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 Experiences with Staff  Pre Arrival: Ease of scheduling appointment Getting through to the Office by phone Personal manner of telephone staff  During the Visit: –Office Wait Telling the patients what to expect and why? –Personal manner of office Staff Front desk, back office

 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 Provider Specific

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. Communication is the key to Everything

“Apparently, patients are less concerned with how much their physicians know than with how much they care.”

Who do you communicate with? Patients Families Physician Colleagues Nurses Administrators Hospital/ office staff Insurance company representatives Attorneys Medical Record Documentation Media

Why 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.

barriers What are barriers to effective communication with patients? 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  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

What can you do? Determine if the issue can be resolved between you and the patient Take the HEAT

Taking the HEAT H ear them out E mpathize A pologize T ake 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?