Better care requires consideration of individuality

“The (hospital room) environment is as important to the family and the patient as the treatment of the disease, the assessment and the aftercare.”

—Raelene Brooks, dean of the University of Phoenix College of Nursing

When I help a company make big changes, I always ask if they believe that change starts with the environment (the overall company culture) or with the individual. It’s a bit of a chicken-and-egg question. An individual leader who wants to take a more personal approach may encounter organizational systems that get in the way because those systems don’t take into account what’s important to the individual (i.e. values, beliefs, skills, etc.). Likewise, new organizational systems will only be successful if the individual employees are ready and willing to use them.

So I was deeply touched by the wisdom that Raelene Brooks, Ph.D., dean of the University of Phoenix College of Nursing, shared with me at the 2024 Healthcare in the Age of Personalization Summit. She helped me open the second day of the summit with a conversation that connected the employee-focused themes of day one with the patient-centered themes of day two—and revealed the importance of personal stories in helping us respect each other’s individuality.

This article is the eighth in a 14-part weekly series where I’m sharing insights from the summit. We heard from a wide range of healthcare experts – leaders from all corners of healthcare organizations, from the boardroom and executive suite to the bedside. We covered topics such as why personalization matters, how we can shape our organizational cultures to facilitate it, what leadership skills are needed, how personalization is achieved when people know they matter, and how you can incorporate personalization into your employer brand.

In this session, I interviewed Dr. Brooks, who has been in nursing for 30 years and spent over 17 of those years as a nurse in a Level 1 trauma unit in downtown San Diego before transitioning into education and earning a Doctorate in Nursing Science.

“My mom was a third-grade teacher and my brother is a seventh-grade teacher of autistic children. I think teaching is just innate,” she said. “I spent a lot of time in my younger years thinking about how I could make a bigger impact in nursing. I taught all the newly graduated nurses when they entered the trauma unit and I realized the reach (as a teacher) is greater.”

Dr Brooks said she has also begun to recognize the barriers and limitations in the way nursing education focuses on the essential skills needed to provide quality care, while ignoring important skills related to knowing how to see a person in their full humanity.

Why is this skill so important? Because recognizing patients as individuals—including their values, fears, and family dynamics—can pave the way for a more comprehensive and effective approach to personalized healthcare.

The personal story is important

Through her upbringing, Dr. Brooks learned to deal with individuality despite differences.

“My father joined the US Navy in 1963, and at that time immigrants from the Philippines were only allowed to be stewards for the US naval officers. He had 12 brothers and sisters and a mother who was a widow, and he did it to support them.”

Her grandmother later immigrated to the United States at the age of 51, knowing only three English phrases: “yes,” “no,” and “thank you.”

“My father was stationed at the Naval Postgraduate School at the time,” she said. “He was able to rise through hard work and – I’ll be honest – through a lot of discrimination in the system and get through the Navy system and become an engineer.”

She said he was able to bring six brothers and sisters with him, and they shared a small house in Monterey, California, with their grandmother – 10 people in total.

“You can imagine that there are 10 people living in one house and multiple generations living together – compassion and respect for each other was required,” she said. “I learned that early on. And that really carried over into my nursing practice.”

I share so much of their life story because our personal story says so much about who we are and how we work, but we’re not often encouraged to bring those parts of ourselves into the workplace.

Going beyond the boundaries of school lessons

Dr. Brooks shared a story that demonstrated how personalization can help healthcare providers confidently meet the individual needs of their patients. She recalled a former trauma patient named Ernie who ended up in the emergency room at least twice a month.

“I remember Ernie as a young ICU nurse,” she said. “He was a veteran. He was retired. He always came to the emergency room because he would fall off a very high bar stool while drinking at a bar near the hospital. Long-term drinking can cause brain shrinkage. He fell (and) hit his head, and we had to do a CT scan and all kinds of tests to make sure he didn’t have a brain bleed. After four or five times, I said to the paramedics who brought Ernie in, ‘Can you ask the people at the bar to put him on a chair?’ They didn’t.”

Ernie ended up in the emergency room again.

“One day after work, I went to the bar in my scrubs and said, ‘My name is Rae. I’m taking care of Ernie. I need you to put Ernie on a chair so he doesn’t fall so high off the floor.’ I hardly ever saw Ernie again. That gave me a lot of strength and made me realize that there was a way to really make a difference outside the confines of what I learned in nursing school.”

In nursing school, the focus is almost exclusively on policies and procedures.

“It’s limiting and formative,” Dr. Brooks said. “What we don’t learn is the part about the family and how the practices in every family are very different. And you have to be respectful and understand the background of the patients and why 12 people want to be in the room for a Code Blue or three people want to be in the room to sleep with the patient.”

In the previous articles in this series summarizing previous sessions of the Summit, a recurring core message was that our organizational systems in healthcare have depersonalized us. We spend so much time learning the technicalities of our roles—whether we’re doctors, nurses, or even administrators—but we don’t develop the same ability to see patients and staff in their full humanity. That’s a skill that doesn’t necessarily come naturally. We have to cultivate it.

“We teach policies, procedures, safety, how to administer, treat and assess,” Dr. Brooks said. “But the part about caring and compassion, we thought the students would already bring that. Frankly, we need to teach that.”

When Dr. Brooks was a new professor, she was making her rounds in the clinic with 10 students. She entered a patient’s room and saw that it was messy. She took the nursing student aside and asked him how he thought the patient was doing. The student responded by telling her everything he had done: the standardized list of things required of a nurse in that situation.

“I told him, ‘Excellent, great work. Now I want to ask you something. Can you do me a favor and take a look at the room?'”

Dr. Brooks described the room as having tissues, cups and straws on the floor and the patient disheveled. She asked the student, “How would you feel walking into this room if this was a family member?” Again, the student only saw what he had been trained to see and said the patient “looks fine, he’s safe, his vitals are stable.”

He relied exclusively on the medical model. Focusing on the medical model is of course good, but it is incomplete.

“I said, ‘Okay, but let’s talk about the environment. Would you want to walk into the room and see your mom or dad in that kind of environment? Remember, we’re in the business of holistic healing. We want to create an environment where patients can get well and recover. And I don’t think that’s the environment your patient is currently in.'”

Dr. Brooks said if she could make a big difference, it would be “to make the environment for the family and the patient as important as the treatment of the disease, the assessment and the follow-up. That is a mission of compassion, a mission of caring and healing in the bigger picture.”

Watch this short video to hear more from the panel.

Next time: Navigating the unknowns of healthcare.