Background:
Although physicians are increasingly being trained in communication best practices, improving HCAHPS (hospital consumer assessment of healthcare providers and systems) patient experience scores remains challenging. As faculty engagement in and resulting adoption of communication strategies is unknown, we sought to assess faculty perceptions and adoption of communication elements one year after a communication improvement intervention.
Methods:
After a literature review, a 29‐item list of patient communication best practices was compiled. Hospitalist faculty were engaged in selecting elements they believed were both essential to effective communication and allowed for objective measurable feedback on their performance (Table 1). A final nine‐item checklist was created through consensus decision‐making. Starting in October 2011, faculty participated in a one‐hour training session that provided participants with specific examples of effective speech and language for each checklist item and used role‐play to deliver feedback on communication. Faculty who participated in the training were then observed at the bedside by a trained observer to assess their performance on the checklist elements and provide individual coaching. A year after the start of the intervention, faculty were surveyed to assess their engagement and adoption of the checklist items.
Table 1. Final Elements of Hospitalist Communication Checklist
| Beginning |
| Knock and ask to enter the patient’s room |
| Address patient by name and acknowledge family |
| Introduce yourself by name and role (use the whiteboard) |
| Middle |
| Avoid jargon and offer interpreters |
| Explain how long things will take and what happens next |
| End |
| Summarize plan of care and check for understanding |
| Assure ability and willingness to follow plan |
| Encourage questions of patient and family |
| Thank the patient and family |
Results:
Forty‐two (75%) of the faculty attended training in the first year, with 22 (52%) faculty receiving at least one observation. 31/42 (74%) hospitalists completed the survey. 28 (90%) respondents believed using the communication elements improved both the patient experience and quality of time spent with patients. 26 (84%) of participants felt that all the checklist items were effective or very effective for improving the communication experience. Although most faculty felt the communication elements were very effective, several elements were rated as performed less frequently (Figure). A majority, 24 (77%) respondents, had taught residents on their team about the communication elements.
Conclusions:
Engaging hospitalists in developing their own communication checklist, while offering training and structured observations, appears to result in engaged providers who believe that these elements improve not only the patients’ experience, but also the quality of time they spend with patients. Lower self‐reporting of specific element use compared to a high level of perceived effectiveness shows that there may be barriers to the application of some of these elements beyond engagement. Further work seeks to understand these barriers.
Figure. Provider reported performance and perceived effectiveness of communication elements