1. Hypertension Best Practice Session 4 Communication

2. Hypertension best practice elements
Blood pressure (BP) measurement: include two BP readings if first is high (≥140/90 mmHg)
Timely follow up: monthly visits until BP controlled
Treatment algorithm: low-cost, once-daily meds
Communication: building trusting relationships
Outreach: using a registry
Begin this session by briefly reviewing the elements of the hypertension best practice.
Tell the group that Session 4 will focus on communication for the entire session and that we will continue to work on communication pieces in Sessions 5 and 6.

3. Learning objectives Improve recognition and handling of emotions
Enhance verbal and nonverbal expressions of empathy
Increase ability to elicit and negotiate patient concerns

4. Session outline Empathy Video Review Key Communication Strategies
Role Play Demonstration
Practice Skills (with each other in small groups)
Discuss Homework
Our communication session 4 has 4 parts.
We will review key communication strategies
We will do a role play demonstrating communication strategies
You will have an opportunity to practice skills (with each other in small groups)
And we will have an assignment to complete before our next session.

5. Empathy: The Human Connection to Patient Care
Empathy video
Empathy: The Human Connection to Patient Care
We will watch a video entitled Empathy - the Human Connection to Patient Care. After the video, you may want to state that this video can bring up strong emotions in the viewers. Ask the staff “what struck them during the video?” Ask staff for emotions and feelings that stood out for them in the video. Ask what made a particular emotion or feeling stand out for them in the video. You may want to share some of your own reactions to the video.
The main points here are to have them notice the nonverbal communication both for patients and staff/providers.

6. Communication strategies
Build rapport
I – Introduce yourself, attend to comfort
D – Describe what’s next (including wait time)
E – Elicit patient concerns
A – Articulate/express empathy
L – Leave in a positive way
We will now review verbal and nonverbal communication strategies so everyone is on the same page.
We developed this mnemonic to assist you with remembering how to create an ideal rapport with your patients.
Read Slide and give examples as appropriate. You could ask if they describe what’s next - including a wait time currently.

7. Identifying patient beliefs and eliciting concerns
What do you believe is the cause of this problem?
What course do you expect it to take?
How serious is it?
How does it affect your body and your mind?
What do you most fear about this condition?
What do you most fear about the treatment? (Box 2 Kleinman et al., 2006)
Give staff and providers the Kleinman article and ask them to See Box 2. Then state that this slide goes a little more deeply into eliciting patient concerns as discussed on the prior slide. This article discusses how to explore different beliefs and elicit patient concerns so you can better understand the choices patients might make regarding their health. These open-ended questions are one way to obtain patient beliefs and concerns.
Read the questions on the slide.
Ask the staff/providers what open-ended questions they typically ask patients and how that has worked for them.

8. Strategies associated with higher patient satisfaction scores
Focus on patient’s agenda.
Draw out the story. “OK”; head-nodding; listen to 3-5 sentences uninterrupted; opportunity to express patient concerns; ask probing questions; tell about yourself.
Demonstrate understanding. Respond empathically; show caring; show familiarity with medical or social history.
Provide detailed explanation. What is happening and why; present options to patients.
Complete the patient’s agenda. Deliver what was promised or negotiate until later.
(Table 1 Tallman et al., 2007)
Give Tallman article out to staff and providers. Tell them that this article videotaped patients and providers at Kaiser Permanente. The authors analyzed the videos to see what communication strategies were used in each video. They also interviewed patients after the visit to see what communication strategies they liked or did not like at the visit. They then categorized the strategies used in the providers with higher and lower patient satisfaction scores. They describe in this article the strategies used by the providers in the higher patient satisfaction scores group. The providers did not necessarily do every strategy at a single visit.
Read slide to your staff/providers and give examples:
Focus on patient’s agenda – this does not mean you have to address every patient concern at the visit. Successful providers negotiated the list of concerns, addressing several of most importance to the patient and stating they would see them back soon to address the rest of their concerns.
Draw out the story – this could be something simple like head nodding or saying okay to show you are listening. You could ask questions about their primary concern to show you care and want to determine what the cause is of their problem. Telling bout yourself is not simply a social statement but something to help motivate them to change. For instance, you might say my husband did not take the flu shot for years due to the concern about not feeling well, but he is finally taking the flu shot and is feeling fine. Again, you would not use all these in the same visit necessarily.
Demonstrate understanding – recognize their emotion verbally by stating it back to them such as this sounds really frustrating. I have a lot of respect for how you are dealing with this issue. Showing respect to patients verbally can be very powerful.
Provide detailed explanation so patient’s understand different choices and why you are suggesting a specific option.
Complete the patient’s agenda – again, you do not need to address all patient concerns but you want to have a plan to address the ones you did not get to in that visit and address the few you said you would address.
These are strategies you will want to practice.

9. Non-verbal communication strategies
Sitting down
Leaning in toward the patient
Nodding
Eye contact
Dealing with computers in the room
Review the nonverbal communication strategies with your staff.
Some of these strategies will be displayed in the video clip.

10. Role Play Demonstration
When we do this session live, we do a role play to demonstrate the communication strategies – see the role play case in the supplemental folder.
After the role play or video ask your staff the following questions. Ask your staff the following questions:
Did they notice the IDEAL mnemonic being used.
What communication strategies did they notice from the video or role play?
Staff should at least respond by saying the following:
The student nurse introduced herself
She elicit the patient concern
She describe what’s next like the therapy, and that the patient will get a prosthesis.
She elicit patient concerns about her amputation
The student nurse articulated and express empathy
She left in a positive way by helping the patient to realize she was getting better

11. Practice skills outline
Break up into small groups
2. Role play one to two cases
a) Case 1: identifying and dealing with emotion
b) Case 2: eliciting and negotiating patient concerns
Discuss homework
Choose a communication skill (Question 1) to practice for next time
Have your staff to break out up into small groups. Staff should play their current role; nurse/MA, clinician, receptionist, etc. The facilitator should be the patient for case 1. In Case 2, the facilitator should watch and let others be the patient.
Provide each staff with the case scenario/script for their role.
Use the role play cases in the Supplemental Folder.
See Homework Assignment in the Supplemental Folder

12. Disclaimer
Use of these slides alone will not improve blood pressure control within your practice.
Blood pressure control will be achieved through active quality improvement efforts in conjunction with these slides.
Practice coach consultation is available to assist you in improving outcomes.

13. Acknowledgements This work was made possible with funding from:
The Mt. Sinai Healthcare Foundation
U.S. Centers for Disease Control and Prevention
Special thanks to:
Better Health Partnership participating clinics
Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga)

14. Contact Info
For questions about the online toolkit or assistance with implementation, please contact our coaching team at

15. Thank you!