Meeting the Challenge of Healthcare Communication

Transcription

1 The Institute has cntributed enrmusly t my ability t teach physicians ne f the mst imprtant parts f the patient prvider relatinship slid, effective cmmunicatin. James R. Gavin, III, M.D., Ph.D. Past President Mrehuse Schl f Medicine Meeting the Challenge f Healthcare Cmmunicatin The Institute fr Healthcare Cmmunicatin (IHC) was rganized in 1987 t enhance the quality f healthcare by imprving cmmunicatin between clinician and patient. Natinally accredited, the Institute has partnered with hundreds f healthcare rganizatins ver the years t train mre than 160,000 physicians and ther healthcare prfessinals thrughut Nrth America. THE IMPORTANCE OF HEALTHCARE COMMUNICATION A clinician may cnduct as many as 150,000 medical interviews during a typical career. If viewed as a medical prcedure, the interview is the mst cmmnly used prcedure that the clinician will emply. Yet cmmunicatin training fr clinicians and ther healthcare prfessinals histrically has received far less attentin thrughut the training prcess than have ther clinical tasks. This is s even as evidence cntinues t munt that a structured apprach t cmmunicatin measurably imprves healthcare delivery. Research shws a crrelatin between dctr cmmunicatin skills and the patient s willingness (r ability) t cmply with a medical regimen. Studies als shw that the physician s ability t explain, listen, build rapprt and empathize can have a prfund effect n patient satisfactin and cnfidence. Imprving dctr patient cmmunicatin has been shwn t be an imprtant step tward better results in the areas f preventative medicine, therapeutic behavir change, and lng term self management f chrnic illness. Studies indicate that imprved cmmunicatin between dctr and patient is an imprtant factr in reducing the likelihd f malpractice suits.

2 We ve fund that successful cmmunicatin results in better patient care, as well as greater satisfactin fr bth the patient and clinician. Gary Friedlaender, M.D. Prfessr and Chairman f the Department f Orthpaedics and Rehabilitatin Yale University Schl f Medicine In cnsequence, dctr patient cmmunicatin, nce treated lightly as mere bedside manner, is nw cnsidered an imprtant practical skill. The U.S. medical licensing exam nw includes a clinical skills sectin that explicitly tests examinees n ability t cmmunicate with patients. In its 2004 reprt n adding behaviral and scial sciences t the medical schl curriculum, the Institute f Medicine stressed the imprtance f teaching cmmunicatin skills in the schls. Cmmunicatin and patient centered care are n the agenda f many f the mst influential healthcare assciatins, including medical specialty scieties, the Veterans Health Administratin, the Institute f Medicine, and the Centers fr Medicare and Medicaid Services. Insurance cmpanies in seven states are ffering discunts n malpractice insurance t physicians wh have upgraded their cmmunicatin skills by means f IHC curses. Given the increased recgnitin f the imprtance f healthcare cmmunicatin, medical schls are expanding their cmmunicatin training acrss the clinical and pre clinical curriculum. Hwever, many healthcare prfessinals practicing tday have had little r n frmal training in effective cmmunicatin techniques. VISION, MISSION AND ACHIEVEMENTS OF IHC IHC is an independent nn prfit rganizatin. IHC was riginally rganized in 1987 as the Bayer Institute fr Health Care Cmmunicatin. Visin statement IHC seeks t ptimize the experience and the quality f healthcare thrugh effective cmmunicatin. Missin statement IHC advances the quality f healthcare by ptimizing the experience and prcess f healthcare cmmunicatin. We accmplish this by: 2

3 Creating and disseminating innvative educatinal prgrams and services Advcating fr the imprtance f cmmunicatin as an essential aspect f healthcare Engaging in cllabrative research n cmmunicatin in healthcare Partnering with ther leading rganizatins that share ur visin Achievement highlights IHC has cnducted mre than 12,000 wrkshps reaching 160,000 physicians and healthcare prfessinals in the United States and Canada. IHC s grwing netwrk f partners numbers mre than 200 healthcare rganizatins. These include hspitals, medical schls, managed care cmpanies, malpractice insurance cmpanies, and natinal medical specialty scieties. All full time IHC staff members are seasned prfessinals representing a wide range f health and human behavir disciplines, have written n clinician patient cmmunicatin fr peerreviewed jurnals, and are master teachers. In additin t the full time staff, a netwrk f cperating cnsultants and faculty members extends the wrk f IHC t every state and prvince within Nrth America. Mre than 1,200 faculty members have been trained. Many medical scieties and universities, including the American Academy f Orthpaedic Surgens and the Yale University Schl f Medicine, have adpted Institute prgrams. IHC is natinally accredited t prvide cntinuing medical educatin and cntinuing nursing educatin by three majr accreditatin agencies (ACCME, AAFP, and ANCC). The staff f IHC cnduct research n pertinent tpics and cnducts utcme studies in partnership with ther rganizatins. Members f IHC s staff, faculty, and Advisry Cuncil have cnsulted with r made presentatins t scres f medical schls, residency prgrams, hspitals, managed care rganizatins, gvernment health entities, and prfessinal scieties. IHC s activities have been featured in the medical trade press and in majr media such as The Wall Street Jurnal, The Washingtn Pst, and The New Yrk Times. 3

4 CURRENT WORKSHOPS AND PROGRAMS Develpment and implementatin f training wrkshps are majr activities f IHC. IHC s prgrams are interactive and experiential, featuring videtapes, simulatins, and case studies. IHC s flagship wrkshp, Clinician Patient Cmmunicatin t Enhance Health Outcmes, has trained mre than 175,000 clinicians in the 4Es f Cmmunicatin (Engage, Empathize, Educate, Enlist). The current rster f wrkshps and prgrams includes: Clinician Wrkshps Clinician Patient Cmmunicatin t Enhance Health Outcmes Team and Patient Centered Cmmunicatin Skills fr the Patient Medical Hme Chices & Changes: Clinician Influence and Patient Actin Difficult Clinician Patient Relatinships Strangers In Crisis: Cmmunicatin fr Emergency Department and Hspital Based Clinicians Candid Cnversatins: Talking with Female Patients abut Sexual Health Caching Clinicians fr Enhanced Perfrmance Disclsing Unanticipated Medical Outcmes Managing Cmmunicatin: After Unanticipated Medical Outcmes Cnnected: Cmmunicating and Cmputing in the Exam Rm Care Nt Cure: Dialgues at the Transitin Cnversatins at the End f Life Intensive Cmmunicatin Skills Prgrams fr Nn Clinicians and Patients Treating Patients with C.A.R.E. Caching fr Impressive Care P.R.E.P.A.R.E. t be Partners in Healthcare C.A.R.E. = Cnnect, Appreciate, Respnd, Empwer P.R.E.P.A.R.E. = Plan, Reprt, Exchange infrmatin, Participate, Agree, Repeat ACCREDITATION IHC awards cntinuing educatin credits under the auspices f its natinal accreditatin frm: ACCME: The Accreditatin Cuncil fr Cntinuing Medical Educatin AAFP: American Academy f Family Physicians ANCC: American Nurses Credentialing Center Malpractice insurance cmpanies in six states prvide premium discunts t their insured physicians wh attend IHC skill building wrkshps. 4

5 WORKSHOP DEVELOPMENT IHC cnducts its wrkshps, and develps the materials and prgrams used in them, based n the best available evidence f what cnstitutes effective clinical and educatinal practice. IHC wrkshps are based n scientific research in medicine, psychlgy, cmmunicatin and related fields. In develping IHC prgrams, we rely upn a variety f data surces t identify prfessinal practice gaps amng the target audience. This prcess includes cnferring with client leaders and clinical staff, relevant external bdies, cntent experts, literature review, patient satisfactin scres, trends in medical licensure and graduate medical educatin. Such extensive effrts assist with prgram planning, develpment and sustainability within client rganizatins. The prcess begins with the creatin f an anntated bibligraphy t assure that state f the art infrmatin is available t the design team. The bibligraphy becmes part f the wrkbk as a resurce fr participants after the wrkshp. Once the bibligraphy has been assembled, experts frm IHC staff and its Advisry Cuncil are brught tgether with cnsultants t develp the framewrk fr the new prgram. Thrugh an iterative prcess between this team and the staff respnsible fr the develpment f the prgram, a design is created and materials are develped. Extensive pilt testing then takes place with revisins made after every test. Pilt test sites are selected fr their diversity t assure that the prgram is applicable in all delivery systems. Audi visual materials are then prduced. The prgram is intrduced t the faculty, wh are physicians r behaviral scientists with extensive experience as teachers r clinicians, thrugh an intensive faculty develpment prcess, usually ne week in length. Whenever pssible, an utcme study is launched t evaluate prgram effectiveness. Our dctrs have fund the Institute s mdel t be a pwerful tl fr building relatinships. David Shearn, M.D. PARTNER ORGANIZATIONS Directr, Physician Educatin and Develpment Kaiser Permanente IHC has mre than 1200 trained faculty members and has wrked with mre than 250 prgram partners t ffer Institute prgrams t clinicians in every specialty and type f practice in the United States and Canada. Partners include medical schls, specialty scieties, gvernment agencies, medical grups, hspitals, malpractice insurance cmpanies, and managed care rganizatins. IHC launched its Prgram Partner Award in The award recgnizes partners wh have made an 5

6 extrardinary effrt t address the issue f clinician patient cmmunicatin within their rganizatins. Recipients f the award include: 1999 Veterans Health Administratin 2000 Permanente Medical Grup 2001 Geisinger Health System 2002 Physicians Reciprcal Insurers 2003 American Academy f Orthpaedic Surgens 2004 Cpic Insurance 2005 Affinity Health System 2006 Washingtn State University Cllege f Veterinary Medicine 2007 ISMIE Mutual Insurance Cmpany 2008 Michigan State University WORKING PARTNERSHIPS IHC has had extensive experience wrking with healthcare systems, medical specialty grups, gvernment and public hspital systems, Safety Net facilities, multi specialty prvider rganizatins, and prvider netwrks. Currently, IHC is wrking clsely with the Califrnia Health Care Fundatin (CHCF) n its Team Up fr Health initiative and training staff frm five Califrnia clinic based rganizatins t wrk mre effectively with patients living with chrnic illnesses and cnditins. IHC has partnered with the Califrnia Health Care Safety Net Institute (the quality imprvement arm f the Califrnia Assciatin f Public Hspitals) t prvide training in cmmunicatin skills fr hspital based clinics. IHC has cllabrated with medical specialty grups such as the American Academy f Orthpedic Surgens (AAOS) fr several years. This partnership led t the creatin f tailred materials t address the identified deficits in cmmunicatin skills amng this specialty grup t better meet their patients cmmunicatin needs. T ensure cngruence between learners current scpe f practice and wrkshp cntent, this partnership prduced relevant vide case studies specific t the clinical envirnment f rthpedics.. IHC then trained 47 AAOS Cmmunicatin Mentrs in a custmized versin f IHC s CPC faculty curse. Thse Mentrs have taught 234 wrkshps t 4,200 practicing rthpaedic surgens and residents since IHC has prvided train the trainer curses and has develped custmized prgrams fr the Veterans Administratin as a key cmpnent f its Patient Centered / Medical Hme Initiative the VA s natinal mdel f health care delivery. The pilt fr this prgram was cnducted in July 2010 and a subsequent training was cnducted in Nvember The Veterans Administratin System is the largest integrated healthcare system in the United States and ffers IHC wrkshps at VA Medical Centers and Hspitals thrughut the cuntry. Mre than 200 trained VA faculty have taught 3,695 fur hur wrkshps t 51,915 practicing physicians and ther VA clinicians acrss the United States. 6

7 IHC has als wrked clsely with the leadership f the American Assciatin f Diabetes Educatrs (AADE) t develp a prgram that emphasizes the imprtance f assessing patient self care behavirs in clinical interactins. As a result f the AADE cllabratin, IHC designed custmized activities in the wrkshp, Chices and Changes, and integrated self care behavir cmmunicatin assessment tls and the chrnic care mdel t meet specific cmmunicatin needs in delivering care t patients with diabetes. Frm these experiences, IHC has learned t adapt its educatinal prgrams and the delivery f thse prgrams and assciated fllw up services, t the unique needs f rganizatins. IHC is cnfident that these partnerships and experiences prvide it with the experience t meet the training needs f a wide variety f health care rganizatins, prfessins, and clinicians. KEY LESSONS FOR SUCCESS The effectiveness f IHC s Prgrams in meeting identified educatinal needs relies heavily n an rganizatin s selectin f prspective training faculty, and n the evaluatin and sustainability f bth faculty and prgram cntent. IHC advises clients that prspective faculty be selected n the basis f specific criteria, and that the client s infrastructure is cnducive t teaching cmmunicatin training within the rganizatin. When client rganizatins d nt select faculty carefully, r where administratrs fail t encurage gd cmmunicatin skills fr bth patient and rganizatinal benefit, there is a high likelihd that the cmmunicatin training effrt will fail. IHC has cnducted large scale evaluatin studies using RCT design and a rbust educatinal interventin (3 mnths f wrkshps and ne n ne caching and feedback). Hwever, a client s evaluatin effrts are ften limited t testing the effect f wrkshps n clinicians cmmunicatin behavir, health utcmes and patient satisfactin. Cnsequently, IHC implemented a system whereby it sends an reminder t all learners 6 weeks after an IHC wrkshp abut the cmmunicatin techniques they intended t incrprate int clinical practice as a result f their learning. This reminder system reinfrces practice skills, first identified by the learner in a behaviral plan cmpleted at the end f the wrkshp. Learners then participate in an nline survey which inquires abut the effect f newly practiced cmmunicatin skills in their clinical practice. The pst wrkshp survey prvides IHC with data that are srted t measure the impact f varius IHC wrkshps n specific practice behavir. Frm lng experience, IHC recgnizes that clinician expsure t a half day skill building wrkshp will nt change the prevailing culture. Only thrugh sustained and cmmitted effrt will educatinal prgramming have an enduring effect n the demnstrated utcmes f gd cmmunicatin between clinicians and patients: better health utcmes increased diagnstic accuracy enhanced adherence t a treatment regimen reduced malpractice liability imprved patient and clinician satisfactin 7

8 IHC wrks with clients t develp an apprpriate prcess fr implementing a crdinated effrt t intrduce cmmunicatin skills training int the n ging life f the rganizatin. Our cmpany has wrked clsely with the Institute in develping prgrams in healthcare cmmunicatin, fr ur insured physicians. These prgrams have been very well received by the physicians; we are cnfident that they have prvided them with tls t help imprve patient relatinships, and thereby, the quality f care. This is in keeping with ur wn gal f reducing the frequency and severity f malpractice suits, by addressing the underlying patient safety issues. Anthny Bnm President and CEO (AFP) Physicians Reciprcal Insurers ADVISORY COUNCIL Since its inceptin, IHC has benefited frm the guidance f its Advisry Cuncil. Cmpsed f leading researchers and clinicians frm Canada and the United States, the Cuncil members wrk clsely with members f the staff t develp prgrams, evaluate research prpsals, and advcate fr the imprtance f cmmunicatin as an essential aspect f healthcare. Cuncil members include: Kathleen Bnvicini, EdD, MPH Executive Directr / Chief Executive Officer Institute fr Health Care Cmmunicatin Thmas L. Campbell, MD William Rcktasel Prfessr; Chair f Family Medicine University f Rchester Susan Chen Directr f Cunseling / Chairpersn Carla Walburg Rthschild Sciety fr the Human Animal Bnd Jhn C. Laidlaw, MD, PhD Cnsultant Cancer Care Ontari Dennis Nvack, MD Prfessr f Medicine Assciate Dean fr Medical Educatin Drexel University Cllege f Medicine Mira A. Stewart, PhD Directr, Centre fr Studies in Family Medicine The University f Western Ontari Jacqueline Dunbar Jacb, PhD, RN, FAAN Dean, Schl f Nursing University f Pittsburgh SOURCES OF FUNDING IHC was riginally established thrugh funding frm Bayer Pharmaceuticals, which remained a generus cntributr ver the years. IHC als receives grants t supprt specific prjects, enters int cntracts with varius rganizatins t develp and implement cmmunicatin imprvement prgrams, and sells materials t rganizatins cnducting its prgrams. The large majrity f IHC s budget cmes frm fees fr educatinal and cnsulting services, prduct sales, cntracts, and prject grants. A small percentage derives frm the wrk f a frprfit subsidiary. Majr IHC prgrams have been funded thrugh partnerships with the Veterans Health Administratin, the American Assciatin f Diabetes Educatrs, the American Academy f 8

9 Orthpaedic Surgens, and the Rbert Wd Jhnsn Fundatin, in additin t Bayer Pharmaceuticals, Bayer Diabetes Care, and Bayer Animal Health. Since 2005, IHC has been an independent nn prfit educatinal rganizatin determined t be tax exempt under Sectin 501(c)(3) f the US Internal Revenue Cde. The Institute played a key rle in helping ur physicians imprve their cmmunicatin skills. This imprvement in physician skills led t significantly higher patient satisfactin scres that have been maintained even thugh we have increased prductivity. Randy Hutchisn Directr, Custmer Services and Perfrmance Enhancement Geisinger Health System BOARD OF DIRECTORS IHC is an independent nt fr prfit crpratin legally incrprated as a private perating fundatin in the state f Indiana. Fiduciary respnsibility fr IHC rests with an independent bard f directrs, whse members currently include: Rbert Levine, MD Chairman Institute fr Healthcare Cmmunicatin and C chair f the Executive Cmmittee Yale University Interdisciplinary Prject in Biethics Directr, Law, Plicy and Ethics Cre Center fr Interdisciplinary Research n AIDS Prfessr f Medicine and Lecturer in Pharmaclgy Yale University Kathleen Bnvicini, EdD, MPH Executive Directr and Chief Executive Officer Institute fr Healthcare Cmmunicatin Rbert L. Engle, DBA Assciate Prfessr f Internatinal Business Assistant Directr f Eurpean Unin Business Studies Quinnipiac University Schl f Business Rbert Klppenburg Secretary/Treasurer Institute fr Healthcare Cmmunicatin and Vice President, Synta Pharmaceuticals Richard Kull, MD Psychiatrist Masnicare Jhn C. Laidlaw, MD, PhD Cnsultant, Cancer Care Ontari Bernard A. Marlw, MD CCFP FCFP Frmer Directr f Cntinuing Prfessinal Develpment (Ret.) Cllege f Family Physicians f Canada James Meuser, MD, CCFP, FCFP Directr f Cntinuing Medical Develpment Cllege f Family Physicians f Canada Sherri Rigby, DVM Vice Chairman Institute fr Healthcare Cmmunicatin and Area Veterinary Services Manager Bayer Healthcare, LLC, Animal Health W. Wayne Westn, MD, CCFP, FCFP Chairman, Canadian Operating Cmmittee, Institute fr Healthcare Cmmunicatin; and Prfessr Emeritus, Department f Family Medicine, University f Western Ontari 11/2012 9