Connection Fosters Empathy

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast, exploring empathy and patient experience. I'm Steph Bayer, senior director of the Office of Patient Experience here at Cleveland Clinic in Cleveland, Ohio. Dr. Adrienne Boissy will be stepping down as a show's host, and I'll be assuming hosting duties at this time. We want to thank Dr. Boissy for all of her work on this podcast, and we're excited to continue to delve into the human experience in healthcare. Today, I'm very pleased to have Paul Kuzmickas here. Paul, welcome to Studies in Empathy.

Paul Kuzmickas: Thank you. Thanks for having me.

Steph Bayer: Paul has worked as an attorney in Northern Ohio for over 15 years. In his current role, he's the director of the Ombudsman department at the Cleveland Clinic. The Ombudsman department is essentially our patient representative group. They hear complaints, they respond to patient requests, and they also receive compliments. Paul's also an adjunct professor at law at Cuyahoga Community College. Good to see you, Paul.

Paul Kuzmickas: You as well.

Steph Bayer: So ordinarily, I would ask a guest how they came into healthcare, especially after a career firmly rooted in law, but in your case, I know a little more, and I might even be part of the guilty party that tricked you and brought you in here. We met, what, 20 years ago, when we were in law school? We were seven at the time, and I know of your amazing people skills and recruited you into a role like this. Could you have imagined 20 years ago that this is where you would end up?

Paul Kuzmickas: Not really. I envisioned myself in Los Angeles. I probably should have guessed it would be something, though, communication based, helping people-type role. As you probably remember, there are many in law school who just camped out in the library all day and night. And, I think probably some had a sleeping bag and a stuffed animal in their cubby, but from what I recall, I think you and I were a bit different. We got out more, we had more of the law school experience by getting to know people, being leaders, and some of the clubs and organizations and tried to bring fun into that stressful law school environment, and I think, somewhat, that's what we do here. There's so many people in a hospital that are sad and stressed and getting burned out and we try to bring some resiliency and bring the fun, make fun of each other. Usually, you making fun of me, and intentionally bring some of that levity to a stressful environment like healthcare.

Steph Bayer: I think it's a great way to look at it. And yeah, we were not always the most studious, but man, we were the coolest, in my head. Hey, I might be guilty of recruiting you in here and given your people skills, it was a great choice in my part. What has made you stay, though? What's the passion for patient experience that you currently exude? How did that come into play?

Paul Kuzmickas: It's probably cheesy, but I think fundamentals, at its core, I think it's good, old-fashioned customer service. One of my first jobs was being a bagger at a grocery store and carrying the groceries out for all the people that came and bought their groceries there. Stuff that comes from my family, I think, just that good old-fashioned being there for people. And I think some people may have lost that along the way. I think that's some of the problems we have in society today and the ability to just be kind and put someone else first, it's kind of like holding the door for someone or allowing someone to have your seat on the bus that needs it more, but on a much grander scale in patient experience, we're holding the door to healthcare for patient after patient, or we're giving them a seat on the train to wellbeing, things like that, I guess. And, we don't just talk to them, which I think is the other important part.

Paul Kuzmickas: We hear their story, and we do something. We don't just say "have a nice life, thanks for telling me about that", and then move on to the next one. I think of one recently where, during COVID, we had to have some restrictions on visitation, and there were cases after cases after cases, where fathers and mothers and other family members were reaching out and contacting us that they were having their very first ultrasound and seeing their baby for the very first time and how to do that alone. And, that stood out to us that maybe there's a gap there. We restricted some of the visitation to some of the necessary things. And, in the heat of the moment, you don't really think that some things are necessary, but to a mother and a father and another mother and a grandparent and husband and husband, or wife and wife, whoever it is, that's important to them in that moment to have that opportunity to be there together for that very first ultrasound and hear the heartbeats for the very first time. So, we pivoted and made changes and worked with leadership. We're lucky that we have such strong leaders at the Cleveland Clinic that respond to the Ombudsman office and some of the complaints that we hear and are willing to pivot and make a change and do what's right in those times when we have the ability to do so.

Steph Bayer: Yeah. That's a really great point that we're not just hearing complaints, but we're actually taking actions. And, that's a really powerful thing to be entrusted with. I love that you see that and that your kindness, which isn't always a quality that lawyers lead with, comes through. One of the things as I think about though, making the changes and the visitation example you laid out is perfect. It's really important when we can make a change, but sometimes we can't. And, one of the things I see most in talking more about COVID and how the job has changed a bit during COVID, are things like masking. People don't always want to mask and that's become very controversial. Is that something that your team struggles with in messaging? How do you support people with masking? What do you do to make it easier for others?

Paul Kuzmickas: Yeah, it's definitely been a hot topic, whether it's the masking, whether it is the vaccine. Lots of different elements of healthcare have unfortunately leaked out into political landscapes or other areas where, at the Cleveland Clinic, we try to follow science-based principles, and others, who maybe get their medical degree on Facebook, which happens all the time, I heard it's a much cheaper way to do it, have different philosophies or different ways of things. So, as a big part of the Ombudsman office, we don't want the caregivers to have that burden. You're delivering care, you're the nurse, you're the doctor. You want to have that good patient-physician relationship, and you don't always want to be the bad guy. So, that's one of the things that the Ombudsman office prides ourselves in, is coming in, in that moment, and helping you to stay clinical, provide care. Maybe you see something and you call it out, but the Ombudsman office can be there to really be that support, whether it is for masking or any of the other things.

Paul Kuzmickas: So, it's definitely something that's grown a ton during the COVID timeframe. We want to make sure that both patients and caregivers, visitors, that everyone's safe. So, we're really here to tough love a bit on some of those. It's a bit rough, it's hard for the Ombudsman office. At times, we hear the worst of the worst and the saddest of the saddest, especially when it all started. But, we're just here to try to provide support wherever it's needed. I remember when COVID first started and we started doing COVID tests, the Ombudsman office and you yourself as one of the leaders in patient experience was there to help work the COVID testing lines. And, we had way more people that wanted to be tested than we had tests and yeah, we could have the doctors or the nurses, or whoever's working stand there and send all these people home.

Paul Kuzmickas:  But, we decided as patient experience that we were going to step in and put a lot of that sadness on our shoulders. And we were the ones that have to tell mother and father and grandparents that "no, I'm sorry, you don't have the right paperwork", or whatever the case may be, that "you're not going to be able to get a COVID test today", and have to send those people home and see them cry in their cars and be scared and upset and not know what to do or where to turn next. And, we really tried to step up and carry that load on our backs so that a lot of the other caregivers didn't have to. Same thing with visitation. I remember the very first day that it came out, that we had to close the doors a bit and restrict visitation.

Paul Kuzmickas: There were a lot of people that had come from out of town or drove a while to get here, and hadn't heard that yet, and hadn't really been warned ahead of time. So, instead of a random caregiver screeners working the door or police standing at the door, sending people home, we made sure that the Ombudsman at every hospital, took the time to stand at the door that whole day and really help provide an empathetic way to unfortunately break the news that we have to send you home and the patient can come in and receive care, and we'll make sure they get to wherever they need to get to. But, unfortunately, the visitors are unable to stay. And, really being able to do that and communicate that in a way that is so hard and so difficult for that visitor. But, I just can't imagine how harder it would be if someone cold or cranky or in a bad mood had to deliver the news. It's one of the good things about the Ombudsman office is just having that extra communication, interpersonal skill ability to know how to deliver the saddest news in a way that at least feels supportive.

Steph Bayer: That's a great point. I remember back in March 2020, the one you were referring to where we did not have enough testing at that time. And, we had very limited criteria, and I remember you, me, our chief experience officer, we were masked-up, faces shielded-up, putting our heads near people that were terrified and telling them that today's not the day you're going to get this. You don't qualify based on this. And, the fear in people's eyes. It was really, really tragic in that moment. And I realized our job, it had changed. I also remember, as a leader and someone who cares about my team, including you, the weight that had on me and how concerned I was about our teams and making sure that our teams felt supported, because we're asking them to stand in the front and to give some the bad messaging that people weren't ready to hear, and how expectations for healthcare had changed. How do you find ways to show your team that you're with them? I've seen it literally show up, but how do you show them that we're in it together, and there's a connection? What are some things that you've done, especially during COVID?

Paul Kuzmickas: There's a variety of things. I think one of them is we broke the entire Ombudsman group across the enterprise, including our triage coordinators, nearly 40-something people into four different teams with a senior Ombudsman that heads each team. So, you have a group that you can turn to, a smaller group. They provide support. The senior Ombudsman has one-on-one visits with each of those team members. And they do fun challenges or competitions amongst the teams so that it provides support, but also fun competition, a variety of different things. We also try to stay social. We were very social pre-COVID, whether it's going as a team to Docapalooza or various events off campus. Right when COVID was starting, we had to cancel a big Ombudsman escape room trip that we all had planned.

Paul Kuzmickas: So, keeping that social, that support, that fun during COVID was difficult. So, what I decided to do was host virtual trivia. On multiple different occasions, I took the time to find and come up with a bunch of trivia questions that were fun and goofy and silly, but like also challenging. Sometimes I wore game show outfits and shaved a funny game show, seventies, mustache onto my face, had fun backgrounds and did Zoom virtual trivia night. And, it became a thing which was cool. I ended up hosting one for philanthropy. I ended up hosting one for Dr. Adrienne Boissy and a team of all-executive team leadership that wanted to do one. So there were a whole bunch of different ones that we did. And sometimes it got mixed up and it was Family Feud or Jeopardy or a variety of different things.

Paul Kuzmickas: We did a Name That Tune one where I just played a bunch of random songs and people reminisce about all their favorite songs from the 1990s, before you and I were born, of course. And so that was really fun. So, we kept it virtual and did as much as we could. As things start to open up, we've expanded a bit. So we had a shuffle board night, so we all went out and went to this Forest City shuffle board close to our area and socialized a bit. We did top golf. So we all went out and had our masks and got in our different separate bins that you get. And they only let you have certain number in the area. And we did a fun top golf event. We have a chili cook-off coming up that we had to cancel, and we have a silly trophy that we pass around and you get to hold it, proud on your desk when you win the chili cook-off trophy. So we try to, or at least I tried to, with my leadership team of seniors, do as much as we can to provide support, but also provide fun to keep that resiliency going as much as you can.

Steph Bayer:  I think you did a phenomenal job. I joined some of these events and I had a great time. And, I think you're right on the money that by creating these connections, the connection guards against burn, the connection fosters empathy, and you do a phenomenal job instinctively of finding ways, even in virtual settings of spreading the connection. So, I'm glad that you do that.

Paul Kuzmickas: Yeah. I think it really helps with teamwork when you have trust. And I think you have trust and build trust when you can kind of get to know each other a little bit on a personal level. So we really try to focus on that.

Steph Bayer: That's so true. Shifting gears a little bit, sometimes when trust is broken, especially when patients and visitors don't feel they can trust a healthcare setting, workplace violence can increase. And, I know you've been very involved in our workplace violence efforts. Can you talk me about your work with workplace violence and how our organization can create a more supportive work environment?

Paul Kuzmickas:  Yeah, definitely. I think partly it starts from the top down. Our CEO said in a town hall, even before the pandemic, that workplace violence in healthcare was a national epidemic, and really put a heightened focus on it. I am part of the enterprise workplace violence committee and we have a workplace violence committee at every regional hospital. There's an Ombudsman in every workplace violence committee in every regional hospital, because we really want to be there. I alluded to it earlier with some of the things we do. We're not just here for the patients and their visitors and families, but also here for the caregivers. We really want to give them empathy and give them support. So, workplace violence is an important aspect of that. We work to create this new workplace violence database, so that there's a one true source for everyone across the enterprise to quickly and easily log workplace violence events.

Steph Bayer: So, this is like serious safety events, and when people fill in, they have one form and it goes to all the right parties?

Paul Kuzmickas: Correct. So, rather than people being unsure of how to report workplace violence and therefore they don't ever do it, we created and educated the enterprise on this workplace violence page where they could go and report that. And, every single one of those gets followed up on. So, the Ombudsman office documents every single case that gets put in. We want to make sure that if a patient misbehaves or a visitor misbehaves in Lutheran Hospital or goes down to Medina hospital, or it gets cold and they are snowbirds and winter and Florida, and they misbehave at Weston in Florida, that we are able to look across the enterprise and see the previous history of workplace violence event for each and every patient and visitor. We don't want a patient to misbehave at one hospital, and then no one knows about it at any of the others, so they have no ability to respond or be prepared.

Paul Kuzmickas:  So, we have a serious safety flag that we work to create that's part of EPC, so that every caregiver that opens a patient's chart can see guidance and tips on how to be safe based on a previous serious safety event of a patient. We try to save these for the most serious of safety events so we're not labeling patients or prejudicing them in any way, but we want to make sure that if something bad happened, whether it's violent or whether it's more of a sexual nature and someone who maybe inappropriately touches different caregivers, we want to notify everyone about that too. So, it gives guidance on what to do, and then we're there for them. Again, we log every single one. We reach out as needed. I'm part of an SOS team for moral support that can go out and help the victim.

Paul Kuzmickas:  We work really closely with our victim advocate to make sure that not only are we paying attention to the person who committed workplace violence and making sure there's some sort of follow-up for them, again, it's not swept under the rug or just logged into the cloud somewhere, but also therefore the victim of that workplace violence and make sure that they're receiving that support that they need. They know how to reach out to it, and I think that's really helpful because as a caregiver, if you don't know that something's being done about it, both to the at fault person and in support of you, then you're going to have less trust in your organization and feel less safe in your job. And I know at the Cleveland Clinic, trust, safety and support is a big thing that we want to provide to all of our caregivers. I've seen and heard the worst of the worst. When I was in college, I worked in retail at the GAP during Black Friday, and I know when people don't get their right size khaki, they can get pretty upset. So, we incorporate all kinds of different principles that people have from all their variety of backgrounds before becoming an Ombudsman to make sure that we're here provide safe support in conjunction with our Cleveland Clinic police department who are amazing for all of our caregivers.

Steph Bayer: Yeah. And we also work closely with our spiritual care team. They do Code Lavenders. So after the event's over your team, not only creates the safety flags, but the Code Lavender can attend to the emotional needs of the team and they can offer holistic support. It's really a wonderful– when you mentioned SOS, it made me think that there are a lot of folks at this organization that are trying to attend to those workplace violence events in the aftermath. And, with workplace violence, there are some studies that are suggesting incivility and actually workplace violence has been increasing during COVID. Have you noticed anything in your data that suggests that is happening here?

Paul Kuzmickas: I think it has greatly. I know one of the things we do when there's workplace violence events often is a written behavior agreement. So, we want to give patients and visitors the benefit of the doubt a bit, maybe they don't understand or realize that their behavior was inappropriate. Sometimes they're extremely stressed out because of the scary healthcare situation they're involved in. So, we try to give them a warning and sometimes we put that warning in writing. And, I think we looked back at some of our data and had gone from like 17 of these pre-COVID to like around 185 of them in the past year. So, just that many more patients and visitors acting out. We've had to restrict visitation. Sometimes, they have this one designated visitor and we have to restrict it so it becomes somebody else, because of this behavior and making sure that we're keeping people safe.

Paul Kuzmickas: Sometimes it's the stress of the ailment. Sometimes it's the stress of COVID. Sometimes it's the stress of being the one low visitor and seeing your loved one sick day after day after day, and no matter what it is, it doesn't mean it's appropriate. So, there's that fine line that you have to balance of being there to support the patient and their loved one in their time of some pretty severe, scary, stressful situations, but also letting them know what's right, what's not right, and what's appropriate. So, I think, to answer your question, during this time, we definitely have seen a pretty high increase, unfortunately, in these workplace violence events.

Steph Bayer:  What I heard you say is, as you were answering that, and I would just want to call out again, because he gets so important, is that we have, for instance, behavior contracts, agreements, we have ways to help start with expectation-setting. Sometimes, the expectations aren't aligned, in fact, very often what a visitor or what a patient expects to see from a healthcare organization is not what the healthcare organization expects to be responsible for, and that can cause the escalation and the misunderstanding. And, I think it's a really lovely service that often you start with that "let's explain, help me understand what's happening. Let's get this clear for all of us before we necessarily take punitive action". And, I want to commend you for being curious, because that's really important.

Paul Kuzmickas: We definitely want to provide the support and be there for them and try to restrict even if we have to in the least restrictive way possible at first and give people a chance. I know there was a husband who had been a bit inappropriate following nurses into other patient rooms, which during the time of COVID is obviously a safety hazard. Following nurses, into nurses stations and being a burden and impeding the care of the patients themselves. And, we had to reduce this husband's visitation to three or four hours a day. So, it doesn't have to be complete and total visitation, but somewhat reduced. Funny enough, this particular husband really wanted to bring his wife breakfast one day and that wasn't during the visitation hours that were assigned, and it was sort of a bad moment for nurses, and we got involved in a crazy case where the nurse actually happened to find him army crawling across the ground, past the nurses' station, dragging a soft cooler, attached to his foot behind him that had her breakfast because he really wanted to bring it to her that day. And, fortunately, or unfortunately they saw him army crawling past the nurses' station and had to stop him. I think they probably let him give her breakfast to her that particular day, but we had to have a conversation with him about again, boundaries and what you can and can't do. So, there's a lot of crazy, crazy things we get involved in both during COVID time and beforehand.

Steph Bayer:  It's fascinating. And, it speaks to how important it is for people to connect and the concern. So, we're talking about workplace violence, we're talking about visitation, we're talking about having to reinforce the same policies like masking again and again, and how you also make time and show up for your team. How do you show for yourself, Paul? What do you do to decompress after work and make sure that you refill your bucket?

Paul Kuzmickas: That is a good question. I need my bucket refilled from my bucket refilling. I have five sons and they're in every sport possible, and I coach almost all of them. I think right now I'm coaching two different football teams, a tackle and a flag. Basketball starts next week. So, I do that, it's a good outlet for getting away and taking your mind off things. I feel for all the teachers of America that deal with the youth daily. But, like I said, sometimes I need an outlet from that outlet because it could be a lot and stressful, in a different way, of course. I'm a big fan of movies. I like to go to the movies often, even if I'm just by myself, I'll go see whatever's coming out. I read a lot of books, sometimes intellectual, great stuff. Like 'The Truth about Employee Engagement' that Dr. Jim Merlino gave us all as a gift, which is a great book, or cheesy stuff like the newest Game of Thrones or Star Wars book or something like that, to balance those out. And, I'm super passionate about Cleveland sports as well, which also can be its own level of stress at times. But, I think those are some of my bucket re-fillers.

Steph Bayer: Well, this helps explain why I see you with energy drinks so often. Paul and I have an ongoing argument about his energy drinks.

Paul Kuzmickas: Yes, I have that with my wife also.

Steph Bayer: If you were to distill all of your vast patient experience, knowledge, everything that you know, into just a few sentences as we wrap up, what wisdom would you want to leave people with about how to make sure that they see patients and that they help patients?

Paul Kuzmickas: I think empathy, if everyone's being honest, can be hard. Some may say "we're stressed out ourselves, we're burned ourselves, do we have the bandwidth to put ourselves in someone else's shoes?" But, although empathy can be hard, I think it's necessary. We have to take a step back and be the parent, be the bigger person. It's like a game of Jenga. If you come into a situation with a bad attitude and start pulling pieces away, the patient and/or visitor's going to respond with a bad attitude and the whole thing's going to fall. But, if it's the opposite and instead of pulling pieces away, we're putting pieces on and building that support and building that base and building that structure, even if on the inside, we're not feeling it, just putting on those acting shoes and being the leader, being that empathy leader, being kind and being there for each other first, taking that first step, I think it really helps. So, I think that's my biggest statement, is just be the bigger person, be the person that takes that first empathy step for everyone else.

Steph Bayer: I think that's a great, great thing to leave it on. And, you certainly take that first empathy step with your team and with our patients all day. And, thank you.

Paul Kuzmickas: You are welcome.

Steph Bayer: This concludes the studies and empathy. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcast. Thank you for listening. Join us again soon.