Patients’ poor understanding of medical information discussed during their hospital admission can result in lack of adherence to treatment plans and poorer health outcomes. Improving communication with patients can not only improve patient satisfaction and engagement but can also improve quality of care. Little is known about available tools to improve hospitalist communication with patients.
To develop and implement an evaluation tool to improve physician communication.
A list of 29 best practices for patient–physician interactions was compiled based on current literature. To engage faculty, all hospitalists were asked to select 10 elements they believed were both essential to effective communication and allowed for measurable feedback on their performance. A 10–item checklist was created based on their votes (see Table 1). We then provided training sessions for faculty. Four one1–hour sessions were held over two 2 months with 27/34 (80%) faculty on service for the quarter attending. The training provided participants with specific examples of effective speech for each checklist item and employed a role playing exercise to provide participants with structured feedback on their communication techniques. Participants were also provided with a laminated “pocket–card” with the checklist items. We conducted real–time observations to assess compliance with the checklist elements and to provide coaching. Within one month of training, a trained observer shadowed faculty on service during one faculty–selected patient interaction. In the first two 2 months of implementation, 8/16 (50%) faculty participated. The observer rated faculty on the 10 elements using a scale of 0 (did not address), 1 (addressed but needed improvement), 2 (completed effectively), and provided immediate feedback. Faculty performed the best on knocking and asking to enter, introducing themselves by name and role, and encouraging questions at the end of the interaction (88% completed effectively). The lowest performing elements included inquiring about patient concerns early in the interview and discussing duration/next steps (with only 38% and 63% completed effectively) In a follow–up faculty survey, all respondents found the training and observation with coaching helpful, and most perceived improved patient appreciation and personal job satisfaction through implementation of the checklist.
Engaging hospitalists in developing their own communication checklist, providing training sessions for faculty, and offering structured observation opportunities are not only feasible, but provide insight into areas of difficulty for hospitalists. Further study is needed to determine whether checklists and professional observation can lead to measurable improvement in patient satisfaction with physician communication.
|Communication Element||% Performed Effectively|
|Knock and ask to enter the patient’s room||88|
|Address patient by name and acknowledge family||88|
|Introduce yourself by name and role (use the whiteboard)||75|
|Elicit patient concerns||38|
|Avoid jargon and offer interpreters||75|
|Explain how long things will take and what happens next||63|
|Summarize plan of care and check for understanding||75|
|Assure ability and willingness to follow plan||75|
|Encourage questions of patient and family||88|
|Thank the patient and family||75|