Engaging Physicians in a New Communication Curriculum
Engaging Physicians in a new patient communication initiative
At Northwell Health we have embarked on a journey of improving our patient experience scores. Northwell Health is a 22 hospital integrated health system comprised of both community and tertiary hospitals, 61,000 employees and 4000 employed physicians and another 8000 voluntary physicians.
This journey began with establishing our Culture of Care, which is 4 hour course rolled out to all our employees. It has become the basis of our culture and a promise to ourselves. The foundation is CARE: Connect, Awareness, Respect and Empathy. With the recognition that there is a national movement to interconnect Patient Experience, Quality and Safety, we are committed to all with the goal of improving patient outcomes.
Beyond the culture of care, we always knew we would need a more intensive Physician communication curriculum that would provide physicians with a framework and structure for interaction with patients. It is the recognition that communication, like other skills in medicine, need to be practiced and honed to incorporate into everyday practice.
We have partnered with The American Academy of Communication in Healthcare (AACH), an organization that for more than 30 years has been in the forefront of research and teaching relationship centered healthcare communication to improve patient safety, interdisciplinary teamwork, and patient experience scores. It is a train the trainer model.
At Northwell, we have now trained our first group of physician facilitators to teach the course, which consisted of 7 full days of training, and we are ready now to roll out the course to our physicians.
The issues we are struggling with are:
- How do we create the greatest buy in from the physicians?
- Which physicians should we introduce the course to first?
- How do we engage our next group of facilitators, given the amount of work it takes to become a facilitator
- How do we create a sustainability model? In other words, we expect improvement in metrics initially, but what creates the sustained improvements?
It is good to have a structured curriculum like you mentioned train the trainer model. It is good practice to have your physician facilitators to teach the course, as you mentioned consisted of seven full days of training, and you are ready to roll out the course to your physicians.
How do we create the greatest buy-in from the physicians?
Greatest “buy in” comes if your physicians were included in this from the beginning of the initiation of this project and had their voice in planning to its implementation phase. If we can prove the value to our physicians in taking this seven days’ course in terms of quality as well as quantity. If we can add CMEs (Continuing Medical Education hours) to the modules will help.
Which physicians should we introduce the course to first?
The value of this program should be introduced to physicians who are willing to attend and have the commitment to stay longer in that organization. I think in the beginning Hospitalist will be a good to consider.
How do we engage our next group of facilitators, given the amount of work it takes to become a facilitator?
Need to have some incentive programs for them in terms of bonuses or a recognition by organizational leadership periodically. It is also important to share with these facilitators your patient care data in terms of Press Ganey scores, fewer errors and more collaboration in quality as well as quantity etc.
How do we create a sustainability model? In other words, we expect improvement in metrics initially, but what creates the sustained improvements?
Sustainability is a challenge but if this program needs to survive and to be sustained, it needs to be periodically revisited and revised in terms of its impact. This impact needs to be shared and filtered through the entire organization and become a part of an organization culture among physicians. This program needs an ownership, monitoring, periodic reevaluation in terms of metrics followed by processes to meet the required targets to make this as a living and breathing process.
In my experience in Dutch hospitals and other healthcare institutions with organizing and maintaining these kinds of communication- and leadership programs the only way such a program can be successful is if the physicians see the program as ‘their’ program and the organization helps and facilitates them in making sure the program can be organized. The lead, at least partly, has to be with the main targetgroup, the physicians, and they have to be able to influence the program: intensity, content, desired outcomes, translation to added value in their work etc.
I can imagine that there is a small group of physicians who really want this program and who really see the need en urge to create and maintain such a program? If not: you could find a way to ‘create’ a small ‘winning’ team with both a few ‘physician champions’ (who are open en into this and want to be involved) and a few organisation ‘champions’ (who feel the urge en need and will facilitate the physicians, put time and effort in it). They can become the ‘ambassadors’ for this program by giving them influence on the content and approach of the program. This will take some energy and time. This team also can think about how to communicatie impact, sustainability etc. Involvement of board (med director and HR) is also very important in this first phase.
In my experience I often see that when done intensively and correctly (create a winning team with key stakeholders in beginning) this will create a lot of momentum and value adding in future. I even see on regularly basis that at least one enthusiastic physicians wants to become a facilitor and/or stay involved. And that would be great and can be realized (f.e. by arranging organisational support for such physician to be able to take the facilitating role). And ofcourse then as a hospital you could think about the relevance and importancy and translate this into incentives for physicians who really want to be involved!
Anyway: at least create involvement of a few of the enthusiastic physicians is really relevant en important!
great initiative and totally agree that improving communication skills will benefit patient experience and quality of care…
It sounds like you’re on the right track – good initiative! In DK it’s often said, that doctors can’t communicate, mostly referred to the lack of time given to spend on communication for the individual doctor. But of course, some doctors are not that good at communicating or at least should have their communicative skills polished; others communicate well – and thereby also embrace the patient’s wishes to outcome etc – at a whole other and more profound level thereby enhancing the quality of patient experience.
In DK some projects have actually been made, where doctors learn about there communicative skills – forces and not-so-forces – by teaming up with another doctor throughout a whole day of consultations; a colleague that actually spends a whole day just by observing and “scoring” their colleague on certain pre-defined communicative skills e.g. how to address the patients issues, capability of listening and so forth. Afterwards the score is made up and the doctor become aware of his/hers forces and which issues that need to be addressed. Both doctors actually learn from this observing/observed study (which is flipped so both try both roles), because the doctor that observes actually reflects a lot on his/hers own way of addressing the patients while observing a colleague. The next step after this observing phase is then a more professional approach with a short training period for each doctor in the issues that need to be addressed (also including competences in shared decision making).
A lot of doctors were reluctant to the project – you have also probably heard most doctors say, that they “communicate very well, thank you”. But when they are actually showed, that this is not necessarily the case both by being observed and “scored” and by reflecting on there role as observers – they actually engage. Because no doctor is actually satisfied about not being good. So with your project you should address most doctors professional vanity of being the best they can.
We have implemented a very similar program at my organization. All employees completed a 4 hour course and then managers did additional 1 hour programs each month in 2016 to keep the program going. Along the way, it was recognized that physician communication scores were not where they should be and additional training is being provided in the form of a mandatory 8 hour course.
To gain buy-in, the facilitators presented to the service line leaders, Medical Executive Council, Council of Chairs, Medical Staff, and Advanced Practice Provider Council. They focused on the plan for all providers to attend and the content that would be covered. They provided their own patient experience scores and demonstrated how they improved after implementing the techniques learned in the course. As providers have gone thru the course, successes have been shared and data shared.
To create sustainability, the organization adopted a goal this year to have the overall score for “recommend this provider” in the 90th percentile. Individual scores are provided monthly to each provider and Chairs and Service Line leaders are charged with ensuring that providers review these. They are also built into the provider’s quarterly quality incentive so there is some monetary incentive for individuals. Each Chair and Service Line leader have the goal as one of their goals for their department/service line.