Patient goals all that really matter in health care

Lawn

 Where do you want to be in five years?  How fast do you want to run your next 10k? What promotion do you want to earn?  We all set goals, in both our personal and professional lives. Our parents, coaches, and bosses all tell us that we must set goals if we want to reach our full potential.

Goal-setting is also important in health care. For example, studies have shown it can improve communication and understanding among care providers working in an Intensive Care Unit.  Setting goals may even shorten the duration of the patient’s stay.

Last Friday I started another week of ICU clinical service in Saskatoon.  I took over the care of someone who, during my first bedside visit, seemed just like any other patient that I’ve looked after during my career.  But this patient clarified for me the true value of setting meaningful goals with our patients and their families.

It’s my usual practice to create a list of daily goals for each patient as we complete our morning rounds.  Every morning we meet at the bedside of each patient. Often the patient’s family joins us too.  Each team member presents his or her assessment, then together we create a plan for the day, to address the identified problems.  By the end of the group discussion, we have a list of daily goals for the next 24-hour time frame on the whiteboard next to each patient’s bed.  These goals solidify and help communicate the plan, making sure we all know what each team member needs to contribute that day.

On Saturday morning I came in to the ICU and started rounds. When I entered Mrs. C’s room, her daughter jumped up with excitement and said, “Look at what Mom wrote for you!”  She showed me a piece of paper on a clipboard, with two goals written in somewhat shaky writing.


“Heal this broken body. Cut grass.”  Those are two Big Hairy Audacious Goals. They are emotionally compelling, strategic, and require time, effort, and commitment from the team. Now we knew what she wanted to achieve.  Now we could relate to who she was before she became “my patient.”  Now she was a real person, with a real life. Now I, along with all the nurses, respiratory therapists, and physiotherapists, all knew what she wanted to do, where she really wanted to be.

Mrs. C gave me permission to take this photo and share her story.  When she heard me set her 24-hour medical goals, she decided to do something much more meaningful: tell me what she really wanted to achieve.

At this point in her stay she had been in our ICU for three weeks.Before she was admitted to our hospital, Mrs. C lived fairly independently in her own home, supported by her loving kids and grandkids.  Her greatest joy was cutting her grass.  She wanted to recover enough to get back to her farm and tend to her land.

The following Monday one of Mrs. C’s sons returned to our hospital from a brief visit home.  He had stopped by his mother’s farm to take photos of the grass she longed to cut.  In my head I had imagined a small lawn.  But what his photo revealed was Mrs. C loved to jump on her riding tractor mower to tend to a huge farmyard full of grass!

The daily goals I set with my team focus on the medical management: a negative fluid balance, a specific level of wakefulness, followup with a pathology report, moving to the next step on the ICU mobility protocol.

These goals are important. They provide direction for the ICU nurses and therapists. But they aren’t inspirational or motivational. They are simply small steps that must be taken to get us to what really matters: the goals set by our patients.

Photo credit for lawn image: AdamKR

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9 Responses to “Patient goals all that really matter in health care”

  1. Cindy Dumba
    May 30, 2012 at 10:09 am #

    Hi Dr. Susan Shaw, It’s with great pleasure and a little sadness that I read your wonderful stories. Both of my parents had spent many months collectively in hospital prior to their deaths in 2006 and 2010. Their care while in ICU was always wonderful, but so often, as patients, they felt ” talked over” rather than ” talked to.” RQHR is making great efforts to improve patient family oriented care. How I wish my mom and dad could have had a doctor come in and speak directly to them, ask them questions, talk to them about goals! It is so important to a patient and their families to be part of their own health care team. When clear goals are set, the days, hours, and minutes in hospital are so much easier to get through. Thank you for the wonderful work you’re doing. Cindy

    • Dr. Susan Shaw
      Dr. Susan Shaw
      May 30, 2012 at 1:22 pm #

      Hi Cindy. Thanks for adding your story to the conversation. Too often we default to “talking over” rather than “talking with” our patients and their families. Being open to different types of conversations hopefully can improve the care we provide to our patients and the personal satisfaction we can gain from working as part of a team.

      And you are right, there is so much good work being done across the province to improve the patient experience. As a patient advisor, I’m sure you see great opportunities to push us further!

      • Cindy Dumba
        May 30, 2012 at 1:56 pm #

        “Talking with”……..is a much better phrase. Thanks for responding. I’m thrilled as a patient advisor to be part of this process, and to witness positive change. As an avid advocate for my parents while they were in and out of hospital, it was sometimes very frustrating (and sad). It does my heart good to see the efforts of so many good people as our system moves toward patient and family centered care. Initiatives and policies are all fine…..but it takes good “people” to carry them out! I enjoy reading about your wonderful efforts with your patients. I know for sure you are making a difference ( a welcome one) in the lives of your patients and their families.

  2. Nancy Klebaum
    May 29, 2012 at 10:16 am #

    My father was a patient in RUH’s ICU for 3 weeks this winter. The care he received was genuinely compassionate and patient and family centred. The “whiteboard” was not used until the last of his stay following heart surgery but it was an amazing tool: simple, easy, but very meaningful to us as family. We saw clearly the goals that the staff had for him each day and those were our goals as well.
    When we attended rounds each day, it was so reassuring to hear the goals that the team had for his care. It felt like the plan was clear, understood by everyone and doable. These goals gave us a compass by which to measure his progress and to help us understand when adjustments had to be made.
    Goals that are understood and shared by the person providing the care as well as by the client/patient are far more likely to be accomplished, than those that we as “professionals” decide are the right ones to focus on.
    Thanks for a great story.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      May 29, 2012 at 10:26 am #

      I hope you are all doing well after what must have been a difficult winter. Thank you for sharing your personal experiences with goal-setting in the ICU. Its great to hear what impact these conversations have on our patients and families.

  3. Heather Thiessen
    May 28, 2012 at 9:15 pm #

    What a wonderful story and one that truly hits my heart directly. For I have been that patient in the ICU and to have a physician actually take the time to listen to my personal goals of what I would like to aspire to outiside the ICU is heart warming. I have used the white board for goal setting in the past but would have never dreamed in my times in the ICU to use this the way this lady did. For I felt that would have crossed the line and made the physician uncomfortable or wonder if they really did care, as they did have other patients to concern themselves with. Bravo to this lovely lady who dared to share her goals outside the ICU. I am insired by this and encouraged that health care professionals like Dr. Shaw actually do care about us the “patient” not only as the patient but as a partner in the team to get better and be able to probably graduate home faster too.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      May 28, 2012 at 9:37 pm #

      Thanks so much Heather (and who would have guessed two commenters in a row would have the name Heather!)

      We need to work together to make it easier for patients, their families, and healthcare providers to have open conversations about what matters to patients. Any ideas on how best to make this happen would be greatly appreciated!

  4. Heather Hedstrom
    May 28, 2012 at 8:30 pm #

    This was a great example of compassion with medical care. I applaud you looking at the patient as a contributing person in their recovery rather than just the subject. This was a great story and a source of my renewed faith in Saskatoon’s medical care system.
    I have had family experiences where there have been too many questions as to “what is the next step”. Goal setting and a clear, perusable plan is needed but not always defined.

    • Dr. Susan Shaw
      Dr. Susan Shaw
      May 28, 2012 at 9:09 pm #

      Hi Heather – thanks for your comments. Your description of healthcare workers seeing a patient as “the subject” is, unfortunately, all too true all too often. Part of providing patient-centred care is having these important conversations where we determine goals and actionable plans together

      As a bit of an aside, when I started my training in ICU medicine way over ten years ago (!) most ICU patients were unable to communicate as we used far more drugs to sedate them. We thought that was the best care. Since then we’ve learned that patients have better outcomes when they are less sedated. And I’ve learned that my career is far more rewarding (and actually easier) now that many, if not most, of my patients are comfortable, safe, and able to talk with their nurses, therapists, and doctors.

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