Steven Littlehale
Steven Littlehale

Driving my Grandma to one of her favorite restaurants to celebrate a significant birthday (she prefers that I don’t specify which) offered me an important lesson in communication.

She was in a chatty mood, sharing stories of being a single mother, learning to drive in her thirties so that she could provide a better life for her children, etc. Usually conversations with “Gram” were less reflective and more a string of funny quips. A few years back when she went to her high school reunion (75th!), I asked her where it was held. She replied wryly, “a phone booth!”

We got on the topic of her “senior citizens” club. She explained that they were once again displaced and without a location to meet (something she said happens often, given their lack of external funding). She went on to address the impact of these displacements, sharing that it can often take months for members to “find each other” and renew their regular schedule of meetings, social activities and, most importantly, informal support.

Well, I am a nurse … and nurses solve problems. I immediately launched into problem solving mode, peppering Grandma with questions, ideas and solutions … but I wasn’t getting much response. I offered suggestions, one after another, trying to be a good grandson and solve this dilemma.

“Come on Grandma,” I thought to myself. “My shift is about to end and I have other residents to see.” Some habits die hard, and as I snapped back to reality to recognize that I was driving to a birthday dinner, I knew it was time for Nurse Littlehale to stand down.

But I really wanted to solve this problem for Grandma, although she wasn’t having any of it. She wasn’t asking me to solve anything, and though coming from a good place, I was asserting my own needs onto her. We simply were not communicating.

The truth is that some of the greatest challenges we have in healthcare today stem from our inability to communicate with one another. Effective communication drives everything from diagnostic accuracy to medication adherence and patient satisfaction and safety. Whether it’s during shift change or a care transition, the inability to communicate relevant information in a succinct and meaningful way is one of the greatest contributors to the mediocre outcomes and high cost plaguing our system today. Enter the IMPACT Act.  

The IMPACT Act establishes a common vocabulary in the form of new data and measures, as well as a standard electronic file (C-CDA) to communicate about the resident across all care settings. The information travels with the person, offering providers access to a longitudinal record, thus enabling the facilitation of person-centric, coordinated care. The IMPACT Act is poised to benefit all stakeholders by improving the efficiency and safety of care transitions regardless of care setting.

Still, I worry about the reliance on IMPACT, namely technology to “solve all.” Have pre-populated care plans led to better care outcomes? I’m not sure. From what I can tell, those organizations that make the effort to further customize these care plans by discussing them with the interdisciplinary team and with the resident/family, in essence making the plan a living document, clearly see the benefits.

Back to Grandma.

“Gram, does your senior citizen’s group have a webpage?” Silence.

“Do you have an email list or listserv” Silence.

“Do you have an online newsletter or electronic bulletin board?” More silence.

“Grandma,” I finally asked in exasperation, “how do you communicate with other members of your club?”

She simply exclaimed, “We talk!”

Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.