dilemmas in communication: hospital...
Post on 27-Mar-2018
218 Views
Preview:
TRANSCRIPT
DilemmasInCommunication:HospitalMedicine
PatrickKneeland,MD
ExecutiveMedicalDirectorforPatientandProviderExperience|UCHealthDirectorofQuality,Safety,andExperience|DivisionofHospitalMedicine|UniversityofColoradoHospital
Disclosures
InstituteforHealthcareExcellenceFacultyMemberandConsultant
LearningObjectives• ExploretherelationshipbetweencommunicationandHCAHPS.
• Identifycommonareasofcommunicationbreakdowninhospitalmedicine.
• Developaframeworkfortheroleofeffectivecommunicationinpatientexperienceofcare,includingpatientsafety,andhealthoutcomes.
• Exploreevidence-basedapproachestocommunicatingeffectivelyinhospitalmedicine.
PatientExperience- theWhy?FocusOnValue
Policy(ACA)Patients
PayorsAnd
Employers
Providers(It’swhywe’reinthis!)
ValueBasedPurchasing
ValueBasedPurchasing
https://www.youtube.com/watch?v=jjCu4nxOHlQ
ValueBasedPurchasing
PotentialFinancialImpact
9
2013 1%
2014 1.25%
2015 1.5%
PossiblePercentageWithheld
WhenIreflectonthewidespreaduseofpatientsurveysinhospitalsandclinicstomeasure“patientsatisfaction”or
“patientexperience,”Iamskepticalforthefollowingreasons:
What’sthedifferencebetween“patientsatisfaction”
and“patientexperience”?
IHI:AccessScience
Relationships
MichaelPorter(NEJM):HealthStatusAchieved/Retained
ProcessofRecoverySustainingHealth
Kano:Must-be’s
PerformanceAttributesAttractiveQuality
TomLee:ReliefofSuffering,
BringingPeaceofMind
IHI:AccessScience
Relationships
MichaelPorter(NEJM):HealthStatusAchieved/Retained
ProcessofRecoverySustainingHealth
Kano:Must-be’s
PerformanceAttributesAttractiveQuality
TomLee:ReliefofSuffering,
BringingPeaceofMind
1EtiquetteandManners
ImaginingYourselfAsAPatient,RankThese3CommunicationPriorities
2InformationClearlyCommunicated
3DemonstratingthatYouCareaboutMeAsaPerson
PopQuiz:
Whatarethe3questionsontheHCAHPSsurveyintheYourCareFromDoctors
domain?
ExperienceImpactsQuality
ExperienceImpactsMarketShare
Hospital Quality Alliance program scores hospitals in the highest quartile of HCAHPS ratings were, on average, about 2 to 4 percentage points higher than the HQA scores for hospitals in the lowest quartile of HCAHPS ratings
2-4% Points
41%of patients choose providers
based on non-clinical experience
Hospitals with a patient-centered care approach, see decreases in malpractice claims, despite an increases in patient care activity.
ExperienceImpactsMalpracticeClaims
ExperienceImpactsSafety
Highpatientsatisfactionislinkedto:
decubitusulcerratespostoperativerespiratoryfailure,
Fallshospitalinfectionrates
PhysicianPerspectiveonCommunication
• 250,000patientencountersduringourprofessionallifetime
• Upto25%oftheseencountersaredescribedasfrustrating
• 50%offrustratingencountersarealsodescribedasdysfunctional
PURPOSEJOY
PATIENTSWhy
HowWhat
TheWhyofExperience?
AdaptedfromSimonSinek,StartwithWhy
WhatDoPatientsWantfromTheirHealthCareProvider?
MajorContributorstoPatient’sHealthCareExperience
Havingadoctorwholistenstothem 85%
Havingadoctorwhoiscaringandcompassionate 71%
Havinga doctorwhoexplainswell 69%
Having convenientandquickaccesstohealthcare 47%
Havingpleasantinteractionswithotherstaffinthedoctor’soffices
41%
Being abletotalkaboutcostofcareandnecessityoftestingandtreatment
29%
Ensuring doctorsdisclosefinancialconflictsofinterest 22%
Having adoctorwhoprovidesholisticoptionstocare 8%
Havingdoctors’officeinchargeof coordinatingcare 6%
Havingadoctorofthesame languageandculture 4%
Having adoctorwhoprovideschoice 4%
WhatDoPeopleWantFromTheirHealthCare?AQualitativeStudyLeana S.Wen&Suhavi TuckerResearch|Vol.7,2015|June25,2015
Extremely Important (%)
Describes Your Doctor
Well(%)
Gap*
Treats you with dignity and respect 85 73 -12Listens carefully to your health care concerns and questions 84 68 -16Is easy to talk to 84 69 -15Takes your concerns seriously 83 69 -14Is willing to spend enough time with you 81 62 -19Truly cares about you and your health 81 63 -18Has good medical judgment 80 65 -15Asks you good questions to really understand your medical conditions and your needs 79 61 -18
Is up-to-date with the latest medical research and medical treatment 78 54 -24
Can see you at short notice, if necessary 71 53 -18Responds promptly when you call or email with questions or concerns 60 38 -22
Has a lot of experience treating patients with your medical condition(s) 58 45 -13
Could get you admitted to a leading hospital when you need it 55 46 -9Has been trained in one of the best medical schools 27 25 -2Is of your own sex or gender 15 36 +21Is of your own race or ethnic background 10 30 +20
HarrisInteractivePollof2,267USAdults,2004
• 80%ofpatientsfeeltheirdoctorsaretoobusytolistentotheircomplaints
WhatDoPatientsWantfromTheirHealthCareProvider?
Extremely Important (%)
Describes Your Doctor
Well(%)
Gap*
Treats you with dignity and respect 85 73 -12Listens carefully to your health care concerns and questions 84 68 -16Is easy to talk to 84 69 -15Takes your concerns seriously 83 69 -14Is willing to spend enough time with you 81 62 -19Truly cares about you and your health 81 63 -18Has good medical judgment 80 65 -15Asks you good questions to really understand your medical conditions and your needs 79 61 -18
Is up-to-date with the latest medical research and medical treatment 78 54 -24
Can see you at short notice, if necessary 71 53 -18Responds promptly when you call or email with questions or concerns 60 38 -22
Has a lot of experience treating patients with your medical condition(s) 58 45 -13
Could get you admitted to a leading hospital when you need it 55 46 -9Has been trained in one of the best medical schools 27 25 -2Is of your own sex or gender 15 36 +21Is of your own race or ethnic background 10 30 +20
HarrisInteractivePollof2,267USAdults,2004
• 80%ofpatientsfeeltheirdoctorsaretoobusytolistentothem
WhatDoPatientsWantfromTheirHealthCareProvider?
ChallengingCommunicationScenariosinHospitalMedicine
PainManagement
DemandingPatientsandFamilies
ConversationswithConsultants
AddressingPreviousCommunicationorCareBreakdownswithOtherProviders
Addressingresourceuse/highvaluecare
EndofLifeScenarios
Substanceabuse
AddressingMedicalErrors
Whataboutthisone?AddressingPreviousCommunicationorCareBreakdownswithOtherProviders
AddressingPreviousCommunicationorCareBreakdownswithOtherProviders
OftenOurDefault
OR
OftenOurDefault
OR
PrepareforBattle Explain/OfferSolutions
1EtiquetteandManners
ImaginingYourselfAsAPatient,RankThese3CommunicationPriorities
2InformationClearlyCommunicated
3DemonstratingthatYouCareaboutMeAsaPerson
Whatdoestheevidencesay?(TheGoodNews)
Openendedlisteningwithreflectionbacktospeaker
Recognizeemotionandrespondwithempathy(Beforeproblemsolvingorexplaining!)
+
Openendedlisteningwithreflectionbacktothespeaker
Someexamplesofopenendedquestions:
IwanttomakesureIunderstandyourprimaryconcernstoday,whereshouldwestart?
Thatwasalotofinformation,whatquestionsorconcernsdoyouhave?
Ispoketoyournurseanditsoundslikeyouwerenauseousovernight,whatelseisonyourmindtoday?
Itisimportanttomethatweareonthesamepage,canyouexplaintomewhatyourunderstandingoftheplanforthedayis?
RecognizeEmotionandRespondwithEmpathy(Beforeproblemsolvingorexplaining!)
Someexamplesofwhatthismightsoundlike:
Icantellthatyouarefrustratedbyreceivingmixedmessages.Iamsorrythatthemessagehasnotbeenclear.Let’sworktogethertodaytoclarifyallofyourconcerns.
Anyonewhowasjustgiventhisnewswouldbeanxiousaboutnextsteps.Iwanttomakesuretogiveyouachancetoprocessthisandaskthequestionsyouhave.
Iamsorryyouhavebeenwaitingsolong.IamherenowandyouhavemycompleteAttention.
Howdoesthisapplytodifficultconversationswithcolleaguesorconsultants?
LearningObjectives• ExploretherelationshipbetweencommunicationandHCAHPS.
• Identifycommonareasofcommunicationbreakdowninhospitalmedicine.
• Developaframeworkfortheroleofeffectivecommunicationinpatientexperienceofcare,includingpatientsafety,andhealthoutcomes.
• Exploreevidence-basedapproachestocommunicatingeffectivelyinhospitalmedicine.
top related