This presentation takes a look at the barriers and improvement opportunities that exist within Oncology and Healthcare in general to build a better patient and healthcare provider communication experience.

1. 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
Administrators
32nd Annual
Meeting
2015
San
Antonio,
Texas

2. Disclosure
Ø Private Consultant
Ø Patient and Provider Advocate
US Cancer Specialists2

3. Introduction
“Extensive research has shown that no matter how knowledgeablea
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

4. 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.
US Cancer Specialists4

5. Communication
6

6. US Cancer Specialists6
Definition:
Ø The imparting or interchange of thoughts,
opinions, or information by speech, writing,
or signs.
Ø Information or ideas transmitted from one
party to another.
Ø Requires that all parties understand a
common language that is exchanged.

7. Modes of Communication
US Cancer Specialists7
Inter-­‐Professional
• Provider
to
Provider
Health
Literacy
• Provider
to
Patient
Inter-­‐Personal
• Patient
to
Patient

8. What’s being
Communicated?
9

9. US Cancer Specialists9
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

10. US Cancer Specialists10
Healthcare Patient
• Empathy and Caring
• Active Listening
• Thorough Evaluation
• Diagnosis Information
• Prognosis
• Proposed Intervention
• Alternate Options
• Informed Decision Making

11. The Barrier
11

12. US Cancer Specialists12
The Great Wall

13. 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
US Cancer Specialists

14. The “Great Wall” Effect
US Cancer Specialists14
• 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

15. Communication Needs
of Provider and Patient
16

16. Active Listening
US Cancer Specialists16

17. Active Communication
US Cancer Specialists17
• 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

18. Understanding the New
Healthcare Consumer
19

19. Consumer vs. Patient
US Cancer Specialists19
• 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.

20. Wants & Needs
US Cancer Specialists20
• 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.

21. Impact of Poor
Communication
1

22. US Cancer Specialists22
Adherence
Based upon a Health Care Quality Survey, it was found that
25% 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
follow
Felt it was against their personal beliefs
Reported they did not understand what
they were suppose to do
*The
Commonwealth
Fund

23. Most Frequently Identified Root Causes
US Cancer Specialists23
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

24. US Cancer Specialists24
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

25. Accreditation and
Regulatory Impact on
Effective
Communication
1

26. The Joint Commission
National Patient Safety Goal (NPSG) 2
S Improve the effectiveness of
communication amongst caregivers.
US Cancer Specialists26

27. 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

28. US Cancer Specialists28
• 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”

29. Evaluation of
Communication
Effectiveness
1

30. HCAHPS & Communication
US Cancer Specialists30
The strongest predictor of overall HCAHPS scores is
how patients rate provider communication skills.
Source:
Bavis
and
Fulton,
Press
Ganey
Whitepaper.

31. Perception of Care
US Cancer Specialists31
3 of 4 patients rate hospital quality
based on perception of care
rather than objective measures.
Source:
Professional
Research
Consultants,
National
Consumer
Perception
Study.

32. 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

33. US Cancer Specialist33
• 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

34. Communication Tools
for the New Healthcare
Consumer
34

35. US Cancer Specialists35
Use
of
Communication
Channels
• Mobile
• Secure Text Messaging
• Email
• Social
• Live Chat
• Patient Portal
• Secure email
• Tele-­health

36. e-Health Literacy
US Cancer Specialists36
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 different
information 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

37. US Cancer Specialist37
“Sweet
Spot”

38. Time for Improvement
US Cancer
Specialist
1

39. 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.
43
US Cancer Specialists

40. Proactive Change
US Cancer Specialists40
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.

41. 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
US Cancer Specialists41
“People
want
to
know
how
much
you
care before
they
care how
much
you
know.”
James
F.
Hind
(Author)

42. 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
US Cancer Specialists42

43. US Cancer Specialists43
Final Thoughts
• There is No Such Thing as over Communication!
• Encourage Transparency and Feedback
• Remove Barriers to Communication

44. 44
Thank
You
Email:
mpeters@uscancerspecialists.com @uscaspecialist
US Cancer Specialists