Patient and Family
Engagement
Communication Strategies
Karen Cook, RN
Nurses – The Most Trusted Profession
Communication…
The act or process of
using words, sounds,
signs, or behaviors to
express or exchange
information or to express
your ideas, thoughts,
feelings, etc., to
someone else
HCAHPS Correlation Studies
Source: The table above was updated 5.3.13 using 3Q11-2Q12 CMS data.
Georgia Hospitals Average Trend
Nurse Communication
Georgia vs. National Avg.
Georgia State Avg
National Avg
79
78
78
78
78
77
77
Avg Top Box
77
77
76
76
76
76
75
75
75
75
74
74
2009
2010
2011
2012
Georgia Vs. Nation Vs. SG Partners
Average Change in Top Box Results in One Year
Studer Group Partners vs. Non Partner
1.3
Patients who gave a rating of 9 or 10 (high)
1.6
1.1
Clean and Quiet
1.3
1.2
Discharge Instructions
1.5
2.0
Patients always received help as soon as they wanted
0.7
Yes, patients would definitely recommend the hospital
1.3
1.8
Staff always explained about medicines before giving…
1.0
Pain was always well controlled
2.5
2.3
1.2
1.4
Nurses always communicated well
1.6
0.80
1.0
Doctors always communicated well
0.20
Non-Partner Change
0.70
1.20
1.70
2.20
GA
Hospitals
Change
in one
year
+.64
2.70
SG Partners Change
Source: The graph compares the change In one year in “top box” results achieved by Studer Group partners vs. non-partners. Change is from 3Q10-2Q11 to
3Q11-2Q12. The “top-box” is the most positive response to HCAHPS survey questions.
Communicating with Empathy
Empathy
Connectivity
Trust
Conscious
Verbal
Non-Verbal
Feelings
Influence
Compliance
Clinical
Outcomes
Excellence
Actions
The researchers identified 384 "empathetic opportunities," but
found physicians responded with empathy to only 39 of them.
Archives of Internal Medicine, Sept, 2008.
Nonverbal Communication and Empathy
Eye contact most highly linked to empathy
TWO Social touches (not associated with tasks such
as handshake, healing touch, pat on arm, etc.)
Source: Journal of Participatory Medicine.. August 14, 2013. Vol. 5
Physician Empathy = Positive Clinical
Outcomes
"Our results show that physicians with high
empathy scores had better clinical outcomes than
other physicians with lower empathy scores."
Empathy
• Higher Empathy
Good Control
• Lower Empathy
Poor Control
*Source: Thomas Jefferson University, Physician's
Empathy Directly Associated With Positive Clinical
Outcomes In Diabetic Patients
good control*
(A1c<7.0 percent)
good control*
(LDL<100mg/dL)
moderate control*
(A1c≥ 7.0% and
A1c≤ 9.0%)
moderate control*
(LDL≥ 100 and ≤
130 mg/dL)
poor control*
(A1c>9.0 percent)
poor control*
(LDL>130 mg/dL)
Patients’ Perception of Care = Quality
Vascular Catheter-Associated Infection
Patients and Families as Partners
How do they know this?
We tell them
“You know your health better than we do and we
need your help to help you get healthy again.”
“You are the only one that can tell us if we are
delivering on excellent care from your perspective
so we need your input on…”
“We want to help you manage your pain.”
Benefits of Patient and Family Engagement
Improves multiple aspects of hospital performance
Overall improvements in quality and safety
– Patients and families as allies in safe medication use,
infection control initiatives, observing care processes,
reporting complications
– Reduction in preventable readmissions
Improved patient outcomes
– Emotional health, symptom resolution, pain control,
physiologic measures
Improved CAHPS® Hospital Survey scores
– Patient-provider communication, pain management,
medications, provision of discharge information
AHRQ Patient Engagement
Toolkit - Information to Help
Hospitals Get Started
Benefits of Patient and Family Engagement
Better response to the Joint Commission standards or
other accreditation
Improved financial performance
– Decreased litigation and malpractice claims
– Lower costs per case due to complications
– Improved patient flow
– Less waste associated with higher call volume, repetitive
patient education efforts, diagnostic tests
Enhanced market share and competitiveness
– Establishment of brand identify around patient and family
engagement
Increased employee satisfaction and retention
AHRQ Patient Engagement
Toolkit - Information to Help
Hospitals Get Started
Critical Care Family Navigator
Establish and maintain a feeling of
warmth, goodwill and trust between
the staff and the family
Establish expectations early in the
ICU admission
Prevent misunderstandings and
conflict, service recovery as
needed
Convey a receptive, professional
attitude towards families as
partners in care
Support the family at point of need
What is Patient and Family Engagement?
Tool provided: AHRQ Patient Engagement Toolkit
Patient and family engagement:
Creates an environment where patients, families,
clinicians, and hospital staff work together as
partners to improve the quality and safety of
hospital care
Involves working with patients and family members
as:
Members of the health care team
Advisors at the organizational level
AHRQ Patient Engagement
Toolkit - Information to Help
Hospitals Get Started
Much of Hospital Communication is One-Way
Flow of communication is “one-way” from communicator to
receiver. (think discharge instructions)
Advantages
Fast
Appears neat and quick
Disadvantages
Knowledge is imposed
Learning is authoritative
No feedback
Little influence on human behavior
Barriers to Communication
Physical/environmental barriers
Personal barriers
Physiological (Illness/Disease)
Psychological barriers (Mental)
Cultural barriers
Personal Experiences
TIME (think discharge instructions)
Language/Literacy
Factors Influencing Communication:
Perceptions
Values
Emotions
Culture
Knowledge
Role and relationships
Environment
Gender
Personality
#lovemynurse
Engagement is Truly Two-Way
Both sender and receiver take part.
The process of learning is active , open and
honest.
Patient’s needs, values and preferences are center
Promotes mutual understanding
Values diversity, creativity and empowerment
ACTIVE LISTENING
RESPECT
Influences human behavior
Guide to Patient and Family Engagement
Includes four strategies to support engagement:
1. Working with Patients and Families as Advisors
2. Working with Patients and Families at the
Bedside: Communicating to Improve Quality
3. Working with Patients and Families at the
Bedside:
Nurse Bedside Shift Report
4. Working with Patients and Families at the
Bedside:
Care Transitions from Hospital to Home:
IDEAL Discharge Planning
AHRQ Patient Engagement
Toolkit - Information to Help
Hospitals Get Started
Patient Centered Care Delivery Model
Hourly Rounding®
1.
2.
3.
4.
5.
6.
7.
8.
Use opening Key words: Round
Perform scheduled tasks
Perform 3P’s
Additional Comfort measures
Environmental assessment of room
Closing Key words
Tell when you will return
Log the round
Nursing and
Patient Care
Excellence
Individualized Patient
Care
1.
2.
3.
4.
Ask what 2-3 things will ensure excellent care
Write on board
Used by all members of the care team
Ask each shift to reinforce listening
Bedside Shift Report
1. AIDET® introduction
2. Communication of current state and plan of
care
3. Teach back reinforcement of important
patient care information such as drug side
effects
Post visit calls
1. Questions designed to assess patients
progress at home
2. Listening with more than your ears
Reference: Studer Group Patient Care Model
The BASIC Best Practices are Rooted in
Communication
Tell the Patient/Family What you want them to know by
using key words, signs, sounds, or behaviors
Validate Understanding with staff
– Can explain why key words are important
– Demonstrate competency in communication
Validate understanding with patients and families
– Use key words
– Teach-back to validate comprehension
Individualized Care - Care/White/Communication Boards
Nurse leader rounding on patients
Hourly Rounding
Bedside handover
Discharge process including post visit calls
Often Missing Key Piece - Validation
Nurse Leader Rounds – focused on
communication and validating that our best
practices are in place. Are we having the impact we expect
from the patient and families perspective?
Shoulder-to-shoulder direct observation and
immediate feedback to staff on implemented best
practices. Are we coaching behaviors?
Whiteboard and Hourly Rounding® log checks –
Have we fulfilled the promise?
Skill labs – Do you know with certainty the skills your staff
demonstrate? Are you and your staff doing these things every
patient, everyday – Always?
Often Missing Key Piece - Validation
Top Performers Use Key Words
During this hospital stay:
How often did the nurses treat you with courtesy and respect?
How often did nurses listen carefully to you?
How often did nurses explain things in a way you could
understand
Staff took my preferences and those of my family or caregiver
into account in deciding what my health care needs would be
when I left.
When I left the hospital, I had a good understanding of the
things I was responsible for in managing my health.
When I left the hospital, I clearly understood the purpose for
taking each of my medications.
How Do They Know?
We tell them…
“Do you mind if I sit while I explain the test you are going to
have today?”
“ Mr. Jones, as I was listening to your wife, she has many
questions about your new medication…”
“I was listening to you speak about your pain and it occurred
to me that we could try….”
“I want to make sure I am listening to you so do you mind if I
turn the TV off while we talk about your care?”
“I have to document in this electronic record but just know
that while I may look away from you, I am listening to you.”
“Kathy does a great job explaining medicine side effects, can
you tell me one of the side effects she taught you today?”
Hardwire AIDET® and Key Words at Key Times
Narrate the care – be more verbal in our approach
with patients and families
Watch body language and avoid silent assessments
Do you really accomplish the objectives of AIDET®
Acknowledge/thank – courtesy and respect
Introduction – instill confidence
Duration/Explanation – reduce anxiety
Acknowledge
A
Acknowledge
Key message: You are important
Eye Contact
Shake hands
Acknowledge everyone in the room
Sit
91% of patients want to be addressed by name and 78% of
patients wanted their physician to shake hands YET
physicians use the patients’ name less than 50% of the time.
* Annals of Internal Medicine
* Mayo Clinic Proceedings
Introduce
I
Introduce
Name
Specialty and what a Hospitalist is
“ I am Dr. Beeson, I am a hospitalist, and hospitalists
see patients in the hospital only, I am working with
your doctor who sees you in the clinic”
75% of patients admitted to the hospital were unable to
name a single doctor assigned to their care.
*Archives of Internal Medicine
Duration
D
Duration
Key Message: I anticipate your concerns
How long will the hospital stay be?
How long will the test, procedure, appointment or
admission actually take?
How long will you be on service?
How long before you come back and see the patient?
Patients’ rating of quality is more predicted by their rating
of the quality of communication than technical care.
* Annals of Internal Medicine
Explanation
E
Explanation
Listen to the patient’s story – 2 minutes!
Clarifying questions
Empathy through words and body language
Explain the treatment plan
Using language that patient and their family can
understand with “teach-back” if appropriate
74% of patients are interrupted by physician within 17
seconds of giving their history.
*J Gen Int Medicine, 2005
Thank You
T
Thank You
Key Message: I appreciate the opportunity
to care for you
Closing Key words
What other questions can I answer for you?
Thank you for your patience in our slight
delay today.
Types of Communication: Verbal
Language:
Chief vehicle of
communication.
CLEAR & BRIEF
The words we use:
Abdomen vs Tummy vs
Stomach
Pacing
Timing and relevance
Humor
Tone
Examples of verbal @
SVH
Nurse Advisor
Intercom/Switchboard
Room Service
Walkie Talkies
Appointments: SVPN
Vocera
HCAHPS
Triage ER
Report to Floor
Huddles
Types of Communication: Written
An interaction that
makes use of the
written word and at
times pictures.
SIGNS
WHITEBOARDS
MENUS
Emails/Texts
Education handouts
Medication Bottles
Manuals, Orders
Policies and Procedures
EMR
Patient complaints
Written Communication
Written Communication
Written Communication
Hardwire the Use of Communication Boards
These are for the patient,
not for the staff
Customize them for your
facility or care area
Focus on the use of the
information by the whole
care team
Gaps in data on the board
don’t fulfill the promise to
patients and families
Hardwire Use of Patient/Family Tools
General Admissions
Orthopedic & Bariatric
39
Hardwire Use of Patient/Family Tools
Hardwire Bedside Shift Handover
Transitions in care have potential
for medical errors
Research shows bedside shift
report can improve:
Patient safety and quality
– Improved communication
– Decrease in hospital-acquired
complications
Patient experiences of care
Time management among and
accountability between nurses
– Decrease in time needed for shift
report
– Decrease in overshift time
Addressing HIPAA concerns
Health information can be disclosed for:
Treatment
Health care operations
Payment
HIPAA acknowledges incidental disclosures may occur
Not a HIPAA violation as long as
Take reasonable safeguards to protect privacy
Disclose only or use the minimum necessary
information
Strategy 3: Nurse Bedside
Shift Report (Tool 3)
Accelerator – Patient/Family as Advisors
Patient and family advisors help us provide care and
services based on patient- and family-identified needs
rather than our assumptions
Patient and family advisors offer
Insight on our strengths and areas where changes may
be needed
Feedback on practices and policies that can help
patients and families be active partners in their care
Feedback that is timely and gives a fuller picture of the
care experience than standard patient and family
satisfaction surveys
Information to Help Hospitals
Get Started
Accelerator – Patient/Family As Advisors
Formal – Advisory Council
Focuses on strategies, priorities, input on decisions
Informal – Spontaneity, convenience
Waiting rooms, bored families
Invite 2 families per unit to have lunch that day with
the CNO (planned every other week)
Past employees who received care
“What rules did you have to break to get care?”
“What made you most/least proud of the care?”
Electronic Family Advisors
Accelerators: Every Department, Every Experience
Accelerators - Infrastructure
Senior leaders integrate family/patient engagement
strategies into culture
Serve as role models for engaging in partnerships
with patients and family members
Provide resources to support initiatives
Integrate into personnel policies and practices
Align incentives to results
Final thoughts
Our hospital is committed to patient and family
engagement — everyone plays a critical part
Patients and families won’t engage if they believe
that you don’t want them to—it is simply too risky
for them
Your job is to make it safe for them to be involved,
not just as patients but as partners in their care
How do they know ___ - you tell them
How do we know ____ - we ask