Patient-Centeredness & the Persistent Fax Machine

Patient-centered care is one of the six factors of quality in healthcare. Yet, there are many opportunities for improved patient-centered care.

To anyone that has had to fill out a form or receive a form from a healthcare provider or practice, there is a great likelihood of being told to ‘fax it back’.

Yet, how many have access to a fax machine at home?

Next, you are working to find a way to get the information back to or from the healthcare facility or organization that is not through a fax machine.

Knowing most do not have a fax machine, and encountering this issue, this is one example of an opportunity to improve patient-centered care.

In the bigger picture, healthcare has opportunities to explore the healthcare experience through the eyes of patients and unveil the blind spots to truly address patient-centeredness.

This is just one example but there are many others.

The article here provides several factors that contribute to the persistent challenge however, at some point, we will not be using fax machines….

In the meantime, one area of impact is on quality through that patient experience.


~ Dr. Kelley

What is the role of the patient in patient-centered care?

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If you’ve ever been a patient, you know that you immediately become more vulnerable when in a healthcare environment. Whether entering a primary care office or a tertiary care medical center, the vulnerability presents itself for all of us (even the healthcare professionals).

I believe that there will always be a sense of vulnerability for patients because of the nature of being in need of healthcare service at that moment in time. However, I do wonder about how we view patient-centered care as a concept and if we have an opportunity to amplify the patient’s perspective for the benefit of their overall experience.

For over 20 years now, the National Academy of Medicine’s Crossing the Quality Chasm‘s breaks quality into six factors:

1. Safe
2. Efficient
3. Effective
4. Equitable
5. Timely
6. Patient-centeredness

Each of the 6 factors are defined within that report. In this piece, I want to focus on patient-centeredness. Patient-centeredness is defined in that report as:

“This aim focuses on the patient’s experience of illness and health care and on the systems that work or fail to work to meet individual patients’ needs. Similar terms are person-centered, consumer-centered, personalized, and individualized. Like these terms, patient-centered encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient (NAM, 2000, p.48).”

Having had a few recent experiences as a patient (e.g., primary care and optometry)  and having listened to many about their experiences with healthcare, I began to wonder more about the operationalization of patient-centered care to address healthcare quality.

Some questions that run through my mind include…

  • Who decides what patient-centeredness means (and how it is measured) within a healthcare organization? 
  • How are the preferences of the individual patient being incorporated into the delivery of quality care? 
  • What mechanisms are available to help support patient-centeredness during a patient’s healthcare experience? 

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I personally have had very positive patient-centered experiences and some not so positive experiences. I imagine you have had a range as well. As we see movement toward more active participation in one’s own health with increasing access to data and information, I believe patient-centeredness will become a more prominent need from patients as they seek to be actively involved in their care.

For healthcare professionals, perhaps consider if there are additional opportunities to enhance patient-centered care.

For patients, perhaps find ways to engage in this dialogue with your healthcare professionals where appropriate.

Perhaps at some point we will even move away from the term ‘patient-centeredness’ toward ‘person-centeredness’. However, that may be a more long-term aspiration on my end…

Have a great weekend,



Know My Nurse Life!

Today there are many ways to communicate with our nursing peers. We have the ability to speak face-to-face and by phone. However, SMS messaging has become a popular form of communicating with over phone calls.

Over 81% of the adults in the United States own a smart phone today.  Over 95% of nurses own and use a smart phone each day. With  over 3.8 million nurses having access to a smart phone, it is not surprising that SMS messaging is a likely communication tool between nursing peers on and off of a work day. (All but 2% of those with a smart phone use SMS messaging on a regular basis).

A while back, I began to think about how much fun I had bonding with my nurse colleagues on every day aspects of being a nurse. Whether trying to put isolation gowns and gloves on without an issue or finding the scissors and tape when you need it to having the right shoes on for the long shifts, there was often some level of humor found that helped bond with each other.

However, trying to express this on SMS text messages could be made better. What if we had nursing related images that represented many of the things we as nurses needed over the course of our work day or shift? Things that represent that Nurse Life experience?

The standard emojis didn’t translate to healthcare or nursing. So, I got together with my team and said, “What if we made digital images or “stickers” that represented the day to day life of the nurse?

From there we got to working on Know My Nurse Life!

Know My Nurse Life is our iOS based SMS app that offers 20 different digital images that represent the nursing professional experience day to day. This app is available for consumer purchase in the Apple app store. A link to that app is found here: Know My Nurse Life 

Below several of the images are featured from our instagram page: @nightingaleapps

Tell us your favorite one by taking a screen shot and tagging us on Instagram or Facebook! We’d love to hear from you!


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Enjoy and have a wonderful weekend!



Tiffany Kelley PhD MBA RN-BC

Founder & CEO

Nightingale Apps LLC

May you find the opportunity in every challenge.

The internet erupted on Saturday about something that Senator Walsh in Washington State said in a hearing about nurses. Her tone and underlying assumptions about our ability to play cards while at work were very disrespectful to the 4 million of us in the United States.

This is the second time in a few years where someone in the public eye made an uninformed statement about the most trusted profession in the United States for 17 years in a row.

I’ve learned over the years, through my own entrepreneurial endeavors, that assuming statements are often due to a lack of knowledge.

If we had to put a care plan together and form a nursing diagnosis for this situation, we’d likely use something similar to: “Knowledge deficit related to the reality of being a nurse.


Let me share some of my realities about being a nurse:

  • I never played cards while caring for patients. (I’ve never played cards in any of my nursing roles over the last 19 years).

Some things that I always did while caring for patients include:

  • I always felt as though despite all that I had done for my patients, there was more I could have done to care for them as I left each day over and above what was necessary. (Try carrying that around at the end of every shift and having it add up over time).
  • I always dreaded night shift because that first hour was the most anxiety provoking for me. Parents wanted to put their children to bed to get their rest (understandably so). I would be getting out of report around 7:30pm not even having prepared any of the 8 o’clock meds for my 4-5 patients all due at the same time.

 As nurses, we know we have to prioritize those patients that are in need first but try telling one parent that his or her child needs to wait while you care for another. That is REALLY hard to do. I often wouldn’t finish that first 8 o’clock med round until 11 o’clock at night.

(OF NOTE: Why do we expect nurses to deliver all of their patients’ meds in the same hour right after starting their shift and not having assessed any of them yet? Can someone find a new innovative solution to this system level problem?)

  • I always worried about whether or not one of my assigned patients would code on me during my shift. I often had palpitations before work each morning because of this concern.
  • I always wanted my patients to have a new clean bed or crib and bathed (if an infant) or have an opportunity to shower if possible. This wasn’t required but it was something I felt was important to do.
  • I always prioritized my patients and their families over my own personal needs for nourishment over 12 hours. Sometimes I wouldn’t eat anything until 8 or 9 hours into my 12-hour shift.


I say this about myself, but I know that I am not alone. Perhaps I had palpitations more than other nurses, but the other statements are likely transferable to most if not all other nurses.

Today, I spent a lot of time on my computer catching up on some things.  While working at my desk, I would occasionally open Twitter in seek of a distraction.  I could not open Twitter without a flurry of reactions to Senator Walsh’s remarks today.

Throughout the day, I continued to think of the Woodhull Report. In the most recent report, the results demonstrated that nurses are only cited in 2% of journalists’ stories.

If we are only in 2% of stories, how can we assume that the public knows the extent of our work? Well, one thing we can safely say going forward is that everyone will know we don’t play cards. 🙂 

Yet, this just scratches the surface. How do we use this unfortunate incident that set Twitter ablaze today as an indication that we can do more as a profession to educate others on what we do?

How do we proactively educate a nation on why we are the most trusted profession year after year at a level that abominates the possibility of such comments from happening in the future?

Honestly, it starts with us, the nursing professionals. If we each share our knowledgeable voices on a proactive and consistent basis in a consumable way, we can begin to make the positive change necessary to dispel misconceptions and assumptions.

Think about how you might be able to share something you know with others that might not know it.

We’re trained for this! We educate our patients every day about things they do not know but need to know for their own health and wellbeing.

How can you educate others through your spoken or written words in a way that can influence their perspective? How can you present the information in a way that opens the door for the reader or listener to want to know more and ask more questions?

If I can educate someone not in healthcare about the role of nurses in informatics, interoperability, and innovation, you can find your niche and do the same.






Acknowledging Personal Growth through Public Speaking

Last week I had some major flashbacks this afternoon as I approached the Northeastern campus. I was invited to speak on innovation in nursing and healthcare to graduate nursing students. I’ve done this annually for the last several years.

As I approached the classroom, I had memories of rushing to class two nights a week for 4 years after being at work all day. I used to park in this garage as I would rush to make it to class on time.


I then spoke for 2 1/2 hours straight tonight 😳🤣.

As I left, I remembered how much I greatly disliked speaking in front of a class 10+ years ago.

I’d stress about it all day.

My knee caps would shake while I tried to remember what I wrote on my notecards.

I wouldn’t think about anything else but the fact I needed to do that for about 5 minutes, 10 at most.

Now I enjoy it and find it one of the fun parts of my job.

While I’m talking, I don’t think about anything else going on in my day. I make fun of myself and laugh about it. Most importantly, I hope the students think differently as they leave about the opportunities that might catch them by surprise at some point in their career.


**If you are interested in having me come to speak at your event, school, conference etc., please do reach out at and I’d be happy to discuss further**

Workarounds and their power for finding Innovative Solutions

If you are anything like me, you see ways to make improvements wherever you go and wonder why something is the way it is…

As nurses and healthcare professionals we need to make improvements often through workarounds to get our work done.

In this piece, I describe those innovative behaviors through workarounds in the context of neonatal nurse environments.

Workarounds are clues that something could be done better, often at a system (and not individual) level. “Do you consider yourself to be an innovative nurse? The concept of innovation is frequently permeating conversations around the future of nursing. Many may hear the term innovation, and wonder “what does it really mean to me as a nurse?” and others may think “innovation does not really apply to me.” Yet, you may be surprised to learn that you are innovating in your role as a nurse every day in your work..”

To read the full article, Workarounds as the Catalyst to Drive a Culture of Innovation, click here.