Teach-Back [Date] [Name/Organization] Thank you for coming today. My name is _____________ and I’m here to talk with you about the teach-back method. A program created by the Minnesota Health Literacy Partnership

Objectives Define teach-back and its purpose Describe the key elements for using teach-back correctly Use teach-back in the clinical setting After today’s session I hope you all will be able to : Define teach-back and its purpose Describe the key elements for using teach-back correctly Incorporate teach-back into your practice

The problem with communication is the illusion that it has occurred. -- George Bernard Shaw The problem with communication is the illusion that it has occurred. Or as one patient advocate has said, “what’s clear to you…is clear to you”.

Teach-Back Basics . . . Let’s start with the basics.

Teach-Back Basics What is it? Who should I use it with? When should I use it? Where should I use it? Why should I use it? How should I use it? I will describe the who, what, when where, why and how of the Teach-Back Technique

Teach-Back . . . Asking patients to repeat in their own words what they need to know or do, in a non-shaming way. NOT a test of the patient, but of how well you explained a concept. A chance to check for understanding and, if necessary, re-teach the information. So, what is the teach-back technique? Basically it is asking patients to repeat back in their own words what they understand from what they’ve been told. It is NOT a test. It is a way to let you know how well you’ve explained a concept. And, it needs to be completed in a non-shaming way. It is important that the patient recognizes it is to make sure you explained everything correctly. Using teach-back provides you with the opportunity to confirm what the patient really understands and re-teach if necessary….right there…while they are still in the office with you. Doing this in real time can help reduce potential medication errors and mistakes with care instructions.

Teach-Back . . . Who? Elderly Ethnic and racial minorities/LEP Persons with limited education Persons of low socioeconomic status Persons with chronic disease Use teach-back with ALL your patients. It is especially critical to confirm understanding through teach-back with those most at risk for having difficulty understanding and acting on health information. Those most at risk include: the elderly, ethnic and racial minorities, those with limited education and low socioeconomic status as well as people with chronic diseases.

Teach-Back . . . Where? Teach-Back can be used in all clinical settings . . . Clinic Home Health Hospital What other clinical settings would this work in? Would this work in non-clinical settings? Teach-back can work in any setting and in all situations where you want clarification for what was taught/said. Where could you use teach-back? What are some specific clinical examples? (some ideas to generate discussion: Discharge instructions, new medications, new self-care techniques, informed consent, goals of care, etc.) Would this work in non-clinical settings? (ideas for discussion: yes, this would work for scheduling follow-up appointments, following directions to get to the lab or radiology departments, understanding health insurance information, etc. ) In fact, you could even try to practice at home with your spouse or teenager. (laughter) In other words…use teach-back EVERYWHERE!

Teach-Back . . . When? The teach-back technique should replace the more common practice of simply asking a patient, “Do you understand?” Experience shows that patients often answer “yes” to such questions, even when they understand nothing. Any examples? Who here has ended a conversation with the question “do you understand”? I know I have. When we use this with our patients, they most likely will nod or answer yes, but you won’t have any idea what they really understand. Teach-back will replace this more common question and provide you with the chance to know what the patient understood from what you said. Does anyone have any examples of where teach-back worked or where it didn’t? Work, home?

Teach-Back . . . Why? Teach-Back is supported by research! “Asking that patients recall and restate what they have been told” is one of the 11 top patient safety practices based on the strength of scientific evidence.” AHRQ, 2001 Report, Making Health Care Safer “Physicians’ application of interactive communication to assess recall or comprehension was associated with better glycemic control for diabetic patients.” Schillinger, Arch Intern Med/Vo640 l 163, Jan 13, 2003, “Closing the Loop” Not only is teach-back a good thing to do, it is supported by research. In fact, the Agency for Healthcare Research and Quality considers teach-back one of the top 11 patient safety strategies. Another study showed that when physicians used interactive communication techniques like teach-back, diabetic patients had better glycemic control.

Teach-Back . . . Why? Provides an opportunity to check understanding with the patient and re-teach if necessary. Re-phrase if a patient is not able to repeat the information accurately. Ask the patient to repeat the information again, until you are comfortable they really understand it. If they still do not understand, consider other strategies (pictures, videos, analogies). One of the most important elements of using the teach is the opportunity to re-teach information. You will know if real-time, while you are still with the patient, whether or not they understood what you were hoping they would. If they didn’t get it the first time, remember it’s not their fault. Think about another way you could explain the information… Maybe you could use an analogy or use pictures or diagrams. Also make sure information is available to help the patient remember what they are supposed to do when they are home.

Teach-Back . . . How? Ask patients to demonstrate understanding “What will you tell your spouse about your condition?” “I want to be sure I explained everything clearly, so can you please explain it back to me so I can be sure I did.” “Show me what you would do.” Chunk and check Summarize and check for understanding throughout, don’t wait until the end. Do NOT ask . . . “Do you understand?” Here are some ideas of how you might do a teach-back. “What will you tell your husband about the changes we made to your blood pressure medicines today?” “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?” If you are teaching how to take medicine like injections or inhalers or how to dress a wound, you might ask “Can you show me what you will do at home?” When using the teach-back, remember to not overload the patient with too much information before asking for understanding….don’t wait until the end of the visit…ask throughout the encounter, chunking information into sections and check in along the way. And, do not ask, “Do you understand?”. Asking yes or no type questions doesn’t help you know what the patient really understood. Remember, asking more open-ended questions is the key to a successful teach-back.

Teach-Back in Action http://www.youtube.com/watch?v=2N0gCzdVFnM Now let’s watch a short video about teach-back. http://www.youtube.com/watch?v=2N0gCzdVFnM

Additional Points. . . Slow down. Use a caring tone of voice and attitude. Use plain language. Break it down into short statements. Focus on the 2 or 3 most important concepts. Here are some other keys to having a successful teach-back. Remember to slow down, don’t speak so quickly. Give the patient time to hear what you’ve said before moving on to a new point. Use a caring tone of voice and attitude. Help the patient feel more comfortable about asking questions and speaking up about their care and concerns. Use plain language. Use words that everyone can understand, not just a doctor or a nurse. Remember to keep it simple and avoid medical terminology or abbreviations when possible. Break things down into short statements. This can help you limit yourself to conveying only the most important information for that patient. And finally, focus on the 2 or 3 most important concepts that this patient needs to know to take care of themselves. Using these skills will help improve your communication with your patients and make sure you are speaking in a way your patients will understand.

Teach-Back Humor Even seemingly simple instructions can be misunderstood remember to use the teach-back method to be sure your patients understand.

Resources Minnesota Health Literacy Partnership (MHLP) http://www.healthliteracymn.org/ American Medical Association (AMA) http://www.ama-assn.org/ Agency for Healthcare Research & Quality (AHRQ) http://www.ahrq.gov/browse/hlitix.htm Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/healthliteracy/ Here are some additional resources where you can find more information about health literacy. You may also contact me with any further questions or comments. Please use your own contact information here or ask them to contact the Minnesota Health Literacy Partnership via our website.

Acknowledgements The Minnesota Health Literacy Partnership would like to thank the following organizations for contributions to this training: 17

Questions? Any questions?