Dilemmas In Communication: Hospital Medicine

Transcription

1 Dilemmas In Communication: Hospital Medicine Patrick Kneeland, MD Executive Medical Director for Patient and Provider Experience UCHealth Director of Quality, Safety, and Experience Division of Hospital Medicine University of Colorado Hospital Disclosures Institute for Healthcare Excellence Faculty Member and Consultant Learning Objectives Explore the relationship between communication and HCAHPS. Identify common areas of communication breakdown in hospital medicine. Develop a framework for the role of effective communication in patient experience of care, including patient safety, and health outcomes. Explore evidence-based approaches to communicating effectively in hospital medicine.

2 Patient Experience - the Why? Focus On Value Patients Policy (ACA) Providers (It s why we re in this!) Payors And Employers Value Based Purchasing Value Based Purchasing

3 Value Based Purchasing Potential Financial Impact Possible Percentage Withheld % % % 9

4 When I reflect on the widespread use of patient surveys in hospitals and clinics to measure patient satisfaction or patient experience, I am skeptical for the following reasons: What s the difference between patient satisfaction and patient experience?

5 IHI: Access Science Relationships Michael Porter (NEJM): Health Status Achieved/Retained Process of Recovery Sustaining Health Kano: Must-be s Performance Attributes Attractive Quality Tom Lee: Relief of Suffering, Bringing Peace of Mind IHI: Access Science Relationships Michael Porter (NEJM): Health Status Achieved/Retained Process of Recovery Sustaining Health Kano: Must-be s Performance Attributes Attractive Quality Tom Lee: Relief of Suffering, Bringing Peace of Mind

6 Imagining Yourself As A Patient, Rank These 3 Communication Priorities 1 Etiquette and Manners 2 Information Clearly Communicated 3 Demonstrating that You Care about Me As a Person Pop Quiz: What are the 3 questions on the HCAHPS survey in the Your Care From Doctors domain?

7 Confidence in Provider Team Works Together Cares About Me as a Person

8 2-4% Points Hospital Quality Alliance program scores hospitals in the highest quartile of HCAHPS ratings were, on average, about 2 to 4 percentage points higher than the HQA scores for hospitals in the lowest quartile of HCAHPS ratings Experience Impacts Quality High patient satisfaction is linked to: decubitus ulcer rates post operative respiratory failure, Falls hospital infection rates Experience Impacts Safety Hospitals with a patient-centered care approach, see decreases in malpractice claims, despite an increases in patient care activity. 41% of patients choose providers based on non-clinical experience Experience Impacts Malpractice Claims Experience Impacts Market Share Physician Perspective on Communication 250,000 patient encounters during our professional lifetime Up to 25% of these encounters are described as frustrating 50% of frustrating encounters are also described as dysfunctional

9 What Do People Want From Their Health Care? A Qualitative Study Leana S. Wen & Suhavi Tucker Research Vol. 7, 2015 June 25, 2015 Why How What The Why of Experience? PATIENTS PURPOSE JOY Adapted from Simon Sinek, Start with Why What Do Patients Want from Their Health Care Provider? Major Contributors to Patient s Health Care Experience Having a doctor who listens to them 85% Having a doctor who is caring and compassionate 71% Having a doctor who explains well 69% Having convenient and quick access to health care 47% Having pleasant interactions with other staff in the doctor s 41% offices Being able to talk about cost of care and necessity of testing 29% and treatment Ensuring doctors disclose financial conflicts of interest 22% Having a doctor who provides holistic options to care 8% Having doctors office in charge of coordinating care 6% Having a doctor of the same language and culture 4% Having a doctor who provides choice 4% What Do Patients Want from Their Health Care Provider? Describes Extremely Your Doctor Gap* (%) Important Well (%) Treats you with dignity and respect Listens carefully to your health care concerns and questions Is easy to talk to Takes your concerns seriously Is willing to spend enough time with you Truly cares about you and your health Has good medical judgment Asks you good questions to really understand your medical conditions and your needs Is up-to-date with the latest medical research and medical treatment Can see you at short notice, if necessary Responds promptly when you call or with questions or concerns Has a lot of experience treating patients with your medical condition(s) Could get you admitted to a leading hospital when you need it Has been trained in one of the best medical schools Is of your own sex or gender Is of your own race or ethnic background Harris Interactive Poll of 2,267 US Adults, % of patients feel their doctors are too busy to listen to their complaints

10 Extremely What Do Patients Want from Their Health Care Provider? Important (%) Describes Your Doctor Gap* Well (%) Treats you with dignity and respect Listens carefully to your health care concerns and questions Is easy to talk to Takes your concerns seriously Is willing to spend enough time with you Truly cares about you and your health Has good medical judgment Asks you good questions to really understand your medical conditions and your needs Is up-to-date with the latest medical research and medical treatment Can see you at short notice, if necessary Responds promptly when you call or with questions or concerns Has a lot of experience treating patients with your medical condition(s) Could get you admitted to a leading hospital when you need it Has been trained in one of the best medical schools Is of your own sex or gender Is of your own race or ethnic background Harris Interactive Poll of 2,267 US Adults, % of patients feel their doctors are too busy to listen to them Challenging Communication Scenarios in Hospital Medicine Demanding Patients and Families Pain Management Conversations with Consultants Addressing Previous Communication or Care Breakdowns with Other Providers Addressing Medical Errors Addressing resource use/high value care Substance abuse End of Life Scenarios

11 What about this one? Addressing Previous Communication or Care Breakdowns with Other Providers Often Our Default Addressing Previous Communication or Care Breakdowns with Other Providers OR Often Our Default Prepare for Battle Explain/Offer Solutions OR

12 Imagining Yourself As A Patient, Rank These 3 Communication Priorities 1 Etiquette and Manners 2 Information Clearly Communicated 3 Demonstrating that You Care about Me As a Person What does the evidence say? (The Good News) Open ended listening with reflection back to speaker + Recognize emotion and respond with empathy (Before problem solving or explaining!) Open ended listening with reflection back to the speaker Some examples of open ended questions: I want to make sure I understand your primary concerns today, where should we start? That was a lot of information, what questions or concerns do you have? I spoke to your nurse and it sounds like you were nauseous over night, what else is on your mind today? It is important to me that we are on the same page, can you explain to me what your understanding of the plan for the day is?

13 Recognize Emotion and Respond with Empathy (Before problem solving or explaining!) Some examples of what this might sound like: I can tell that you are frustrated by receiving mixed messages. I am sorry that the message has not been clear. Let s work together today to clarify all of your concerns. Anyone who was just given this news would be anxious about next steps. I want to make sure to give you a chance to process this and ask the questions you have. I am sorry you have been waiting so long. I am here now and you have my complete Attention. How does this apply to difficult conversations with colleagues or consultants? Learning Objectives Explore the relationship between communication and HCAHPS. Identify common areas of communication breakdown in hospital medicine. Develop a framework for the role of effective communication in patient experience of care, including patient safety, and health outcomes. Explore evidence-based approaches to communicating effectively in hospital medicine.