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Improving Physician-Patient Communicatio
What was the challenge, opportunity or issue faced?
The goal at Regions Hospital is to be in the top 10% of hospitals nationwide in patient experience. While many projects focusing on patient experience have been undertaken at Regions, very few have focused on the physician interaction with patients. The patient survey data indicates that overall, patients feel they are treated with courtesy and respect by their physicians, but opportunities exist in the areas of physicians listening carefully and in explaining things understandably. Value-Based Purchasing has provided an opportunity to identify and implement best practices around communication with physicians.
What did you do to address it?
Renee Sauter and Dianne O’Konski, trained physician-shadow coaches from the Guest Experience and the Best Care Best Experience departments, along with Jon Henkel, Director of Guest Experience, worked with Dr. Richard Mahr, Medical Director of Quality in mid-2011 to bring shadow coaching into the hospital environment. Dr. Mahr readily agreed this was a program worthy of further study and trial. As a Hospitalist, he offered the Hospital Medicine group to be the pilot program subjects, again on a voluntary basis. He wanted specifically to assess how often the teach-back method was being used to enhance patient education and understanding. (Teachback is a process in which the patient repeats back to the physician what was just said.) A checklist of best practices was developed for use by the coaches, focusing on behaviors associated with pre-exam preparation, the entry into the room and introduction, the exam (including the use of teach-back), the exam/visit close, and physician interaction with staff. A four question survey was developed to allow the shadowed physician an opportunity to provide feedback. It should be noted that the shadow coaches are not medically trained and only comment on behaviors from a patient experience perspective.
Hospital Medicine leaders were the first to volunteer. Initially, the shadow coaches conducted pre-shadow and post-shadow interviews with patients regarding the physician’s communication. The physicians were shadowed during daily rounds on their patients. Feedback was provided to the physician between patients and an overall debriefing session of 10-15 minutes was conducted at the end of the shadow experience. A formal report of the observation was written and sent to the shadowed physician and to Dr. Mahr. Survey feedback from this group and other physician volunteers indicated they felt the experience was of value and most physicians indicated they would make changes based on the observations. The hospital’s Experience Steering Committee was kept informed of the trial and the results, and endorsed its expansion to other service lines. In late 2011, the hospital shadow program was incorporated into HPMG’s program and is administered by Physician Services. This allows for central scheduling for physician shadow coaching and a larger pool of shadow coaches are available for assignment. Formal reports are sent to the shadowed physician and to Physician Services that highlight observed strengths and areas for improvement. The program has the support of senior leadership at Regions and is available to physicians who practice at the hospital. Dr. Mahr continues to champion the program at Regions. To date, we have shadowed physicians from Emergency Medicine, Trauma and Acute Care Surgery, and Hospital Medicine.
What were the outcomes?
Feedback from the physicians continues to be positive. The patient surveys are not specific enough to identify patient experience behaviors related to individual physicians, so improvement is measured at the hospital unit level. However, advocacy for the program continues to grow from the physicians who have gone through the process. Shadow coaching of residents has also started, primarily for those in their 3rd year of Residency. A new physician orientation program is being developed which will include patient experience components and the shadow program. The program continues to be voluntary.
Regions has four hospital-based Residency programs and three Fellowship programs. A new group of first-year residents and fellows will enter these programs in June. Patient Experience will be a portion of the Resident Orientation and the Residents may volunteer to be shadowed. Regions is also affiliated with the Residency program at the University of Minnesota. Residents from this program rotate through our facility as often as every six weeks and are not included in our formal Resident Orientation; however, patient experience information and webinars are being updated on the resident education website and shadow coaching is offered to them as well.
About Regions Hospital
Regions Hospital is certified as a Level I Trauma Center for adults and for children serving Minnesota and western Wisconsin for more than 130 years. A private, nonprofit, teaching hospital, Regions (www.regionshospital.com) provides outstanding care in women’s health, heart, cancer, surgery, orthopaedics, neuroscience, burn, emergency care and more. Regions is part of the HealthPartners (www.healthpartners.com) family of health care companies that serves 1.4 million medical and dental health plan members nationwide. Follow RegionsHospital at twitter.com/RegionsHospital and www.facebook.com/home.php?#/regionshospital.