communication: the key to unlocking patient care improvement

Michael Peters, MBA, CSSBB, CMC® R.T(R)(T)President/CEO

US Cancer Specialists

Communication: The Key to Unlocking Patient Care

Improvement

Society of Radiation Oncology Administrators32nd Annual Meeting 2015

San Antonio, Texas

Disclosure

Ø Private Consultant

Ø Patient and Provider Advocate

US Cancer Specialists2

Introduction

“Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help.”

US Cancer Specialists3Institute for Healthcare Communication

Presentation Objective

S Increase awareness of how Communication brings forth quality patient care and building patient–provider relationships with compassion and shared respect

S Heighten awareness of the barriers to communication, including the intrusion of regulatory and business functions into the patient–provider relationship.


Communication

6


Definition:

Ø The imparting or interchange of thoughts,opinions, or information by speech, writing,or signs.

Ø Information or ideas transmitted from oneparty to another.

Ø Requires that all parties understand acommon language that is exchanged.

Modes of Communication


Inter-‐Professional • Provider to Provider

Health Literacy • Provider to Patient

Inter-‐Personal • Patient to Patient

What’s being Communicated?

9


Healthcare Provider

• Patient Experience• Patient Engagement• Patient Centered Care• Family Centered Care• Compassionate Care• Centers of Excellence

• US News Best Hospitals• America’s Best Doctors• America’s Best Hospitals• Commission On Cancer• Joint Commission• Magnate Hospital• Malcolm Baldrige• ACR Accredited • ASTRO Accredited


Healthcare Patient

• Empathy and Caring• Active Listening• Thorough Evaluation• Diagnosis Information• Prognosis• Proposed Intervention• Alternate Options• Informed Decision Making

The Barrier

11


The Great Wall

The brick & mortar

13

PHYSICAL ENVIRONMENT• Failure to provide sufficient privacy

CARE PROVIDER OBSTACLES• Inadequate communication skills• Disrespect between care providers• Lacking in sensitivity or empathy• Differences in language and culture• Time pressures/Patient Volume• External or personal factors

PATIENT-RELATED OBSTACLES• Condition, illness or medication• Anxious, embarrassed or in denial• Difficulty describing symptoms• Understanding of medical terminology• Language and culture• Reluctant to ask questions• Time

CULTURAL AND SOCIAL DIVERSITY• Expectations from Provider/Encounter• Adherence/Compliance


The “Great Wall” Effect


• Decreases confidence and trust in medical care• Deters the patient from revealing important information• Causes significant patient distress• Leads to the patient not seeking further care• Leads to misunderstandings/misinterpretation • Underlies most patient complaints• Predicts negligence claims

Communication Needs of Provider and Patient

16

Active Listening


Active Communication


• Builds trust between patient and doctor• May help the patient disclose information• Healthcare decision making• Realistic expectations• Produces more effective practice• Reduces the risk of errors and mishaps (sentinel events)

• Favorably affect clinical outcomes• Adherence to prescribed treatment

Understanding the New Healthcare Consumer

19

Consumer vs. Patient


• Patients are people who have been treated within a designated healthcare center or practice in the past.

• Consumers are those who may, or may not, choose to seek care there in the future.

Wants & Needs


• Consumers expect a level of service-on-demand and an ease-of-access experience.

• Consumers expect to have access to information, be able to understand information provided and use that information to make decisions.

• Consumers are sensitive to cost and expect transparency.

Impact of Poor Communication

1


Adherence

Based upon a Health Care Quality Survey, it was found that25% of Americans report they did not follow their clinician’s advice.*

39%

37%

25%

20%7%

Disagreed with what the clinician wanted to do (recommended treatment)Were concerned about cost

Found the instructions too difficult to followFelt it was against their personal beliefs

Reported they did not understand what they were suppose to do

*The Commonwealth Fund

Most Frequently Identified Root Causes


Over the course of a 10-year period, The Joint Commission consistently found communication to be among the top three leading root causes of sentinel events (unanticipated events resulting in serious injury or death).

0 100 200 300 400 500 600 700 800 900 1000

Human Factors

Leadership

Communication

Assessment

Information Management

2010

2011

2012

2013

Figure 1. Root causes of sentinel events as reported to

The Joint Commission from 2010 through 2013


1. “Do I get bonus points if I act like I care?”

2. “I cared for eight seconds. Then I got distracted.”

3. “If you can fake sincerity, you can fake pretty much anything.”

4. “…treating illnesses is why we became doctors, treating patients is what makes doctors miserable”

5. “The concept you have about me won’t change who I am, but it can change my concept about you.”

20th Century Fox Television

Quality vs. Poor Communication

Accreditation and Regulatory Impact on

Effective Communication

1

The Joint Commission

National Patient Safety Goal (NPSG) 2

S Improve the effectiveness of communication amongst caregivers.


Center for Health & Human Services

US Cancer Specialists27http://www.healthit.gov/providers-‐professionals/ehr-‐privacy-‐security

Ø 2002 Health Insurance Portability and Accountability Act (HIPAA) took effect. • Affected billing, medical records, patient privacy, and the electronic transmission of medical data.

Ø 2010 Affordable Care Act (ACA) becomes Law. • Meaningful Use Program

Ø 2015 Providers and Payers are struggling with threats of Cyber Security and Loss of Private Patient Data


• To Provide a meaningful comparison of hospitals on topics that are important to consumers.

• To Create new incentives for hospitals to improve quality of care.

• To Enhance accountability in health care by increasing transparency of the quality of hospital care provided in return for the public investment.

Agency for Healthcare Research and Quality“HCAHPS”

Evaluation of Communication Effectiveness

1

HCAHPS & Communication


The strongest predictor of overall HCAHPS scores is how patients rate provider communication skills.

Source: Bavis and Fulton, Press Ganey Whitepaper.

Perception of Care


3 of 4 patients rate hospital quality based on perception of care

rather than objective measures.

Source: Professional Research Consultants, National Consumer Perception Study.

US Cancer Specialist32

Team Satisfaction

• Communication among healthcare team members influences the quality of working relationships, job satisfaction, less staff turnover, and has a profound impact on patient safety and satisfaction.

• The elements that contribute to healthcare team satisfaction: • Feeling Supported• Respected• Valued• Work Equity

• Understood• Listened to• Clear Understanding of Role• Fair Compensation


• Most diagnostic decisions come from the history-taking component of the interview.

• Lack of time to tell their story / history, often leads to incomplete data upon which clinical decisions are made.

• Interruptions lead to the patient perception that what they are saying is not important, causing a reticent behavior to offer additional information.

Diagnostic Accuracy

Communication Tools for the New Healthcare

Consumer

34


Use of Communication Channels

• Mobile• Secure Text Messaging• Email• Social• Live Chat• Patient Portal• Secure email• Tele-health

e-Health Literacy


The Pew Internet and American Life Project Survey says 61% of Americans go online for health information, with a majority turning to user-‐generated content.

Ø Timely, robust, and differentinformation with availability and sharing, CDL, EMR, EHR, PHR

Ø Collaboration and coordinated care

Ø Ongoing and more frequent interactions

Ø Interventions, outreach

Ø Drug adherence, biometric feedback


“Sweet Spot”

Time for Improvement

US Cancer Specialist

1

Communication Strategy

Ø Pre-service communications set the tone for the entire encounter.

Ø Post-service communication may be the last touch point a patient has with the organization.

43US Cancer Specialists

Proactive Change


Ø Prospectively Connect

• Creating an environment that eases potential anxiety.• Address commonly heard patient fears proactively.• Understanding patient’s expectations, listening to their preferences.

Ø Create a Profiling Strategy

• Facilitating personal connections• Establishing personal connections.

Fostering of Communication

Ø Pre-Consultation call from Navigator, MA, and/or RN

Ø Tele-Health Consultations

Ø Pre-Simulation Tour

Ø Pre-Treatment Tour

Ø Concierge Care

Ø Department Tour/Staff Introductions


“People want to know how much you care before they care how much you know.”

James F. Hind (Author)

Successful Care Coordination

Ø Improved Direct Telephone access to each other

Ø Improved Information Exchange through a shared EMR

Ø Enhanced Interpersonal Relationships

Ø Clearly Defined Accountability



Final Thoughts

• There is No Such Thing as over Communication!• Encourage Transparency and Feedback• Remove Barriers to Communication

44

Thank You

Email: [email protected] @uscaspecialist
