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January 2017 Archive for High Reliability Healthcare

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Systemic solutions to analyze underlying causes of specific care breakdowns and improve overall quality.

What We Have Here… Is a Failure to Communicate


Jan 26, 2017 | Comments (0) | 6190 Views

By Emily Aaronson, MD
Fellow
Harvard Medical School
Fellowship in Patient Safety and Quality Improvement
Massachusetts General Hospital

Despite the growing emphasis on “patient-centered care,” patient safety lapses attributed to poor communication are still commonplace. Noting this, during my fellowship at The Joint Commission, we developed a Quick Safety framework on this important issue. It’s important to reflect on some of the contributing factors and key drivers to change.

Over the last decade, major communications improvements have been achieved during transitions of care and for patient populations with unique communication needs. Despite that, there is more to be done. Specifically, a focus on all provider-patient encounters.

There are some key components of effective patient-provider communication that should be a part of every encounter:

  • Clear expectation setting
  • A patient-centered approach to communication that ensures patients play an active role in the dialogue and that their values are incorporated into decision making
  • Expressions of empathy
  • A focus on clear information exchange and patient education that promotes the understanding and retention of key information

Issue Rooted in Medical Education
Certainly, no doctor sets out with intentions of leaving patients confused or unengaged in their care.  However, in speaking to patients, that is often what happens.

While we once considered communication a “soft skill” that was innate for clinicians, the literature is now suggesting otherwise. Instead, it is now understood that this is a highly trainable, essential “non technical” skill—a skill in which all providers should be trained in and have to demonstrate competency. Given the demonstrated link between poor communication and poor patient outcomes, communication should be considered a core competency.

Modern medical education incorporates some training on empathy and communications skills, but older doctors weren’t required to take these courses. Even for those who have been exposed to these communication curriculums, there’s still an opportunity for more learning surrounding communication. Although there are increasingly “alternative” modules in medical and nursing schools that often bundle ethics, empathy, communication and emotional skills in medical practice, there is rarely a comprehensive, systematic training in communication. As a result, providers may start their careers both without strong skills in this domain, and without understanding its importance.

High-Level Leadership Support
Like anything else, effective patient-provider communication within an organization needs management’s endorsement to get off the ground.

In addition to embracing an attitudinal shift that communication is not second-tier training nor inherent in an individual’s disposition, there are some concrete steps leadership can take to improve communication, including:

  • Conducting an internal assessment of your organization’s current communication training programs and explicit institutional focus on the value of patient-provider communication
  • Measuring clinicians’ communication-focused skills using, for example, patient experience and scores related to communication competency. This information can also be used as a basis for determining goals to improve performance.
  • Carving out protected, compensated time for training
  • Incentivizing staff on metrics related to provider-patient communication
  • Providing coaching for caregivers who are struggling to achieve competency
  • Perhaps most important: Speaking openly at the highest levels of leadership about the importance of communication

Patient Activation Strategies
No discussion of patient-provider communication can be complete without mentioning patient activation, which has been proven to enhance communication. More activated patients are more likely to:

  • Follow their provider’s recommendations
  • Experience better outcomes
  • Avoid unnecessary readmission

While the health and communication status of the patient usually drives the outcome improvement, it’s important to note that misdiagnoses and medications errors do occur as a result of communication breakdowns, even when the patient doesn’t have a verbal limitation.

Logically, strategies to improve engagement is a three-step process:

1. Understand the type of support your patient population needs
2. Provide it
3. Measure the results.

It’s critical that staff members fully commit to patient activation and are trained in communication skills that allow active patients to maximally participate. What we don’t want is a dichotomy between the organization’s strategy to activate patients and the front-line providers’ skills in cultivating a truly shared-care model. 

Lastly, don’t lose sight of equity in this work. This links to the measurement piece. Being sure that you understand which patient populations are using the resources provided (and which aren’t), and measuring these different populations’ overall degree of activation, ensures that we are not inadvertently creating larger disparities in care. For those groups we are not reaching, we need to think more creatively about their individual needs.

Let’s share successes. What’s worked for you in activating patients in their care?

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