DilemmasInCommunication:HospitalMedicine

PatrickKneeland,MD

ExecutiveMedicalDirectorforPatientandProviderExperience|UCHealthDirectorofQuality,Safety,andExperience|DivisionofHospitalMedicine|UniversityofColoradoHospital

Disclosures

InstituteforHealthcareExcellenceFacultyMemberandConsultant

LearningObjectives• ExploretherelationshipbetweencommunicationandHCAHPS.

• Identifycommonareasofcommunicationbreakdowninhospitalmedicine.

• Developaframeworkfortheroleofeffectivecommunicationinpatientexperienceofcare,includingpatientsafety,andhealthoutcomes.

• Exploreevidence-basedapproachestocommunicatingeffectivelyinhospitalmedicine.

PatientExperience- theWhy?FocusOnValue

Policy(ACA)Patients

PayorsAnd

Employers

Providers(It’swhywe’reinthis!)

ValueBasedPurchasing

ValueBasedPurchasing

https://www.youtube.com/watch?v=jjCu4nxOHlQ

ValueBasedPurchasing

PotentialFinancialImpact

9

2013 1%

2014 1.25%

2015 1.5%

PossiblePercentageWithheld

WhenIreflectonthewidespreaduseofpatientsurveysinhospitalsandclinicstomeasure“patientsatisfaction”or

“patientexperience,”Iamskepticalforthefollowingreasons:

What’sthedifferencebetween“patientsatisfaction”

and“patientexperience”?

IHI:AccessScience

Relationships

MichaelPorter(NEJM):HealthStatusAchieved/Retained

ProcessofRecoverySustainingHealth

Kano:Must-be’s

PerformanceAttributesAttractiveQuality

TomLee:ReliefofSuffering,

BringingPeaceofMind

IHI:AccessScience

Relationships

MichaelPorter(NEJM):HealthStatusAchieved/Retained

ProcessofRecoverySustainingHealth

Kano:Must-be’s

PerformanceAttributesAttractiveQuality

TomLee:ReliefofSuffering,

BringingPeaceofMind

1EtiquetteandManners

ImaginingYourselfAsAPatient,RankThese3CommunicationPriorities

2InformationClearlyCommunicated

3DemonstratingthatYouCareaboutMeAsaPerson

PopQuiz:

Whatarethe3questionsontheHCAHPSsurveyintheYourCareFromDoctors

domain?

ConfidenceinProvider

TeamWorksTogether

CaresAboutMeasaPerson

ExperienceImpactsQuality

ExperienceImpactsMarketShare

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

2-4% Points

41%of patients choose providers

based on non-clinical experience

Hospitals with a patient-centered care approach, see decreases in malpractice claims, despite an increases in patient care activity.

ExperienceImpactsMalpracticeClaims

ExperienceImpactsSafety

Highpatientsatisfactionislinkedto:

decubitusulcerratespostoperativerespiratoryfailure,

Fallshospitalinfectionrates

PhysicianPerspectiveonCommunication

• 250,000patientencountersduringourprofessionallifetime

• Upto25%oftheseencountersaredescribedasfrustrating

• 50%offrustratingencountersarealsodescribedasdysfunctional

PURPOSEJOY

PATIENTSWhy

HowWhat

TheWhyofExperience?

AdaptedfromSimonSinek,StartwithWhy

WhatDoPatientsWantfromTheirHealthCareProvider?

MajorContributorstoPatient’sHealthCareExperience

Havingadoctorwholistenstothem 85%

Havingadoctorwhoiscaringandcompassionate 71%

Havinga doctorwhoexplainswell 69%

Having convenientandquickaccesstohealthcare 47%

Havingpleasantinteractionswithotherstaffinthedoctor’soffices

41%

Being abletotalkaboutcostofcareandnecessityoftestingandtreatment

29%

Ensuring doctorsdisclosefinancialconflictsofinterest 22%

Having adoctorwhoprovidesholisticoptionstocare 8%

Havingdoctors’officeinchargeof coordinatingcare 6%

Havingadoctorofthesame languageandculture 4%

Having adoctorwhoprovideschoice 4%

WhatDoPeopleWantFromTheirHealthCare?AQualitativeStudyLeana S.Wen&Suhavi TuckerResearch|Vol.7,2015|June25,2015

Extremely Important (%)

Describes Your Doctor

Well(%)

Gap*

Treats you with dignity and respect 85 73 -12Listens carefully to your health care concerns and questions 84 68 -16Is easy to talk to 84 69 -15Takes your concerns seriously 83 69 -14Is willing to spend enough time with you 81 62 -19Truly cares about you and your health 81 63 -18Has good medical judgment 80 65 -15Asks you good questions to really understand your medical conditions and your needs 79 61 -18

Is up-to-date with the latest medical research and medical treatment 78 54 -24

Can see you at short notice, if necessary 71 53 -18Responds promptly when you call or email with questions or concerns 60 38 -22

Has a lot of experience treating patients with your medical condition(s) 58 45 -13

Could get you admitted to a leading hospital when you need it 55 46 -9Has been trained in one of the best medical schools 27 25 -2Is of your own sex or gender 15 36 +21Is of your own race or ethnic background 10 30 +20

HarrisInteractivePollof2,267USAdults,2004

• 80%ofpatientsfeeltheirdoctorsaretoobusytolistentotheircomplaints

WhatDoPatientsWantfromTheirHealthCareProvider?

Extremely Important (%)

Describes Your Doctor

Well(%)

Gap*

Treats you with dignity and respect 85 73 -12Listens carefully to your health care concerns and questions 84 68 -16Is easy to talk to 84 69 -15Takes your concerns seriously 83 69 -14Is willing to spend enough time with you 81 62 -19Truly cares about you and your health 81 63 -18Has good medical judgment 80 65 -15Asks you good questions to really understand your medical conditions and your needs 79 61 -18

Is up-to-date with the latest medical research and medical treatment 78 54 -24

Can see you at short notice, if necessary 71 53 -18Responds promptly when you call or email with questions or concerns 60 38 -22

Has a lot of experience treating patients with your medical condition(s) 58 45 -13

Could get you admitted to a leading hospital when you need it 55 46 -9Has been trained in one of the best medical schools 27 25 -2Is of your own sex or gender 15 36 +21Is of your own race or ethnic background 10 30 +20

HarrisInteractivePollof2,267USAdults,2004

• 80%ofpatientsfeeltheirdoctorsaretoobusytolistentothem

WhatDoPatientsWantfromTheirHealthCareProvider?

ChallengingCommunicationScenariosinHospitalMedicine

PainManagement

DemandingPatientsandFamilies

ConversationswithConsultants

AddressingPreviousCommunicationorCareBreakdownswithOtherProviders

Addressingresourceuse/highvaluecare

EndofLifeScenarios

Substanceabuse

AddressingMedicalErrors

Whataboutthisone?AddressingPreviousCommunicationorCareBreakdownswithOtherProviders

AddressingPreviousCommunicationorCareBreakdownswithOtherProviders

OftenOurDefault

OR

OftenOurDefault

OR

PrepareforBattle Explain/OfferSolutions

1EtiquetteandManners

ImaginingYourselfAsAPatient,RankThese3CommunicationPriorities

2InformationClearlyCommunicated

3DemonstratingthatYouCareaboutMeAsaPerson

Whatdoestheevidencesay?(TheGoodNews)

Openendedlisteningwithreflectionbacktospeaker

Recognizeemotionandrespondwithempathy(Beforeproblemsolvingorexplaining!)

+

Openendedlisteningwithreflectionbacktothespeaker

Someexamplesofopenendedquestions:

IwanttomakesureIunderstandyourprimaryconcernstoday,whereshouldwestart?

Thatwasalotofinformation,whatquestionsorconcernsdoyouhave?

Ispoketoyournurseanditsoundslikeyouwerenauseousovernight,whatelseisonyourmindtoday?

Itisimportanttomethatweareonthesamepage,canyouexplaintomewhatyourunderstandingoftheplanforthedayis?

RecognizeEmotionandRespondwithEmpathy(Beforeproblemsolvingorexplaining!)

Someexamplesofwhatthismightsoundlike:

Icantellthatyouarefrustratedbyreceivingmixedmessages.Iamsorrythatthemessagehasnotbeenclear.Let’sworktogethertodaytoclarifyallofyourconcerns.

Anyonewhowasjustgiventhisnewswouldbeanxiousaboutnextsteps.Iwanttomakesuretogiveyouachancetoprocessthisandaskthequestionsyouhave.

Iamsorryyouhavebeenwaitingsolong.IamherenowandyouhavemycompleteAttention.

Howdoesthisapplytodifficultconversationswithcolleaguesorconsultants?

LearningObjectives• ExploretherelationshipbetweencommunicationandHCAHPS.

• Identifycommonareasofcommunicationbreakdowninhospitalmedicine.

• Developaframeworkfortheroleofeffectivecommunicationinpatientexperienceofcare,includingpatientsafety,andhealthoutcomes.

• Exploreevidence-basedapproachestocommunicatingeffectivelyinhospitalmedicine.