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5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes, Quality/Safety and Patient Experiences

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Stephen Wilkins, MPH, is a thought leader, researcher, entrepreneur and blogger at Mind the Gap whose areas of expertise include patient engagement and physician-patient communications. He has over ...

Stephen Wilkins, MPH, is a thought leader, researcher, entrepreneur and blogger at Mind the Gap whose areas of expertise include patient engagement and physician-patient communications. He has over 20+ years experience as a hospital marketing executive, consumer health behavior and patient-centered communications expertise.

Wilkins shared with attendees a definition of patient-centered communications, provided practical examples of patient-centered communication skills in a hospital setting, contrasted a patient-centered style of communications with the more traditional physician-directed or paternalistic communication style and shared evidence demonstrating the benefits of clinician adoption of a patient-centered communication style and skills.

Wilkins identified the top 5 clinician-patient communication gaps found in most hospitals, including examples along with how these clinician-patient communication gaps impact the patients, clinicians and the organization. The webinar also provided strategies for closing the identified clinician-patient communication gaps.

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  • A Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode.
  • Smart checklists are delivered just in time as patients progress through their care plans. The information is always there for reference when needed in case preparation or follow-up instructions are forgotten. To request a free demonstration, respond to the poll on your screen.
  • A Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode.
  • Smart checklists are delivered just in time as patients progress through their care plans. The information is always there for reference when needed in case preparation or follow-up instructions are forgotten. To request a free demonstration, respond to the poll on your screen.

5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes, Quality/Safety and Patient Experiences 5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes, Quality/Safety and Patient Experiences Presentation Transcript

  • The Patient Journey A Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode to improve the e-patient experience.
  • Patient Guidance System Smart Checklists for Patients Delivered online and available 24/7 from home
  • 5 Clinician-Patient Communication Gaps Compromising Your Hospital’s Outcomes, Quality/Safety and Patient Experiences Prepared by: Stephen Wilkins, MPH 3
  • Who I Am • Patient/Patient Advocate/Care Giver • Former Hospital Executive • Health Behavior and Communication Researcher • Entrepreneur • Writer and Thought Leader My Personal Story And Professional Experience Underscore The Following Belief: That the simplest and most cost effective way of fixing much of what is wrong with health care today is by improving the way clinicians and patients talk to each other. Introduction 4
  • Why Is Clinician-Patient Communications Important? The quality of patient-physician communication is associated with better processes and outcomes, including patient self- management behaviors, adherence, satisfaction and health status. Clinician – Patient communication is the primary process by which medical decisions are made and patients are diagnosed and treated. Introduction The Problem With Physician-Patient Communications Is The Illusion That It Occurred Patient-physician communication is therapeutic 5
  • Who Says We Have A Communication Gap? Our Patients Say We Are Great Communicators! 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2005 2006 2007 2008 2009 2010 2011 2012 Usually/Always Sometimes/Never Clinician Demonstrates Excellent Communication Skills 6
  • Our Patients Say We Are Great Communicators! During this hospital stay who often did doctors/nurses: • Treat you with respect? • Listen carefully to you? • Explain things in a way you could understand? Compared to what? Who Says We Have A Communication Gap? % of Patients That Said Always Source: U.S. Department of Health & Human Services, www.hospitalcompare.hhs.gov Doctors "always" communicated well 7
  • Who Says We Have A Communication Gap? 8
  • “Often patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked. Generally speaking, one can assume that the quality of care is, actually, worse than surveys of patient satisfaction would seem to show. Patients need to be taught to be less patient, more critical, more assertive.” Avedis Donabedian. Quality in Health Care 1992 Who Says We Have A Communication Gap? 9
  • A Few Words About Clinician-Patient Communication & Gaps Patient & FamilyClinician • Knowledge • Previous Experiences • Language & Culture • Beliefs & Motivations • Attitudes & Assumptions 10
  • The Truth Behind Patient Ratings Of Clinician Communications Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15) 11
  • Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15) The Truth Behind Patient Ratings Of Clinician Communications 12
  • Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15) The Truth Behind Patient Ratings Of Clinician Communications 13
  • Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15) The Truth Behind Patient Ratings Of Clinician Communications 14
  • • Dosages (56%), • Schedule (68%) • Purpose (64%) • Side effects (11%) of these patients The Truth Behind Patient Ratings Of Clinician Communications 15
  • Did The Doctor Discuss Your Fears And Concerns About Being Hospitalized With You? Olson, D. P., & Windish, D. M. (2010). Communication discrepancies between physicians and hospitalized patients. Archives of internal medicine, 170(15) The Truth Behind Patient Ratings Of Clinician Communications 16
  • Clinician-Patient Communication Gap #1 #1 Lack of Clinician-Patient Agreement Where It Matters  Patient’s diagnosis  Severity of their diagnosis  Treatment plan/care plan  Acceptable outcomes Agreement between patient and physician about theses issues is a crucial indicator and outcome of high-quality communication. Sarkar, U., et al. (2011). Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Education and Counseling, 85(2), 173-9 Problem Diagnosis Treatment Clinician-Patient Disagreement At One Point Prevents Effective Forward Progress 17
  • Clinician-Patient Communication Gap #1 #1 Lack of Clinician-Patient Agreement Where It Matters Chief Health Concerns & Priorities Patients With Self –Reported Multiple Chronic Conditions & Poor Health Status Clinicians’ Perspective Regarding Chief Health Priorities Patient Perspective Regarding Chief Health Priorities • Pain • Unable to sleep • Unable to eat • Dizziness • Cough • Hypertension • Uncontrolled A1C • Not taking medications Zulman, D. , et al. (2009). Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients. Journal of General Internal Medicine. 18
  • Clinician-Patient Communication Gap #2 #2 Focus Is On The Disease - Not The Person With A Disease  Fears & Concerns  Beliefs & Attitudes  Relevant experiences and expectations  Their life & hopes “There is another process that is common in consultations too: the active decision (by clinicians) to stop listening (to the patient) when we have heard as much as we need to know. Launer, J. The Art Of Not Listening. QJM 2007 What’s Missed by the Clinician is any understanding of the context of the patient’s life 19
  • Clinician-Patient Communication Gap #3 #3 Focus Is On Technology - Not The Patient “Hospital Rounds” today seem to take place away from the bedside of the patient – rather they are centered around the virtual construct of the patient called the “I Patient.” The “I Patient” is getting fantastic care… but the real patient in the hospital bed wonders where everyone is. Abraham Verghese, MD 2011 Medicine 2.0 What’s being lost is the therapeutic benefits of touch and talk 20
  • #3 Patients Need To Feel Listened To And Understood Feeling Listened To & Understood Patient Trust Low High Low High Non-Compliance Compliance Patient trust in their clinician is critical to information sharing, adherence, activation and satisfaction. Clinician-Patient Communication Gap #3 21
  • #3 Patients Need To Feel Listened To And Understood Clinician-Patient Communication Gap #3 Chief Health Concerns & Priorities Patients With Self Multiple Chronic Conditions & Poor Health Status Clinicians’ Perspective Regarding Chief Health Priorities Patient Perspective Regarding Chief Health Priorities • Pain • Unable to sleep • Unable to eat • Dizziness • Cough • Hypertension • Uncontrolled A1C • Not taking medications 22
  • Patients don’t know what they don’t know until they are faced with having to do it – Just giving patients information is not enough #4 Clinicians & Patients Think And Speak Differently Clinician-Patient Communication Gap #4 Chief Health Concerns & Priorities Patients With Self Multiple Chronic Conditions & Poor Health Status Clinicians’ Perspective Regarding Chief Health Priorities Patient Perspective Regarding Chief Health Priorities • Pain • Unable to sleep • Unable to eat • Dizziness • Cough • Depressed • Hypertension • Uncontrolled A1C • Not taking medications 23
  • Self Care Management Instructions For Heart Failure Given To Patient By Clinician Clinicians’ Perspective Regarding Type Of Information Exchange Needed - Patients Need To Know What To Do - Patient Perspective Regarding Type Of Information Needed - Understand the “What“ But Need To Know How • Strategies for overcoming barriers • Goal setting • Skills • Self confidence • Support • Diet • Exercise • Take medications • Self monitoring Patients don’t know what they don’t know until they are faced with having to do it – Just giving patients information is not enough #5 I Am Busy – Just Do It Clinician-Patient Communication Gap #5 24
  • #5 I Am Busy – Just Do It Clinician-Patient Communication Gap #5 25
  • Five Types Of Clinician-Patient Communication Gaps - Hospitals • Lack of Clinician-Patient Agreement Where It Matters • Focus Is On The Disease - Not The Person With A Disease • Patients Need To Feel Listened To And Understood • Focus Is On Technology - Not The Patient • I Am Busy – Just Do It The 5 Clinician-Patient Communication Gaps Patient-Centered Care 26
  • Clinician-Patient Communication & Engagement 27
  • Thank You Stephen Wilkins MPH stwilkins@gmail.com 408-448-1537 (PST) @Healthmessaging www.adoptonechallenge.com Mind the Gap Blog 28 Coming in this Fall
  • The Patient Journey A Patient Guidance System helps fill in clinician-patient communication gaps and reinforce important messages through the entire patient journey of an acute care episode to improve the e-patient experience.
  • Patient Guidance System Smart Checklists for Patients Delivered online and available 24/7 from home