It has long been speculated that a patient’s (or their family’s) disappointment with the care they receive in the healthcare system is a key driver for complaints and sometimes even litigation. An important risk control measure to counter this potential effect is to ensure that patients and their families have appropriate education about what to expect. This will help develop realistic expectations about the care they will receive and the possible outcomes.
In an article published in Psychology Today titled “The Danger of Having Unrealistic Expectations,” Dr. Alex Lickerman, M.D. (2010) describes four basic scenarios regarding expectations and experience:
- Low expectations and a poor experience – the low expectations can lessen any disappointment if there is actually a less than positive experience or outcome.
- Low expectations, but a good experience – a “pleasant surprise.”
- High expectations and a good experience – an experience that actually lives up to one’s expectations and is therefore satisfying.
- High expectations, but a poor experience – the individual ends up highly disappointed and oftentimes angry and traumatized.
Lickerman explains that, “Our expectations of our experiences dramatically color not just how we experience waiting for them but the experiences themselves.” Not everyone sets expectations in the same manner and different strategies are better suited for different types of people. So, how can your organization establish realistic expectations in light of this variable?
Expectation Education
The idea of establishing realistic expectations has been used in the acute care setting, particularly as it relates to surgical procedures. In an article published by the American Academy of Orthopedic Surgeons (2009), S. Jay Jayasankar, M.D. states, “The expectation model of patient education, with its focus on developing realistic expectations, is good medical practice and a risk management tool….leading to increased trust and an enhanced patient-physician relationship. The latter, in turn, improves quality and risk management. It is all about expectations!” This “expectation education” model can be translated into other healthcare settings.
A patient’s expectations depend not only on the material they receive upon admission, but also on the way they take that information and transfer it into a personal belief. That may depend on their past experiences, input from friends and family, and even the marketing materials they have seen from your organization or other healthcare entities. First impressions are often the most important, so introductory visits and the admission process may be the best opportunity you have to set the expectations of the patient/resident and their family. Take time to communicate realistic expectations for the course and eventual outcome of treatment.
Involving patients and their family members in goal setting increases their awareness of what functional improvements (if any) can be expected during the course of treatment and what interventions are best suited for goal achievement. By working with the patient and family to set realistic goals, the team can help shape those expectations, beliefs, and perceptions to match what is reasonable and attainable.
Setting realistic expectations starts with an explanation of what services the organization can and cannot provide and what staff can and cannot do. For example, explaining to the resident and their family that certain residents may be required to move into a supervised setting because they are no longer able to live independently provides valuable information and sets a more realistic expectation. It is also helpful to have a dialog with the resident and their family regarding the changes they may experience as a result of the aging process and moving to a new environment
Best Practices for Establishing Realistic Expectations
Establish clear guidelines on services provided, levels of care, and any limitations based on that level prior to admission.
Provide a mechanism to educate and inform patients/residents and their families/caregivers about any policies that directly affect them.
Maintain open communication lines between staff and families; encourage questions and allow for honest answers about changes in health status and abilities.
Build and maintain a foundation of trust and mutual respect.
Conclusion
Developing realistic expectations between the patient/family and the caregiver will help deliver positive outcomes for all parties. Open communication, participation in patient goal setting, and understanding of services to be provided will help patients and their families have a more realistic sense of what to expect, helping to better shape their overall experience.
References:
Lickerman, A. (2010). The danger of having unrealistic expectations. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/happiness-in-world/201003/the-danger-having-unrealistic-expectations
Jayasankar, S. J. (2009). Patient expectations: How do they matter? American Academy of Orthopedic Surgeons. Retrieved from https://www.aaos.org/AAOSNow/2009/Mar/managing/managing6/
