Previewing Expectations

Tell them what you're going to tell them.

Tell them.

Tell them what you just told them.

The secrets to making a great presentation follow this formula. It's no wonder -- for many reasons. We have short attention spans. We need context and structure in order to remember things. Repetitive communication helps us retain information.

The same is true for patients. Last week, I had the honor of addressing the 23rd Annual NRC Health Symposium for Patient-Centered Care in Boston to a crowd of 300+ attendees with one primary focus -- putting the patient first.

One concept I spoke of during my keynote there was one of Previewing Expectations -- something I learned more than 15 years ago from my son Noah's behaviorist, Janice.

As a toddler, my son Noah’s speech delays caused him (and the rest of us) much frustration and resulted in behavioral issues that needed to be addressed. He would often hit, spit or go into uncontrollable temper tantrums. Loud noises like police sirens or toilets flushing caused him pain or discomfort and he would cover his ears. Crowds also bothered Noah, and we noticed his “behaviors” increasing.

When Noah was four we were able to have him evaluated by a renowned neuro-psychologist, who diagnosed Noah’s symptoms as presenting like Asperger’s Syndrome – on the autism spectrum.

We sought out the help of a child behaviorist, named Janice to assist us with Noah at home and at school.

Janice came to our house very early one morning – 6:30am – just in time to witness me serving Noah his breakfast. As most mornings went, I placed Noah’s scrambled eggs on the table in front of him and he’d take his hand and throw the plate off the table leaving eggs strewn throughout the kitchen I was at my wits end. And by this time had learned to use plastic plates!

Janice witnessed what happened and simply whispered, “Nancy, make him the eggs again and tell him that you’re going to give them to him, before you put it in front of him.” Ok. Not a problem. I made the eggs again and before I placed the dish in front of him, I said, “Noah, mommy made you eggs for breakfast, here you go.” He lifted his fork and began eating. What? Impossible I thought. How did this happen? What had I been missing all this time?

Janice explained that the breakfast scenario was a very short-term example of “previewing expectations.” In other words, by letting Noah know that breakfast was about to be served – as opposed to simply placing his breakfast in front of him – he was able to prepare himself for the meal he was about to receive. She told me that the concept of “previewing expectations” would work with everyone in my life. For example, when going to the grocery store with your three children give them a preview in the parking lot by saying “if everyone behaves and doesn’t throw things into the cart, (like they usually do), -- when we get to the checkout line, I will allow you each to get one candy.” It worked like a charm with all three of my children.

Since my recovery, I think that healthcare professionals and systems could benefit greatly if they understood and practiced the concept of “previewing expectations.”

As a long-term patient there were many hours, days, weeks and months that I had time to think – a lot. I often felt that I was in a continuing state of not knowing. Not knowing about what the next procedure might be. Not knowing when I’d be able to breath on my own when I was coming off the ventilator (super scary). Not knowing when my family or friends might be visiting? Not knowing when my doctor would do his or her rounds and not knowing if they’d share any good news that day. The list was endless.

There were sometimes I’d be told something was going to happen – but it was hours or days later when it did. Like being told I’d be off the ventilator the next day and it was four days later when that happened. That’s very unnerving to patients as well.

Imagine if – in the healthcare market – if every patient and their family members had expectations previewed for them so they had a good idea of what to expect – at the very beginning – during intake – or even pre-admission -- for example? What if the previewing of expectations continued during their (hopefully short) stay and prior to discharge?

When people know what to expect their anxiety levels decrease – their stress goes down. When stress diminishes, so do anxious conversations, demands and complaints to and about medical and non-medical staff. Money is saved and patients are more content. It’s a win-win-win scenario. Stays may be shorter and readmissions might go down.

Knowing what to expect and what may be needed – a family member or friend to be with the discharged patient, medical appointments that need to be kept, open lines of communication with a doctor or medical personnel with a phone number that someone will answer the call to answer your questions, are all helpful in shortening stays, increasing satisfaction and decreasing recurring admissions.

More communication – even repetitive communication – helps patients and family members better understand what your expectations are, and can prepare them mentally and physically for what’s to come. Taking the time to communicate and preview expectations allows for more positive outcomes.

What are you willing to over-communicate to your patients and their family members today?

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