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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization Physician Skill Building Dan Smith, MD, FACEP Medical Director Studer Group Physician-Patient Communication

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Page 1: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Physician Skill Building

Dan Smith, MD, FACEP

Medical Director

Studer Group

Physician-Patient Communication

Page 2: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Execution Framework: Evidence-Based

LeadershipSM

2

Page 3: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Why communicate better and deliver a great

patient experience?• Improves clinical effectiveness/treatment adherence

• Improves clinical outcomes and safety

• Increases loyalty and growth

• Improves CAHPS performance

• Reduces malpractice risk

• Improves physician/APP/staff satisfaction

Patients’ rating of quality is more predicted by their rating of the quality of communication than technical care. * Chang, Annals of Internal Medicine

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Outcome = Income

Volume Value

Past Future

Page 5: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

CAHPS® Family of Surveys

Consumer Assessment of Healthcare Providers and Systems

• Family of surveys designed to assess patient perception of care quality

• Allows comparisons of hospitals so that consumers can make choices

• Linkage to value-based purchasing reimbursement to hospitals

• CAHPS Survey Tools:

– HCAHPS

– CG CAHPS

– PCMH CAHPS

– In-center Hemodialysis CAHPS

– Home Health Care CAHPS

– ED PECS

Page 6: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

CG CAHPS Core Questions &Composites15 questions grouped in 5 composites

Getting Timely Appointments,

Care, and Information

(Access)

• Getting appointments for urgent care

• Getting appointments for routine care or

check-ups

• Getting an answer to a medical question

during regular office hours

• Getting an answer to a medical question

after regular office hours

• Wait time for appointment to start

Rating of the Provider (Doctor)

• Overall rating of your Provider

Provider (Doctor) – Patient

Communication

• Provider explanations easy to understand

• Provider listens carefully

• Provider gives easy to understand information

• Provider knows important information about

medical history

• Provider shows respect for what you have to

say

• Provider spends enough time with you

Courteous and Helpful Office Staff

• Clerks and receptionists were helpful

• Clerks and receptionists treat you with

courtesy and respect

Test Results

• Follow up on Test Results

Page 7: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

How we communicate predicts our patient’s

overall rating of care

Page 8: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Chasm between consumer and physician

perception

98%

54%

0%

20%

40%

60%

80%

100%

120%

PhysicianResponse

PatientResponse

Physicians Discussed Patients’ Fears and Anxieties

77%

57%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Physicians ThatThought Patient

Knew

Patients ThatCorrectly Identified

Patients Know Their Diagnosis

Olson, DP and Windish, DM; Communication Discrepancies Between Physicians and Hospitalized Patients” Arch Intern Med 2010; 170 (15): 1302-1307.

Page 9: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Patient Experience is about High Reliability

There are standardized response options to the core CAHPS

questions and this is true for the communication domain

Always

Usually

Sometimes

Never

Yes

Definitely

Yes

Somewhat

No

9, 10

8 or less

ONLY THE TOP BOX RESPONSE COUNTS

Page 10: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

What are the skills to improve

communication and connection?

Page 11: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Patient short list…

1. Who Are You?

2. Are You Any Good?

3. Do You Care?

What healthcare

consumers want to

know:

Page 12: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Timely.

Team.

Effective.

Communicated.

Caring.

Page 13: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Themes Portending a Positive Interaction

Relationshi

ps

Non-verbals Care Plan

and

Partnership

Care Team

and

TransitionsAcknowledge (A of

AIDET®) and 10-5

Rule

Seated Medical jargon

avoidance

Introduction (I of

AIDET®)

Introduction (I of

AIDET®)

Proximity Health literacy

alignment

Role Delineation

Appreciation or Thank

You

(T of AIDET®)

Warm tone Explanation (E of

AIDET®) is

understandable

Consultant

coordination

Empathy Eye contact Duration (D of

AIDET®) and

Timeline

Manage-up

Language specificity Hand wash Confirmed shared

agenda and invited

questions

Handover explanation

Cultural alignment Appropriate touch Care plan summary

and white board

updates

Biocard

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Narrate the Care

Page 15: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

With them…not to them

Shared Care Agenda

“Does that sound like a reasonable care plan?”

Page 16: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Phases of a Patient Encounter and Key

Communications

• First impressions

• Tone and demeanor

• Non-clinical opener

• Awareness and alignment of “why” of the visit (Individualized Patient Care) and information

Beginning

• History and circumstances paraphrased

• P.E and share P.E. findings

• Informed of test results

• Explained working DX

• Explained meds

• Shared plan

Middle• Close the

loop/summarize

• Answer Q’s, Teach Back

• Care coordination/Handover

• Appreciation, admiration

• Lasting impressions

End

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Studer Group Five Fundamentals: AIDET®

A Acknowledge Eye contact, smile and acknowledge everyone in the room.

I Introduce

“Hello Mr. Clark. My name is Dr. Jones, good morning. I have been an

emergency physician for 10 years and I will be caring and coordinating

your care today. During this initial encounter, I want to verify the

information you provided to the ER up front, learn more about the

dizziness you have been having, do a good exam and then describe our

treatment plan…”

D Duration“I would anticipate that you will be here for 2 hours…this may vary

some depending on how you are feeling and the results of the

testing…”

E Explanation“Let me explain the plan with this new medication. It is designed to

reduce your dizziness. It can make some patients a bit drowsy and

perhaps lead to constipation…”

T Thank you“So I wish you all the best. Thank you for the opportunity to care for

you”

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Advantages of AIDET® & Key Words

Decreased anxiety with increased adherence

=Decrease

d Anxiety

Increased

Adherence+Improved clinical

outcomes, more

positive patient

experience and

greater

professional

fulfillment

Page 19: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

•Distance-based guide for interaction

•If you sense a need in a pt/family:

–10 feet: Make eye contact

–5 feet: Acknowledge them

10-5 Rule

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

RECOMMENDATION: AIDET® + “The

Promise”

Tell the patient and family what kind of care

you plan to deliver

Excellent Great

Awesome

Page 21: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

When discussing matters of feeling and attitude, effective

communication is a function of:

Verbal Content: 7%

Vocal Expression: 38%

Visual Cues: 55%

What is important is "CONGRUENCE"

Common Sense Communication Skills

Albert Mehrebian

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Show Empathy

understand and

share the feelings of another

Page 23: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Emotional Intelligence (EQ)

• Describes characteristics beyond technical skill and

cognitive intelligence

• Step one: be aware of your own emotional state/feelings

• Step two: recognize the patient’s

feelings/attitudes/emotional state

• Step three: modulate your response using key words and

empathic cues

• Example

–“I can imagine the frustration of being in the hospital for 2

weeks with this infection, getting home and now being

back in the ED…you have been through a lot recently…”

Page 24: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Effect of sitting vs. standing on

perception of provider time

at bedside

0:01:28 0:01:40

0:03:44

0:05:14

0:00:00

0:01:26

0:02:53

0:04:19

0:05:46

Standing Sitting

Actual Time

Perceived Time

Conclusion:Simply sitting instead of standing at a patient's bedside can have a significant impact on patient

satisfaction, patient compliance, and provider-patient rapport, all of which are known factors in

decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes.Patient Educ Couns. 2012 Feb;86(2):166-71. doi: 10.1016/j.pec.2011.05.024. Epub 2011 Jun 30.

Effect of sitting vs. standing on perception of provider time at bedside: a pilot study.

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Adjuncts to Communication

•Patient communication

white boards

•Biocards

•Care cards

•PACS images

•EHR information

Page 26: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Psychology of “Manage-Up”• Affirming statement which

forecasts positivity of an upcoming

experience, usually with an

individual or a process

• Sets a positive perception of the

care team or care process

• Example: “Dr. Hakim will be

seeing you shortly. He is an

experienced hospitalist who will

continue your inpatient care.”

• Example: “You are very fortunate

to have Judy as your nurse. She is

one of our finest and cares deeply

for her emergency patients…”

Page 27: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

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High Impact Provider Handover

•Professional

•Cordial

•SBART

•The handover is

complete when the

patient and family have

been updated and

understand the care

transition

Page 28: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Service Checklist

•Timely evaluation

•Warm demeanor

•Addressed concerns

•Narrated care plan

•Provided time estimate

•Comfort measures

•Empathy

•Closed the loop

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Deploying a Physician Training Program

29

How do we get this done?

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Slide 30

Educate Train Validate

Our approach (high level)

Why is this important? What are the skills ? How am I doing ?

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Studer Group-Partner Example

Physician Coaching Plan

2013 2014 2015

Focus Groups: ED and Hospitalist

ID’d focus groups

(ED and Hospitalists)

Core Communication Curriculum

Didactic training in 8 sessions

Relationships secured

Begin validation rounding

Intensive Shadow Rounding

with feedback to physicians

ID’d and trained ED champions

Champions begin validation

and training of colleagues

Physician Leadership core skill

training:

Physician Leader Rounding

Running an Effective Meeting

Phys CommunicationTexas, six-hospital system

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32

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33

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Copyright © 2016 Studer Group. Please do not quote or disseminate without Studer Group authorization

Healthcare Flywheel®

Connect

To

Purpose

Page 36: Physician-Patient Communication - Amazon S3 · Physician-Patient Communication. ... (T of AIDET®) Warm tone Explanation (E of AIDET®) is ... emergency physician for 10 years and

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Purpose Worthwhile Work and Making a Difference

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LIVE

LEAD

LOVE

SERVE

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Wherever you go, no matter what the weather,

always bring your own sunshine.

Anthony J. D’Angelo

The College Blue Book

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Dan Smith, MD, FACEP

Medical Director

[email protected]

(850) 439-5882

Insert Your

Photo Here

EVALUATION REMINDER:

We want your feedback to get better. Please

remember to take the session evaluation. Thank you!

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Next Presentation: See What Right Looks Like!

Physician-Patient Communication: Skills Lab

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