March 26, 2019

Do babies get better care when their parents say 'thank you'?

Daily Briefing

    Infants who are critically ill might receive better hospital care when their mothers express gratitude to their clinicians, according to a study published in Pediatrics earlier this month—complementing previous research that showed infant care can suffer when parents are rude to caregivers.

    Can saying 'thank you' improve patient care?

    Arieh Riskin, director of the neonatal intensive care unit (NICU) at Bnai Zion Medical Center in Israel, and his colleagues sought to determine how "[s]mall expressions of gratitude" from different sources might impact care for babies in an NICU.

    To do so, the researches assigned 43 NICU teams, each comprised of two doctors and two nurses, to simulations of common acute care problems. The teams were then randomly assigned to one of four interaction scenarios, during which physicians received:

    • Expressions of gratitude from other physicians;
    • Expressions of gratitude from the patient's mother;
    • Expressions of gratitude from physicians and the patient's mother; or
    • Neutral feedback.

    The judges who evaluated the teams were unware of the interactions the teams experienced.

    While the simulation was designed to imitate real-world scenarios, one limitation to the findings was that they are not based on a real-world experience, Reuters reports.

    Moms' expressions of gratitude have the most impact on care, study finds

    The study suggested that maternal gratitude had the biggest impact on medical team performance, primarily because it led to improved communication and information-sharing among medical teams.

    The researchers found better information-sharing was associated with better performance outcomes, accounting for 41% of the variance in therapeutic performance and 33% of the variance in diagnostic performance.

    These effect sizes were significant, according to Riskin. "[T]he magnitude of the effect is substantially larger than we ever expected," Riskin said, "explaining far more of the variance in team performance outcomes than many other patient safety interventions typically implemented."

    As such, Riskin explained, "Small expressions of gratitude originating from the patients or their families (but not from a medical authority) facilitate patient care and enhance patient safety."

    A darker side?

    But Riskin's previous research reveals a darker side of caregiver-patient interactions: NICU care may suffer when providers are confronted by rude patients or family members.

    For instance, in a 2017 study, Riskin and his colleagues simulated the effects of rude mothers on the patient care provided by 39 NICU teams. They found that teams who had to deal with rudeness performed worse on 11 of the study's measures. Affected measures included not only "diagnostic and intervention parameters of medical care, but also ... team processes—such as information and workload sharing, helping, and communication—that are central to patient care," Riskin said at the time.

    Amir Erez, a University of Florida professor and coauthor of the 2017 study, said, "People may think that doctors should just 'get over' the insult and continue doing their job. However, the study shows that even if doctors have the best intentions in mind, as they usually do, they cannot get over rudeness because it interferes with their cognitive functioning without an ability to control it."

    How to provide excellent care—even to difficult patients

    So how can caregivers do better at providing top-notch care, even when patients or their families aren't expressing gratitude—or even are being outright rude?

    In a 2016 editorial on the subject, physicians Donald Redelmeier and Edward Etchells recommended ways to improve diagnostic accuracy, including engaging in more consultation, reflection, and teamwork.

    They also suggested that providers consider using checklists or computer-assisted diagnostic tools, which can help to "restore order when a physician's thinking might be disrupted by negative emotions" (Rapaport, Reuters, 3/12).

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