emotions and use that information to achieve a positive outcome? For example, once you know that you are highly factual and less socially focused, you can get in the habit of making a special effort to evaluate how a patient or colleague is reacting to you and act accordingly.

Training implications
Obviously, we need to train and develop nurses, staff and physicians on how to provide patient-centered care. Traditionally, this has involved service excellence programs like those adopted to healthcare from Disney or the Ritz Carlton. These have moved some hospitals light years ahead of where they were ten years ago, but they only go so far. From a recent article in FierceHealthcare:

“If you want to go (if you’ll pardon the business cliché), from good to great, the key is not to focus primarily on . . . service excellence, argues Fred Lee, a patient relations and service consultant and author of “If Disney Ran Your Hospital.”… “A service of courtesy is not enough in our business if we are not also meeting people’s emotional needs,” Lee said.

Imagine a patient with bad reaction to anesthesia. It’s fairly routine but still uncomfortable and unnerving for the patient and the family. One nurse may be highly conscientious and clinically competent and taking all the right steps to address the situation. She’ll provide the right treatment and the patient’s symptoms will resolve, but she doesn’t attempt to calm the patient or instill a sense of confidence and even fails to pick up on the anxiety. Another nurse, may not be quite as conscientious or experienced. She may even take a bit longer to figure out exactly what to do, but she is more comforting. She knows to put a hand on the patient’s shoulder and to assure the family that this is normal. The symptoms may resolve in the same amount of time, but the two patient and family experiences were very different.

One hospital CEO told us, “We check all the boxes on our service excellence program and pat ourselves on the back, but our patient satisfaction scores have not improved.” The specific, individual behaviors and interactions of every physician, nurse and staff member are what drive patient-centered care. More importantly, they must understand something about their own behavioral make-up. The first nurse in the situation above may learn that she is highly factual and needs to make a special attempt to understand, and respond to, patient needs. The second may discover that she is so focused on meeting patient needs that she must be actively conscientiousness of the tasks that impact patient outcomes.

The most successful patient-centered care training programs will combine service excellence principles with behavioral assessments that provide staff with useful insight into their own behavioral make-up —including healthcare- specific emotional intelligence.

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