9 minute read
Optimising Patient Satisfaction
Psychologist Kimberley Cairns explores how using trauma-led practice can improve patient experience and practitioner performance
Trauma-informed practice is an evidenced-based model that educates about the importance of a complete picture of a patient’s situation, past and present to assist care providers in formulating the best approach for desired outcomes.1 It is well documented and widely accepted that this holistic approach provides a superior service operation which promotes wellness or healing in its processes.2
Trauma-informed practice has military origins dating back to the Korean War (1950-1953) and The Vietnam war (1955-1975) where at the time medical science was not attuned to the needs of the soldier.3,4 Since then, trauma-informed insights have evolved and positively influenced many settings creating a substantial shift to the way in which we interact with those who have had higher rates of stress and trauma in environments such as schools, the NHS, social care, prisons and adults in the workplace and has become even more relevant since the COVID-19 pandemic.1,2,4-7 With the lack of empirical research in aesthetics, we must sensibly use validated and reliable data that is available from other formal disciplines to inform our best recommended practice. Therefore, trauma-informed practice should be considered an emerging concept within the industry that if adopted has the potential to increase patient engagement and retention, improve treatment outcomes, reduce avoidable redress costs and avoid costly business consequences due to the emotional fallout of the patient.8
Defining a trauma-based approach Historically, trauma was regarded as a purely physical notion that was used in the context of medicine to distinguish between a blunt force or penetration causing injury to the body.9 The definition of trauma has since been expanded to include the lasting emotional experience of three separate, but related components:10
1. Acute trauma – a single event 2. Chronic trauma – the exposure to repeated incidents 3. Complex trauma – the experience of severe and sometimes pervasive adverse events that are often protracted (last for a long time) or are interpersonal (between people) in nature
How trauma affects the brain Biopsychology provides investigation into, and evidence of, lasting trauma through research into how the brain, its neurotransmitters, and other aspects of our biology influence our behaviours, thoughts, and feelings. The conclusive empirical evidence here demonstrates that trauma affects the brain by causing structural damage to the temporal lobes in the prefrontal cortex.11 This area of the brain is known for executive functioning and problem solving. There is also a further biological or chemical damage here that impacts the flow of dopamine to these brain structures.12 Dopamine is a type of neurotransmitter. Your body makes it, and your nervous system uses it to send messages between nerve cells. Why is this relevant to your aesthetic practice? Because dopamine is fundamental to the human motivation and reward systems, therefore it is essentially implicated in every one of your patients.10 Dopamine may be amongst the most important criteria for patient selection, given the near ubiquitous exposure of trauma within the developed population.13 It is of note that some people will be more at risk than others and we must take into account genetics, social factors, economic circumstances, existing mental health conditions and neurological conditions which can all play a contributory factor here.13 When released in large amounts, dopamine creates feelings of pleasure and reward, which motivates us to repeat a specific behaviour e.g. eating or sleeping.14 Dopamine is informing your patients constantly and subsequently motivating them to seek rewards through your aesthetic or cosmetic interventions. However, dopamine cell firing can encode errors in reward prediction, especially when trauma is indicated, and it can provide faulty learning signals.14,15 It is therefore essential to consider how this ‘plays out’ in the clinic and what this means for patient satisfaction and practitioner performance.
Example scenario An excited patient comes into the clinic after seeing a promotion on social media and has a great consultation, loves the team and can’t wait to get started on their journey. They pay a deposit and book in their next appointment. They are thrilled with the treatments and love their new look but then, something shifts. They think they are experiencing an adverse event and they want to see you urgently – they want their money back and they want to look the way they looked before. This could go as far as a formal complaint, disparagement and an insurance company pay out. Whilst we may not be able to test for dopamine directly ahead of any treatment, we can extrapolate findings to confidently evidence base the relevance and argument for trauma-informed practice in your clinic. This therefore provides a unique opportunity for aesthetic providers to incorporate psychology and emotional aspects of aesthetic care and to make an important contribution to healing and growth.12
Implementing the trauma-informed approach It is important to understand that lasting effects of trauma can present in an individual as a loss of safety, a loss of or misinterpretation of danger cues, a loss of physical connection to the body, loss of trust, intimacy troubles, shame, dissociation, depleted self-worth, re-enactment, and a loss of sense of self.16 This can also be inflated or triggered by in-clinic experiences such as poorly constructed consultations, breaches of confidentiality, as well as adverse reactions.
Therefore, the guiding principles for the implementation of a trauma-informed approach are safety, choice, collaboration, trustworthiness and empowerment.17
Trauma-informed care seeks to acknowledge the widespread impact of trauma and how it can affect people and groups through the four Rs: Realisation and Recognising the signs and symptoms of trauma in patients, families, and staff. In turn, this integrates knowledge about trauma into policies, procedures, and practices to implement a system that can Respond to trauma by actively Resisting or avoiding re-traumatisation.17 Below are some of the ways aesthetic practitioners can ensure their patients’ mental health is protected by using a trauma-informed approach.
Expand your consultation skills beyond a ‘fix it’ transaction Offering an immediate solution to a patient’s problem positions you and the patient in a ‘fix it’ mentality which will be working against the four Rs. Avoid consulting and treating on the same day and implement a cooling-off period. Similarly, avoid fulfilling patient-led requests that rely on persuasive communication to do something you are not 100% comfortable with. Do not have another team member do a consultation for you if you intend on treating a patient, as being present in the consultation is essential to realise the impact of trauma and recognise the signs and symptoms that may be present, for example, an urgency for treatment. Increasing your consultation time to suitably explore the past and present to build a more accurate patient profile beyond the presenting concern is necessary to respond accordingly. Be sure to give yourself adequate time to make your notes too (e.g. 50min consultation + 10min write-up). Ask about previous treatments and satisfactions ranging from skincare to invasive surgery. Be curious with motivation and satisfaction – how does this perceived appearance flaw relate to quality of life factors, self-worth, work or education, cost and convenience, intimacy or social support, mental health or wellness function and the sense of safety, danger and connection?
Educate and explain the risks Encouraging fast moving trends may inflate the risk of re-traumatisation in your patient resulting in dissatisfaction, costly and time-consuming complaints, financial redress and complex case management issues. Promotional offers which encourage an urgency for treatment will also attract new risk-taking behaviours to your clinic. It is important to look at the proxy risks of treatment e.g. financial, and emotional risks too. Providing patients with written pre- and post-care advice with a fully explained and transparent treatment plan with prices, payment terms, your cancellation policy, satisfaction redress and your complaints policy demonstrates a clear system that is responding to trauma through procedural means. Support this with a mandatory cooling-off period to ensure time is taken to understand this fully with no financial penalty to the patient for doing so.
Protect confidentiality but not secrecy Pay close attention to patients that only pay in cash, or don’t want to provide a next of kin or a GP contact, or those that are not on top of their regular health screening checks. Recognise that for some patients, aesthetics may be a secretive behaviour that may perpetuate self-neglectful behaviour because of trauma. We must accept that patients may be deceitful in order to protect or disguise their emotional vulnerabilities. In context, a patient may not have adequate meaningful social support despite being social and having lots of friends. This can prove difficult for downtime and treatment reflection for satisfaction as this space can be filled with isolation and negative appearance ruminations which can present a danger to the patient as they look for ways to cope with their maladaptive aesthetic treatment alone. It is important not to judge this, but to be confident to respond to such red flags and have a responsible policy that encourages openness and a supportive atmosphere within your clinic.
Say ‘no’ from the outset This may seem counterintuitive but using blanket advertising and marketing that assumes everyone is a candidate or using gift vouchers for aesthetic or cosmetic interventions is dangerous practice that can inflate insecurities or vulnerabilities in a patient. A symptom of trauma is a disconnection from the body which makes treatment satisfaction harder for these survivors.8 Implicated further is their understanding of what the body is seeking. This may be misunderstood despite every best effort to soothe the discomfort they are experiencing. Establishing strong referral links with experts to support your patient’s needs and clinical decisions is important for successful transition or multidisciplinary care. Saying ‘no’ doesn’t have to mean no treatment. Building trusted outcomes along a patient journey to promote authentic connection and patient retention is essential to identify, access, understand and respond to patterns of internal signals of the body appropriately. You may wish to introduce mindful breathing with your patients and reflect on reactions that give clues to what the patient is feeling.
Consider trauma-informed care Much has been published in recent years about trauma-informed care and the importance of healthcare providers to factor past trauma into their care approach. The main objective is to secure ethical practice and psychological safety to increase your business prospects through improved patient satisfaction and practitioner performance. To further your knowledge you can visit the Integrated Practitioners of Aesthetic Wellness website to learn more ways to ensure the mental health of your patients is protected when seeking aesthetic or non-cosmetic treatments.
Kimberley Cairns is a published psychologist and member of the British Psychological Society with 16 years of acute mental health and aesthetic clinic management experience. Specialising in psycho-aesthetic solutions, Cairns has numerous key appointments including that of clinical advisory and fitness to practice within the JCCP.
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