do i need to learn more communication...

Do I need to learn

more

communication

skills?MIDVALLEY FAMILY PRACTICE

“Judge a man by his

questions rather than his

answers.”

-Voltaire

Life Style as leading cause of

Disability and Years of Life LOST

JAMA (4/10/18); “Number of Deaths and Percentage of Disability-

Adjusted Life – Years Related to the 17 Leading Risk Factors in the

United States. 2016”

#1; Dietary Factors

#2; Tobacco use

#4; Body Mass Index

#8; Alcohol and Drug Use

#10; Low Physical Activity



JAMA (4/10/18); “Number of Deaths

and Percentage of Disability-Adjusted

Life – Years Related to the 17 Leading

Risk Factors in the United States. 2016”






#1; Dietary Factors






#1; Dietary Factors

#2; Tobacco use






#1; Dietary Factors

#2; Tobacco use

#4; Body Mass Index






#1; Dietary Factors

#2; Tobacco use

#4; Body Mass Index


#10; Low Physical Activity

Is Patient Engagement the Holy

Grail?

Patient Engagement: “actions individuals must take to obtain the greatest benefit from the health care services available to them.” - J.H. Hibbard

"Adopting a healthy lifestyle could substantially reduce

premature mortality and prolong life expectancy in U.S.

adults," the authors write. Circulation, 4/30/2018 – (online)

Researchers found that men and women who adopted all five low-

risk lifestyle factors -- body mass index of 18.5 to 24.9 kg/m2,

a high diet quality score, at least 30 minutes of vigorous

exercise daily, never smoking and moderate alcohol

intake -- had an estimated life expectancy of 37.6 and 43.1

years at age 50, respectively, compared with 25.5 and 29.0

years among those who adopted zero low-risk factors. The findings

in Circulation were based on data from the Nurses' Health Study

and the Health Professionals Follow-up Study.

Why is Communication Important?

Patients actively engaged more likely to stay healthy and manage

their conditions better.

Patients not engaged cost 21% higher then engaged patients

Depending on age life style

management represents 30-50% of

overall health risk. Patients engaged

take active role in self management. Is an un-engaged patient and un-engaged life participant?

How many times has your

patient….

1. Return for follow-up and not know why there are at office

2. Agree (but not really agree) to follow treatment plan

3. Miss follow up appointments

4. Did not remember what you talked about last visit

5. Not known their chronic disease diagnosis nor medications

Is Your Practice Similar?

Our internal study found:

25% of our patients are fully engaged

25% are NOT engaged at all

50% are partially engaged

How did we start?

We asked a lot of questions

Reached out to SIM for grant to start intra-office communication

training program.

No curriculum present so …. Started to create a map of what and

how.

Started with Marcia Carteret and Alex Reed in year one and Amy

Gallagher in year two.

Year One: communication basics, cultural and belief system training

Marcia …….

`

Patient engagement

Why communication / language

Cultural, belief system centric communication

Understanding personality types, character traits, how people listen.

Choices of words, when to communicate what

Trauma informed care

40 % of message

50 % of message

10 % of message!

What you hear

Tone of voice

Vocal clarity

Verbal expressiveness

What you see or feel

Facial expression

Dress and grooming

Posture

Eye contact

Touch

Gesture

WORDS ….

The Art of Listening

“If we were supposed to talk more than listen,

we would have been given two mouths and

one ear.”

Mark Twain

Motivational Interviewing

• A directive, client centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence.

• Designed to produce rapid, internally motivated change by mobilizing the client’s own change resources.

Miller and Rollnick, 1991

How do we establish a habit?

There are pros and cons to every behavior

We engage in a particular behavior based on an assessment of

these pros and cons

Ambivalence is the unresolved conflict between the pros and cons,

and leads to continues engagement of the behavior

Persistent ambivalence is the principal impediment to change

Verbal communication

Use of words, numbers and symbols.

Tone, pitch, quality and rate of speech carries more weight than the

words

The latter convey the emotions and meaning, regardless of the

content of the message.

Non-verbal communication

Facial expressions

Eye contact, pupil dilation

Gestures

Body language and posture

Proximity and touch

Most of our communication is non-verbal

(which is missing in emails and tweets)

The Sapir-Whorf Hypothesis

A language is not simply an encoding process but is rather a

shaping force.

Language guides thinking and behavior by predisposing people to see the world in a certain way.

There has been a recent renewal of interest in this hypothesis.

MIDVALLEY COMMUNICATION TRAINING

OUTLINE12-hour training, conducted across 8 90-minute sessions; includes

homework activities

SESSION 1

Establish group guidelines

Set communication goals

Assess strengths and growth areas

Gratitude exercise

Homework: complete personality assessment & VIA

SESSION 2

Review group guidelines

Review discussion from previous week (e.g. goals, strengths, growth

areas)

Discuss personality assessment results

Discuss VIA results

Homework: Find examples of how personality and/or VIA strengths

influenced communication

SESSION 3


Review homework assignment

Discuss sending messages

Discuss non-verbal communication skills

Homework: Find examples of how non-verbal communication


SESSION 4



Discuss tone

Discuss prosody

Discuss conflict management

Homework: Find examples of how tone and prosody influenced

communication

SESSION 5



Discuss specific listening skills

Practice listening skills

Homework: Find positive and negative examples of how listening


SESSION 6



Discuss engagement with patients (Part 1)

Cultural Influences

Trauma Informed Care

Homework: Be ready to share at least 2 examples of how culture

impacted your work. Look at where you or the practice excel and

could grow in terms of being Trauma Informed

SESSION 7



Discuss engagement with patients (Part 2)

Specific language

Filters

Homework: Be prepared to ask any unanswered communication

questions. Pay attention to when you use filters in communication.

SESSION 8



Highlight any areas

Address practice questions

Wrap up activities

Homework: Implement gratitude exercises in the practice. Create

space for a “communication huddle”.

do i need to learn more communication...

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