Physician Skill Building Physician-Patient Communication

Transcription

1 Physician Skill Building Physician-Patient Communication Dan Smith, MD, FACEP Medical Director Studer Group

2 Execution Framework: Evidence-Based Leadership SM 2

3 Why communicate better and deliver a great patient experience? Improves clinical effectiveness/treatment adherence Improves clinical outcomes and safety Increases loyalty and growth Improves CAHPS performance Reduces malpractice risk Improves physician/app/staff satisfaction Patients rating of quality is more predicted by their rating of the quality of communication than technical care. * Chang, Annals of Internal Medicine

4 Outcome = Income Past Volume Future Value

5 CAHPS Family of Surveys Consumer Assessment of Healthcare Providers and Systems Family of surveys designed to assess patient perception of care quality Allows comparisons of hospitals so that consumers can make choices Linkage to value-based purchasing reimbursement to hospitals CAHPS Survey Tools: HCAHPS CG CAHPS PCMH CAHPS In-center Hemodialysis CAHPS Home Health Care CAHPS ED PECS

6 CG CAHPS Core Questions &Composites 15 questions grouped in 5 composites Getting Timely Appointments, Care, and Information (Access) Getting appointments for urgent care Getting appointments for routine care or check-ups Getting an answer to a medical question during regular office hours Getting an answer to a medical question after regular office hours Wait time for appointment to start Courteous and Helpful Office Staff Clerks and receptionists were helpful Clerks and receptionists treat you with courtesy and respect Provider (Doctor) Patient Communication Provider explanations easy to understand Provider listens carefully Provider gives easy to understand information Provider knows important information about medical history Provider shows respect for what you have to say Provider spends enough time with you Test Results Follow up on Test Results Rating of the Provider (Doctor) Overall rating of your Provider

7 How we communicate predicts our patient s overall rating of care

8 Chasm between consumer and physician perception 120% 100% 80% 60% Physicians Discussed Patients Fears and Anxieties 98% 54% 90% 80% 70% 60% 50% 40% Patients Know Their Diagnosis 77% 57% 40% 20% 30% 20% 10% 0% Physician Response Patient Response 0% Physicians That Thought Patient Knew Patients That Correctly Identified Olson, DP and Windish, DM; Communication Discrepancies Between Physicians and Hospitalized Patients Arch Intern Med 2010; 170 (15):

9 Patient Experience is about High Reliability There are standardized response options to the core CAHPS questions and this is true for the communication domain Always Usually Yes Definitely Yes Somewhat 9, 10 Sometimes No 8 or less Never ONLY THE TOP BOX RESPONSE COUNTS

10 What are the skills to improve communication and connection?

11 Patient short list What healthcare consumers want to know: 1. Who Are You? 2. Are You Any Good? 3. Do You Care?

12 Timely. Team. Effective. Communicated. Caring.

13 Themes Portending a Positive Interaction Relationshi ps Acknowledge (A of AIDET ) and 10-5 Rule Introduction (I of AIDET ) Non-verbals Care Plan and Partnership Seated Proximity Medical jargon avoidance Health literacy alignment Care Team and Transitions Introduction (I of AIDET ) Role Delineation Appreciation or Thank You (T of AIDET ) Warm tone Explanation (E of AIDET ) is understandable Empathy Eye contact Duration (D of AIDET ) and Timeline Language specificity Hand wash Confirmed shared agenda and invited questions Cultural alignment Appropriate touch Care plan summary and white board updates Consultant coordination Manage-up Handover explanation Biocard

14 Narrate the Care

15 With them not to them Shared Care Agenda Does that sound like a reasonable care plan?

16 Phases of a Patient Encounter and Key Communications First impressions Tone and demeanor Non-clinical opener Awareness and Beginning alignment of why of the visit (Individualized Patient Care) and information Middle History and circumstances paraphrased P.E and share P.E. findings Informed of test results Explained working DX Explained meds Shared plan Close the loop/summarize Answer Q s, Teach Back Care coordination/hand over Appreciation, End admiration Lasting impressions

17 Studer Group Five Fundamentals: AIDET A Acknowledge Eye contact, smile and acknowledge everyone in the room. I Introduce Hello Mr. Clark. My name is Dr. Jones, good morning. I have been an emergency physician for 10 years and I will be caring and coordinating your care today. During this initial encounter, I want to verify the information you provided to the ER up front, learn more about the dizziness you have been having, do a good exam and then describe our treatment plan D Duration I would anticipate that you will be here for 2 hours this may vary some depending on how you are feeling and the results of the testing E T Explanation Thank you Let me explain the plan with this new medication. It is designed to reduce your dizziness. It can make some patients a bit drowsy and perhaps lead to constipation So I wish you all the best. Thank you for the opportunity to care for you

18 Advantages of AIDET & Key Words Decreased anxiety with increased adherence Decrease d Anxiety + Increased Adherence = Improved clinical outcomes, more positive patient experience and greater professional fulfillment

19 10-5 Rule Distance-based guide for interaction If you sense a need in a pt/family: 10 feet: Make eye contact 5 feet: Acknowledge them

20 RECOMMENDATION: AIDET + The Promise Tell the patient and family what kind of care you plan to deliver Excellent Awesome Great

21 Common Sense Communication Skills When discussing matters of feeling and attitude, effective communication is a function of: Verbal Content: 7% Vocal Expression: 38% Visual Cues: 55% What is important is "CONGRUENCE" Albert Mehrebian

22 Show Empathy understand and share the feelings of another

23 Emotional Intelligence (EQ) Describes characteristics beyond technical skill and cognitive intelligence Step one: be aware of your own emotional state/feelings Step two: recognize the patient s feelings/attitudes/emotional state Step three: modulate your response using key words and empathic cues Example I can imagine the frustration of being in the hospital for 2 weeks with this infection, getting home and now being back in the ED you have been through a lot recently

24 Effect of sitting vs. standing on perception of provider time at bedside 0:05:46 0:04:19 0:02:53 0:01:26 0:00:00 0:03:44 0:01:28 0:01:40 Standing 0:05:14 Sitting Actual Time Perceived Time Conclusion: Simply sitting instead of standing at a patient's bedside can have a significant impact on patient satisfaction, patient compliance, and provider-patient rapport, all of which are known factors in decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes. Patient Educ Couns Feb;86(2): doi: /j.pec Epub 2011 Jun 30. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study.

25 Adjuncts to Communication Patient communication white boards Biocards Care cards PACS images EHR information

26 Psychology of Manage-Up Affirming statement which forecasts positivity of an upcoming experience, usually with an individual or a process Sets a positive perception of the care team or care process Example: Dr. Hakim will be seeing you shortly. He is an experienced hospitalist who will continue your inpatient care. Example: You are very fortunate to have Judy as your nurse. She is one of our finest and cares deeply for her emergency patients

27 High Impact Provider Handover Professional Cordial SBART The handover is complete when the patient and family have been updated and understand the care transition

28 Service Checklist Timely evaluation Warm demeanor Addressed concerns Narrated care plan Provided time estimate Comfort measures Empathy Closed the loop

29 Deploying a Physician Training Program How do we get this done? 29

30 Our approach (high level) Educate Train Validate Why is this important? What are the skills? How am I doing? Slide 30

31 Studer Group-Partner Example Physician Coaching Plan Focus Groups: ED and Hospitalist ID d focus groups (ED and Hospitalists) Core Communication Curriculum Didactic training in 8 sessions Relationships secured Begin validation rounding Texas, six-hospital system Intensive Shadow Rounding with feedback to physicians ID d and trained ED champions Champions begin validation and training of colleagues Physician Leadership core skill training: Physician Leader Rounding Running an Effective Meeting Phys Communication

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35 Healthcare Flywheel Connect To Purpose

36 Purpose Worthwhile Work and Making a Difference

37 LIVE LEAD LOVE SERVE

38 Wherever you go, no matter what the weather, always bring your own sunshine. Anthony J. D Angelo The College Blue Book

39 EVALUATION REMINDER: We want your feedback to get better. Please remember to take the session evaluation. Thank you! Insert Your Photo Here Dan Smith, MD, FACEP Medical Director (850)

40 Next Presentation: See What Right Looks Like! Physician-Patient Communication: Skills Lab The Physician Coaching Team