12 Apr Creating a Culture of Excellence through Effective and Compassionate Communication
Most healthcare providers never receive formal training in basic communication skills. A recent article by Peter Provonost, M.D., Ph.D., FCCM, Senior Vice President, Patient Safety and Quality, Johns Hopkins Medicine, highlighted “The Patient Wish List” generated from patient feedback at Johns Hopkins:
- Let me sleep.
- Keep the noise levels down at the nurses’ station.
- Don’t lose my personal belongings.
- Knock on the door before entering.
- Please keep my white board current and up-to-date.
- Update me and my family if you notice changes in my condition.
- Keep my room clean.
- Listen to me and engage me in my care.
- Please orient me to my room and the hospital.
- Please maintain professionalism.
The list clearly demonstrates patients’ desires for improved communication and respect from their healthcare providers. It is no surprise that two of the main wishes are: “Keep my room clean” and “Listen to me and engage me in my care”.
Reflecting on this list, Linda Scaz, RN, Ph.D., FCN, an experienced teacher of nurses and hospice healthcare providers and a faculty member for The Institute for Healthcare Excellence (IHE), remembers that, when teaching nursing student orientation, she taught the nurses to make friends with the cleaning people — they always had the best communication with patients. They not only cleaned rooms but got to know the patients as they went about their daily duties. They listened as they cleaned! The housekeeping staffs at all of our facilities make it easy. They clean AND they listen.
As healthcare providers, we assume the items on the list are automatic as we provide care for the patients we serve. But they are not. We often lose vital formation by not being attentive or mindful to our patient’s basic needs and rights. In the words of Stephen Covey, “Most people do not listen with the intent to understand. They listen with the intent to respond.” That is what most of us do. We reply — often too quickly — to the needs of our patients.
The Johns Hopkins list is easy, concise, and doable. As healthcare providers, we all strive to be professional. Just imagine if we worked to weave in all the other items on the list! Good communication is the key to delivering what patients want, which ultimately leads to improved quality standards, better care, and satisfied patients and families.
Evidence continues to point to ineffective communication as a significant factor in many medical errors, some leading to patient deaths. A recent report, “Communication Failures Linked to 1,744 Deaths in 5 Years,” documents that communication failures were a factor in 30 percent of malpractice cases, totaling $1.7 billion in malpractice costs. The impact of miscommunication on medical errors is likely even greater than the report indicates, because it looked just at malpractice cases, said Dr. Christopher Landrigan, a patient safety researcher at Boston Children’s Hospital. Miscommunication among medical staff while transferring patients contributed to 80 percent of serious medical errors, according to one estimate by the Joint Commission.
Why do healthcare workers seem to miss the basics? Our medical education, training, and daily practice are often so laser-focused on the diagnostic and technical skills that we suppress what patients really want most — respect and a little piece of us. The housekeeping staff get it — why don’t we? Most healthcare providers do not receive any focused training in communication skills. Yet, a few basic skills can make a world of difference in the patient experience.
Basic Communication Skills
The skills of presence and mindfulness play a crucial role in any conversation or task. Introducing mindfulness training in small but relevant doses can increase awareness and improve communication with a patient or colleague. Dr. Pronovost’s list includes, “Listen to me and engage me in my care.” Being listened to is a top priority for patients, as multiple surveys have demonstrated over the past 20 years. Reflective listening is a basic communication skill that can be learned. Other skills include gathering accurate and efficient information, negotiating agendas jointly, and connecting with patients and colleagues by recognizing emotions and responding appropriately and with compassion.
The Institute for Healthcare Excellence (IHE) has had the privilege of working with multiple organizations that have recognized the importance of bringing basic communication skills to their healthcare team to deliver the desired outcomes, without harm, without waste, and with an exceptional experience for patients and providers. These institutions recognize that excellent technical skills combined with excellent communication skills to create the team-based patient- centered culture necessary to deliver extraordinary value. The IHE develops internal faculty help their colleagues develop these essential communication skills.
Stories from Multiple Institutions
Stories from multiple institutions now clearly demonstrate the connection between communicating effectively and creating value within a healthcare organization. Patient experience, employee experience and engagement, safety, clinical outcomes, and efficiency are closely linked to effective communication skills and the creation of a team-based, patient-centered culture.
Over 12 years, IHE faculty have trained approximately 150 physician and 150 allied health facilitators to diffuse the communication work in 17 institutions. Initial experience at Mayo Clinic Florida led to this institution being recognized as the top national performer in patient experience for two consecutive years following implementation of the skills-based Communication in Healthcare program. Double-digit significant improvement in employee satisfaction, including service to others, mutual respect, and teamwork, was witnessed at Mayo Clinic Florida following implementation of the program.
Mission Health in Asheville, North Carolina, delivered the skills-based communication training to approximately 600 physicians and 10,000 members of the caregiver team. Overall Quality of Care from the patients’ perspective improved from 60th percentile ranking to the 90th percentile ranking. The improvement in patient experience was documented at the unit level as well as the individual physician level following participation in the communication curriculum. Significant improvement in nearly every domain of the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey was also noted. Most importantly, across-the-board improvement in multiple quality and safety metrics led to improvement in overall mortality to a top 10 percent performance nationally, which translates to more than 500 individuals a year returning home to their loved ones, which would not have been possible just four years earlier. Combining performance on outcomes, safety, experience, and efficiency, Mission Health has earned the Top 15 Health System award from Truven Analytics for four consecutive years, a performance that has not been accomplished by any other health system in the United States. Finally, the focus on creating a team-based patient-centered culture has led to top returns on value based payments from both the Centers for Medicare & Medicaid Services (CMS) and private insurers.
Naval Hospital Jacksonville demonstrated a remarkable journey over a four-to-five year period following implementation of the communication program in conjunction with TeamSTEPPS and other initiatives to become a top-performing military institution in the United States. Naval Hospital Jacksonville has assigned the program the title of PCCCI — Patient Caring Communication Curriculum Initiative. This communication initiative is now being diffused to the entire National Capital Region and other Military healthcare institutions.
Most recently, William Beaumont Hospital in Troy, Michigan, has embraced the program. Ten physicians and 20 Allied health facilitators were trained over the last six months by IHE faculty to diffuse the program throughout their institution. To date, they have delivered the curriculum to more than 800 employees, including physicians and allied health staff. The following graphs demonstrate significant improvement in communication with doctors, communication with nurses, and top-box rating of the hospital following implementation of the communication training program
Communication Training Improves Empathy
The Jefferson Scales of Empathy were used to assess the empathy capacity for Beaumont Troy facilitator faculty both prior to their training and three months after their training. The first 120 Beaumont Troy colleagues also participating in the communication training delivered by the internal faculty completed the empathy scale prior to the course and three months after participating in the curriculum. The following graphs demonstrate an “average” 50th percentile empathy capacity at baseline for both groups. Following the faculty training, the empathy capacity for the internal faculty increased to the 75th percentile range. Upon completing the communication training, the empathy capacity of the first 120 colleagues also increased to the 75th percentile range.
Patients expect good technical outcomes. To improve patient experience, we need to couple our excellent technical capacity with a team-based patient-centered culture. At the heart of this cultural evolution is effective, compassionate, patient-centered communication.
We can nurture the communication skills necessary to create respect, empathy, compassion and an authentic sense of truly caring about the people we are privileged to treat.
What patients want is basic: “Clean my room; listen to me.” We can close the gap that has existed for the past 20 years and deliver on these basic wants through effective and compassionate communication.