Transcript Getting the Most out of Every Clinical Encounter

Getting the Most Out of
Every Clinical Encounter
Tips for Increasing Patient
Satisfaction
July 31, 2014
Patient Satisfaction
Pre Arrival:
Experiences with Staff
• Ease of scheduling
appointment
• Getting through to
the Office by phone
• Personal manner of
telephone staff
During the Visit:
Experiences with Staff
– Office Wait
• Telling the patients
what to expect and
why?
– Personal manner of
office Staff
• Front desk, back
office
Provider Specific
Caring and respect Shown by physician
Ability of physician to Communicate
Explanation of tests, procedures, meds
Efforts to include patient in treatment
decisions
How well concerns were addressed
Overall Quality of Care
Communication is the key to
Everything
• Numerous studies have been done to
suggest that certain clinical behaviors
affect the likelihood of achieving
desired outcomes.
• Communication skills can be taught,
learned and practiced, however,
many physicians receive little or no
training in this area.
“Apparently, patients are
less concerned with how
much their physicians
know than with how
much they care.”
Who do you communicate with?
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Patients
Families
Physician Colleagues
Nurses
Administrators
Hospital/ office staff
Insurance company representatives
Attorneys
Medical Record Documentation
Media
Why is it important to focus on communication
with patients?
• Effective communication enhances patient
satisfaction, health outcomes, and
adherence to treatment.
• Learning general communication skills
enables a physician to break bad news in
a way that is less uncomfortable for them
and more satisfying for the patient.
• Breakdowns in communication between
physician and patient have been shown to
be a factor in malpractice litigation.
What are barriers to effective communication
with patients?
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Speech ability and understanding
Time constraints
Illness
Medication effects
Psychological or emotional distress
Racial and/or cultural differences
The Four Habits Model
• The goal of this model is:
– To establish rapport and build trust rapidly
• If new patient visit, it’s the first impression
of you
– Obtain and deliver information
– Demonstrate caring and concern
– Increase likelihood of compliance with
treatment plan
The Four Habits Model
1.
Invest in the beginning
2.
Elicit the patient’s perspective
3.
Demonstrate empathy
4.
Invest in the end
1. Invest in the Beginning
Create rapport quickly
– Introduce yourself to everyone in the room;
shake hands if appropriate
• This establishes a welcoming atmosphere
– Acknowledge if they have been waiting
• “I am sorry that you had to wait.”
• “Thank you for waiting to see me.”
1. Invest in the Beginning
 Convey knowledge of patient’s history
• “It looks like Dr. Jones referred you to see me today, is
that correct?”
• If you require records, this conveys that you have read
them and know why the patient is there
• “Dr. Brown tells me that you were referred by your
surgeon, Dr. Bonesetter. What did he tell you to expect
from today’s visit?”
 Adapt own language and pace to patient
– Check patient’s non verbal's to see if they
look puzzled or confused
1. Invest in the Beginning
Start with open-ended questions
– “Dr. Jones tells me he has been seeing you
for your back pain and tried therapy and a
variety of pain meds, and nothing has helped
your pain. Can you tell me more about that?”
• This is where you will discover what the patients
expect from you or what they have been told by
others to expect.
• Many patients believe that you are the answer to
all of their problems.
1. Invest in the Beginning
If using an interpreter,
look and speak
directly to the patient.
1. Invest in the Beginning
Let the patient know what to expect from
you
◦ “Today I need to understand from you what is
your biggest concern.”
 Patients do not always prioritize their concerns/problems
◦ “I will do an examination, and then I’ll go over
possible tests we may need to order. I may
need the results of those tests before I can
offer you treatment options.”
1. Invest in the Beginning
Let the patient know what to expect from
you
◦ “It sounds like you need a doctor’s note for
work, so please remind me (or my nurse)
before you leave the office today.”
 This decreases potential for conflict by
acknowledging patient’s primary concern.
 Can be initiated by nurse or resident physician.
2. Elicit the Patient’s Perspective
 Assess the patient’s point of view
◦ “What worries you the most about this problem?”
 Determine what the patient’s goal is
 “When you were thinking about today’s visit, how were
you hoping I could help?”
 This uncovers hidden concerns
 Allows the patient to provide important diagnostic clues
 How has this problem affected your daily
activities/work/family?
 Helps determine social stressors that impact patient’s life
 May lead to undiagnosed depression
3. Demonstrate Empathy
Be open to patient’s emotions
– Look for opportunities to use brief empathetic
comments
– In order to sound sincere, say out loud what
they are feeling and why.
• “It sounds like this pain has affected your ability to
participate in your child’s activities.”
• “I can hear how frustrated you are because no
physician has been able to identify the cause of
your leg pain.”
3. Demonstrate Empathy
– Compliment the patient on their efforts to address
the problem.
• “It sounds like you have been doing a lot of
research trying to find a specialist to help you. Let
me explain what I can offer you.”
– Make sure your non verbal's demonstrate
empathy (pause, or facial expression)
• This builds trust and makes limit setting or saying
no easier.
• Conveys to the patient that “you get it.”
4. Invest in the End
Let them know what concerns you have
and deliver information in terms of
patient’s original statement
– “Let me tell you what concerns me. You told
me that you are here because you want me to
find the nerve that is causing all your pain,
and based on your exam, I am not certain if I
am going to be able to isolate one specific
nerve.”
4. Invest in the End
Let them know what concerns you have
and deliver information in terms of
patient’s original statement
– “I am concerned that you have been taking
many different narcotic medications over the
past few years.”
– “I am very concerned about healing problems
after surgery. We need to come up with a
plan to manage your tobacco use and your
blood sugars, both of which can interfere with
your ability to heal.”
4. Invest in the End
 Provide education
◦ Explain the rationale for the tests/treatments
◦ Explain why the test they requested won’t provide you
with needed information
 “Many patients have heard of MRIs, but from my point of
view, I don’t think it will help diagnose your problem, and I
don’t want to waste your time (or money.) I want to be
honest with you.”
◦ Review any possible side effects
◦ Provide written materials or resources for more
information
4. Invest in the End
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Involve patient in decision making
◦ Discuss your treatment goals
 “My goal is to try to manage your symptoms, but I may not
be able to completely stop all of them. I would like to try this
medicine to see if it will help your symptoms so you can
maintain as much function as possible to perform your
everyday activities.”
 Introduce any opioid agreements at this point.
◦ Let the patient know if there are options
 Offering options increases potential for collaboration and
improved compliance
4. Invest in the End
 Assess the patient’s ability and motivation to
carry out the plan
◦ “Are you in agreement with this plan?”
◦ “Does this sound like a plan that you can live with?”
 If the patient tells you that this is not what he wants, you can
acknowledge that he/she has the right to disagree and refer
them back to their physician early in your relationship.
◦ “I am going to send a letter to Dr. Jones and let him
know our plan or your intention to return to see him.”
4. Invest in the End
 Complete the Visit
◦ “What questions do you have?”
 This question reduces the number of return calls and
visits
◦ Establish follow up timeline
 I would like to see you in 4 weeks after your test
◦ If a one time Consult, be clear to communicate
this to the patient.
 “ I am going to write your doctor and tell him what we
talked about today, as well as my recommendations.”
 “It was a pleasure to meet you today.”
What happens if things don’t go
well?
Service failure arises from a
Customer’s perception
of the experience,
NOT from what you believe was
provided.
Customers Response to Dissatisfaction
• The customer decides to tell you or not
– Talker vs. Walker
• The customer may respond publicly or
privately
– Legal Action
– Calling state agencies
– Calling the Office of patient & Family Affairs
– Talking to their referring physician
Typical Complaints by Type
Lost/Damaged
Items
2%
Patient Safety
1%
Billing
7%
Access
9%
Clinical Care
17%
Attitude/Courtesy
18%
Communication
46%
What can you do?
• Determine if the issue can be
resolved between you and the
patient
• Take the HEAT
Taking the HEAT
• Hear them out
• Empathize
• Apologize
• Take responsibility for
action
Hear them out
• Focus 100% on the customer
• Make eye contact
• Be aware of your facial expression and
your tone
• Ask appropriate questions so you fully
understand the situation
Empathize
• How would you feel?
• Be sure to let the customer know that you
get it
• Say out loud
– What they are feeling
– Why they are feeling that way
• Very powerful
Apologize
• It’s not accepting blame or assigning fault
• You are representing Barnes Jewish
Hospital and Washington University
School of Medicine
– I’m sorry that this has upset you
– I’m sorry that this happened
Take responsibility for action
• Focus on what you CAN do for the
customer
• Offer suggestions/choices when possible
• Refer to appropriate individual when
necessary
What can you do?
• If you are not able to resolve, call for help
– Your Attending Physician
– BJH/W.U. Risk Management
• Work together to resolve issue
– Negotiate a reasonable solution, but don’t
compromise the overall goal
– Noncompliance vs. threatening behaviors
Questions?