Transcript Providing Patient Centered Communication

Providing Patient
Centered Communication
Sue Butts-Dion
Improvement Advisor
Institute for Healthcare Improvement
This project was supported by grant number R18HS019508 from the Agency for Healthcare Research and Quality (AHRQ).
The content is solely the responsibility of the authors and does not necessarily represent the official view of the AHRQ.
Learning Objectives
By the end of this module you will be able to:
Demonstrate the connection between improved
communication with patients and improved patient
safety, efficiency, and patient satisfaction.
 Utilize a Model of Successful Communication
Practices in your practice.
 Identify steps for a personal action plan
 Apply principles of patient-centered communication
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Rx: Communicate Caring Also
“Nobody cares how much you know,
until they know how much you care.”
--Theodore Roosevelt
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Successful Methodology
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Source: The Permanente Journal/ Winter 2007/ Volume 11 No. 1
And the research says…
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Between 30-80 % of patients' expectations are not
met in routine primary care visits
Providers often give patients less than 30
seconds to express their concerns
Providers tend not to involve patients in decision
making and, in general, rarely express empathy
Patients forget ≥50% of providers‘ recommendations
Differences in agendas and expectations are often
not reconciled
Source: Epstein et al.
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Collaborative Agenda Setting
1.
Orient patient: “I know you’re here to discuss the
next steps related to your recent hospitalization. I’m
sorry this happened to you; it must be scary. Are there
other concerns to address while we’re here today.”
2.
Mindfulness cue: Remind yourself that you may
not be able to cover all in one visit.
3.
Make a list: “What concerns do you have today? Is
there something else? Sure?” (Pause. Allow the patient
to tell pieces of their story without interruption.)
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Collaborative Agenda Setting
4.
Mindfulness cue: Can I address all concerns today?
When else might we address them?
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Confirm what is most important to the
patient: “We may not have time to discuss all your concerns
today. Is talking about your meds the most important thing to you?”
6.
Express concerns about what must be
covered. “We need to discuss your Florida trip next week—
and also your treatment and meds for the next few months. If we
can’t get to all of the items today, we’ll set up another time.”
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And the research says…
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1984, Beckman and Frankel
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1999, Marvel (used Beckman methodology)
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78% of complete story in ≤2 minutes if uninterrupted
2005, Dyche (used Beckman methodology)
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Patients interrupted after 12 seconds
2002, Langewitz
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Patients interrupted after 23 seconds
2001, Rhoades
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Patients interrupted after 18 seconds
Patients interrupted after 16.5 seconds
2013, Solvoll
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Patients also interrupted by physician’s mobile devices!
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And the research says…
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1984, Beckman and Frankel
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1999, Marvel (used Beckman methodology)
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78% complete story in ≤2 min if uninterrupted
2005, Dyche (used Beckman methodology)
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Patients interrupted after 12 seconds
2002, Langewitz
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Patients interrupted after 23 seconds
2001, Rhoades
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Patients interrupted after 18 seconds
Patients interrupted after 16.5 seconds
2013, Solvoll
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Patients now also interrupted by physician’s cell phone!
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Some Reactions
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Is this process an invitation for a long list? No!
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Patient doesn’t expect to cover every concern raised
Technique helps uncover patient's real agenda
Expectations can be kindly and gently re-oriented
“In our time allotted today, I’d like to cover the most important
items. That way, I’ll be confident that we’ve dealt with them
completely and that you understand them fully. I’m concerned
about these other items. Would you consider another
appointment in the near future to cover them?”
Olson, 2002
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Personal Action Plan
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Change I want to make happen is…
Goal for the next month is…
Specific steps I will take to achieve my goal are…
Challenges in achieving my goal are…
Plans to overcome these challenges are…
Support I need to achieve my goals are…
Confidence I can achieve my goal is…
Source: http://www.swselfmanagement.ca/smtoolkit/SMTK-manual/
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Teach Back, Show Back, Inquiry
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40-80% of the medical information patients
receive is forgotten immediately.
Kessels RP. Patients’ Memory for Medical Information. J R Soc Med. May 2003; 6(5):219-22
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Teach Back or Show Back
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“I want to be sure that I explained your medication
correctly. Can you tell me how you are going to take
this medicine?”
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Teach Back or Show Back
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“I want to be sure that I explained your medication
correctly. Can you tell me how you are going to take
this medicine?”
“Can you show me how you will keep track of your
medications when you get home?”
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Teach Back or Show Back
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“We covered a lot today about your INR, and I want
to make sure that I explained things clearly. So let’s
review what we discussed. What are three foods
you will want to be careful of when taking warfarin?”
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Inquire Often!
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Developing a collaborative action plan
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On a scale of 1 - 10, 10 being the most important,
how important is this to you?
On a scale of 1 - 10, 10 being the most likely,
how likely are you going to do this?
What do you want to do now?
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Lastly...Assume Good Intent
Note found in my medical record:
<Gave instructions to patient’s
husband, he will have her comply
(name) 12/14/2011 8:03:46 AM>
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Challenging Common Assumptions
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Noncompliance
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Not valid construct for understanding patient behavior
Patient is not always the source of the problem!
Solution to noncompliance
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Changing behavior
Changing systems
Source: Anderson, Robert; Patient empowerment: reflections on the challenge of fostering
the adoption of a new paradigm. Patient Education and Counseling 57(2005) 153-157
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Successful Methodology
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Source: The Permanente Journal/ Winter 2007/ Volume 11 No. 1
What Could You Do Today?
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Approach a visit with 1 patient
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Use Successful Communication Practice Model
(See if it takes any longer  )
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Develop an agenda with 1 patient
Try teach back or show back with 1 patient
What else?
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Thank You!
Thank you
for your time
and attention today
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A Few References
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Epstein R, Mauksch L, Carroll, Jaén C. Have You Really
Addressed Your Patient’s Concerns. Family Practice
Management. March 2008.
www.ihi.org
www.deming.org
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