the patient journey · olson, d. p., & windish, d. m. (2010). communication discrepancies...

The Patient JourneyA Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode to improve the e-patient experience.

Patient Guidance System

Smart

Checklists for

Patients

Delivered online

and available 24/7

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5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes,

Quality/Safety and Patient Experiences

Prepared by:

Stephen Wilkins, MPH

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Who I Am

• Patient/Patient Advocate/Care Giver• Former Hospital Executive • Health Behavior and Communication Researcher • Entrepreneur• Writer and Thought Leader

My Personal Story And Professional Experience Underscore The Following Belief:

That the simplest and most cost effective way of fixing much of what is wrong with health care today is by improving the way clinicians and patients talk to each other.

Introduction

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Why Is Clinician-Patient Communications Important?

The quality of patient-physician communication is associated with better

processes and outcomes, including patient self- management behaviors,

adherence, satisfaction and health status.

Clinician – Patient communication is the primary process by which medical

decisions are made and patients are diagnosed and treated.

Introduction

The Problem With Physician-Patient Communications Is The Illusion That It Occurred

Patient-physician communication is therapeutic

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Who Says We Have A Communication Gap?

Our Patients Say We Are Great Communicators!

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2005 2006 2007 2008 2009 2010 2011 2012

Usually/Always

Sometimes/Never

Clinician Demonstrates Excellent Communication Skills

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Our Patients Say We Are Great Communicators!

During this hospital stay who often did doctors/nurses:

• Treat you with respect? • Listen carefully to you? • Explain things in a way you could

understand?

Compared to what?


% of Patients That Said Always

Source: U.S. Department of Health & Human Services, www.hospitalcompare.hhs.gov Doctors "always" communicated well

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“Often patients are, in fact, overly patient; they put up with unnecessary

discomforts and grant their doctors the benefit of every doubt, until

deficiencies in care are too manifest to be overlooked.

Generally speaking, one can assume that the quality of care is, actually,

worse than surveys of patient satisfaction would seem to show. Patients

need to be taught to be less patient, more critical, more assertive.”

Avedis Donabedian. Quality in Health Care 1992


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A Few Words About Clinician-Patient Communication & Gaps

Patient & FamilyClinician

• Knowledge• Previous Experiences• Language & Culture• Beliefs & Motivations• Attitudes & Assumptions

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The Truth Behind Patient Ratings Of Clinician Communications

Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15)

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• Dosages (56%),• Schedule (68%)• Purpose (64%)• Side effects (11%)

of these patients


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Did The Doctor Discuss Your Fears And Concerns About Being Hospitalized With You?



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Clinician-Patient Communication Gap #1

#1 Lack of Clinician-Patient Agreement Where It Matters

Patient’s diagnosis

Severity of their diagnosis

Treatment plan/care plan

Acceptable outcomes

Agreement between patient and physician about theses issues is a crucial indicator and outcome of high-quality communication.

Sarkar, U., et al. (2011). Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Education and Counseling, 85(2), 173-9

Problem Diagnosis Treatment

Clinician-Patient Disagreement At One Point Prevents Effective Forward Progress

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#1 Lack of Clinician-Patient Agreement Where It Matters

Chief Health Concerns & PrioritiesPatients With Self –Reported Multiple Chronic Conditions & Poor Health Status

Clinicians’ Perspective Regarding Chief Health Priorities

Patient Perspective Regarding Chief Health Priorities

• Pain• Unable to sleep• Unable to eat• Dizziness• Cough

• Hypertension• Uncontrolled A1C• Not taking medications

Zulman, D. , et al. (2009). Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients. Journal of General Internal Medicine.

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#2 Focus Is On The Disease - Not The Person With A Disease

Fears & Concerns

Beliefs & Attitudes

Relevant experiences and expectations

Their life & hopes

“There is another process that is common in consultations too: the active

decision (by clinicians) to stop listening (to the patient) when we have heard

as much as we need to know. Launer, J. The Art Of Not Listening. QJM 2007

What’s Missed by the Clinician is any understanding of the context of the patient’s life

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#3 Focus Is On Technology - Not The Patient

“Hospital Rounds” today seem to take place away from the bedside of the patient – rather they are centered around the virtual construct of the patient called the “I Patient.”

The “I Patient” is getting fantastic care… but the real patient in the hospital bed wonders where everyone is.

Abraham Verghese, MD 2011 Medicine 2.0

What’s being lost is the therapeutic benefits of touch and talk

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#3 Patients Need To Feel Listened To And Understood

Feeling Listened To & Understood

Patient Trust

Low

High

Low High

Non-Compliance

Compliance

Patient trust in their clinician is critical to information sharing, adherence, activation and satisfaction.


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#3 Patients Need To Feel Listened To And Understood


Chief Health Concerns & PrioritiesPatients With Self Multiple Chronic Conditions & Poor Health Status



• Pain• Unable to sleep• Unable to eat• Dizziness• Cough


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Patients don’t know what they don’t know until they are faced with having to do it – Just giving patients

information is not enough

#4 Clinicians & Patients Think And Speak Differently


Chief Health Concerns & PrioritiesPatients With Self Multiple Chronic Conditions & Poor Health Status



• Pain• Unable to sleep• Unable to eat• Dizziness• Cough• Depressed


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Self Care Management Instructions For Heart Failure Given To Patient By Clinician

Clinicians’ Perspective Regarding Type Of Information Exchange

Needed - Patients Need To Know What To Do -

Patient Perspective Regarding Type Of Information Needed - Understand the “What“ But Need To

Know How

• Strategies for overcoming barriers• Goal setting• Skills • Self confidence• Support

• Diet• Exercise• Take medications • Self monitoring

Patients don’t know what they don’t know until they are faced with having to do it – Just giving patients information

is not enough

#5 I Am Busy – Just Do It


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#5 I Am Busy – Just Do It


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Five Types Of Clinician-Patient Communication Gaps - Hospitals

• Lack of Clinician-Patient Agreement Where It Matters

• Focus Is On The Disease - Not The Person With A Disease

• Patients Need To Feel Listened To And Understood

• Focus Is On Technology - Not The Patient

• I Am Busy – Just Do It

The 5 Clinician-Patient Communication Gaps

Patient-Centered Care

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Clinician-Patient Communication & Engagement

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Thank You

Stephen Wilkins [email protected] (PST)@Healthmessagingwww.adoptonechallenge.com

Mind the Gap Blog

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Coming in this Fall

mailto:[email protected]

http://www.adoptonechallenge.com/

http://www.healthecommunications.wordpress.com/

The Patient JourneyA Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode to improve the e-patient experience.

Patient Guidance System

Smart

Checklists for

Patients

Delivered online

and available 24/7

from home

the patient journey · olson, d. p., & windish, d. m. (2010). communication discrepancies...

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