Teaching employees the most important skill of all: getting to know their clients

We were discussing the objectives of our training program, especially the caregiving training program. Our newest team member, Ken, asked, “What behavior do you want to see in a well-trained caregiver?”

The first thing that came to my mind was excellent observation skills. A good caregiver – a well-trained caregiver – should be able to walk into a room first thing in the morning and say, “Good morning, Mrs. Smith.”

A good caregiver should stop and listen for a response, and instantly identify the well-being of the client.

She should notice the slightly slurred words, and take the time to ask another question: “Did you sleep well last night?” and listen for the response. Maybe the person is in pain – ask a probing question. Maybe the person is ill – check her temperature and pulse.

In short, a good caregiver should know her clients so well that she can instantly tell when something isn’t quite right – and take the appropriate follow-up action.

Ken, our newest employee looked up at me abruptly and said, “That really hits home.” He shared the experience of visiting the hospital to see his mother-in-law. His wife asked the nurse, “How’s my mom today?”

The nurse responded, “She’s doing fine.”

As they walked into the room, his wife said, “Good morning, mom,” and heard her garbled response. She was clearly not “fine;” in fact, she died a short while later.

At my book club the other night, we were discussing the current dire state of healthcare in America. One of my neighbors had been talking with a British friend who said, “The trouble with you Americans is that you do too many tests. Doctors, nurses and caregivers are no longer trained to really listen to the person and observe. Just send out for another test – that’ll tell you what’s wrong.”

Another neighbor shared, with passion, her experience during the last few hours of her mother’s life. During that final hour, three specialists had come into the room, each reporting, “Good news!” One specialist reported that her mother’s blood work was good – “do you have any questions for me?” An internist reported that a bone scan looked good – “that’s great news.”

All the time, the family knew their mother was dying, as she lay unresponsive in the hospital bed. They felt angered and frustrated that so many people looked at only a part of their mother’s condition; not one of the physicians involved looked at their mother as a whole person.

When I think of a caregiver I’d like to clone, I think of Dianne. She only had a high school education, but had worked as a caregiver for her entire career. When she worked for us, we promoted her, ultimately (after about 12 years) to Resident Care Manager for one simple reason: Dianne knew her residents. She knew exactly what was “normal” for each of them, and her observation skills were second to none.

Dianne could tell, in just a couple of minutes, when someone was not quite right. She knew when to probe with more questions, with a touch or quick vitals check, and when to call the doctor, nurse or family and say, “Something isn’t right. You’d better come right away.”

She knew that family members felt guilt and anxiety, especially initially. She would often call just to say, “Your mom had a really good day today.”

Dianne would sit and comfort the dying person; she’d stay and comfort the grieving family, too, sometimes well into the night. She would never, ever leave a dying resident in the care of a lesser-trained caregiver.

She wasn’t a trained nurse, but she was the best I’ve ever seen at knowing her residents and making sure they got the very best care possible, from every single member of the team. When my own mother was in acute care, I often wished for a nurse, a caregiver, or anyone, as compassionate as Dianne.

Dianne was certainly an extraordinary caregiver by nature. Her commitment and dedication was intrinsic to her personality; and that’s not something that we can train into people.

But her focus on knowing each person in her care, as well as she could possibly know them, is something we can do a better job training into caregivers. Her keen sense of observation and her skill in communication – these are the traits I believe we can train.

Training to grow the very best caregiver possible isn’t a one-time shot. It’s a process that continues throughout the person’s career. We can start it with our online courses, but it takes ongoing supervision and training to really strengthen these skills.