Karen Cook, RN

1. Patient and Family Engagement Communication Strategies Karen Cook, RN

3. Nurses – The Most Trusted Profession Communication… The act or process of using words, sounds, signs, or behaviors to express or exchange information or to express your ideas, thoughts, feelings, etc., to someone else

4. HCAHPS Correlation Studies Source: The table above was updated 5.3.13 using 3Q11-2Q12 CMS data.

5. Georgia Hospitals Average Trend

6. Georgia Vs. Nation Vs. SG Partners GA Hospitals Change in one year +.64 Source: The graph compares the change In one year in “top box” results achieved by Studer Group partners vs. non-partners. Change is from 3Q10-2Q11 to 3Q11-2Q12. The “top-box” is the most positive response to HCAHPS survey questions.

7. Communicating with Empathy The researchers identified 384 "empathetic opportunities," but found physicians responded with empathy to only 39 of them. Archives of Internal Medicine, Sept, 2008.

8. Nonverbal Communication and Empathy • Eye contact most highly linked to empathy • TWO Social touches (not associated with tasks such as handshake, healing touch, pat on arm, etc.) Source: Journal of Participatory Medicine.. August 14, 2013. Vol. 5

9. Physician Empathy = Positive Clinical Outcomes • "Our results show that physicians with high empathy scores had better clinical outcomes than other physicians with lower empathy scores." good control* (A1c<7.0 percent) good control* (LDL<100mg/dL) • Higher Empathy Good Control • Lower Empathy • Poor Control moderate control* (LDL≥ 100 and ≤ 130 mg/dL) moderate control* (A1c≥ 7.0% and A1c≤ 9.0%) Empathy poor control* (A1c>9.0 percent) poor control* (LDL>130 mg/dL) *Source: Thomas Jefferson University, Physician's Empathy Directly Associated With Positive Clinical Outcomes In Diabetic Patients

10. Patients’ Perception of Care = QualityVascular Catheter-Associated Infection

11. Patients and Families as Partners • How do they know this? • We tell them • “You know your health better than we do and we need your help to help you get healthy again.” • “You are the only one that can tell us if we are delivering on excellent care from your perspective so we need your input on…” • “We want to help you manage your pain.”

12. Benefits of Patient and Family Engagement • Improves multiple aspects of hospital performance • Overall improvements in quality and safety • Patients and families as allies in safe medication use, infection control initiatives, observing care processes, reporting complications • Reduction in preventable readmissions • Improved patient outcomes • Emotional health, symptom resolution, pain control, physiologic measures • Improved CAHPS® Hospital Survey scores • Patient-provider communication, pain management, medications, provision of discharge information AHRQ Patient Engagement Toolkit - Information to Help Hospitals Get Started

13. Benefits of Patient and Family Engagement • Better response to the Joint Commission standards or other accreditation • Improved financial performance • Decreased litigation and malpractice claims • Lower costs per case due to complications • Improved patient flow • Less waste associated with higher call volume, repetitive patient education efforts, diagnostic tests • Enhanced market share and competitiveness • Establishment of brand identify around patient and family engagement • Increased employee satisfaction and retention AHRQ Patient Engagement Toolkit - Information to Help Hospitals Get Started

14. Critical Care Family Navigator • Establish and maintain a feeling of warmth, goodwill and trust between the staff and the family • Establish expectations early in the ICU admission • Prevent misunderstandings and conflict, service recovery as needed • Convey a receptive, professional attitude towards families as partners in care • Support the family at point of need

15. What is Patient and Family Engagement? Tool provided: AHRQ Patient Engagement Toolkit Patient and family engagement: • Creates an environment where patients, families, clinicians, and hospital staff work together as partners to improve the quality and safety of hospital care • Involves working with patients and family members as: • Members of the health care team • Advisors at the organizational level AHRQ Patient Engagement Toolkit - Information to Help Hospitals Get Started

16. Much of Hospital Communication is One-Way • Flow of communication is “one-way” from communicator to receiver. (think discharge instructions) • Advantages • Fast • Appears neat and quick • Disadvantages • Knowledge is imposed • Learning is authoritative • No feedback • Little influence on human behavior

17. Barriers to Communication • Physical/environmental barriers • Personal barriers • Physiological (Illness/Disease) • Psychological barriers (Mental) • Cultural barriers • Personal Experiences • TIME (think discharge instructions) • Language/Literacy

18. Factors Influencing Communication: #lovemynurse Perceptions Values Emotions Culture Knowledge Role and relationships Environment Gender Personality

19. Engagement is Truly Two-Way • Both sender and receiver take part. • The process of learning is active , open and honest. • Patient’s needs, values and preferences are center • Promotes mutual understanding • Values diversity, creativity and empowerment • ACTIVE LISTENING • RESPECT • Influences human behavior

20. Guide to Patient and Family Engagement • Includes four strategies to support engagement: • Working with Patients and Families as Advisors • Working with Patients and Families at the Bedside: Communicating to Improve Quality • Working with Patients and Families at the Bedside:Nurse Bedside Shift Report • Working with Patients and Families at the Bedside:Care Transitions from Hospital to Home: IDEAL Discharge Planning AHRQ Patient Engagement Toolkit - Information to Help Hospitals Get Started

21. Patient Centered Care Delivery Model Hourly Rounding® Use opening Key words: Round Perform scheduled tasks Perform 3P’s Additional Comfort measures Environmental assessment of room Closing Key words Tell when you will return Log the round Bedside Shift Report AIDET® introduction Communication of current state and plan of care Teach back reinforcement of important patient care information such as drug side effects Nursing and Patient Care Excellence Individualized Patient Care Ask what 2-3 things will ensure excellent care Write on board Used by all members of the care team Ask each shift to reinforce listening Post visit calls 1. Questions designed to assess patients progress at home 2. Listening with more than your ears Reference: Studer Group Patient Care Model

22. The BASIC Best Practices are Rooted in Communication • Tell the Patient/Family What you want them to know by using key words, signs, sounds, or behaviors • Validate Understanding with staff • Can explain why key words are important • Demonstrate competency in communication • Validate understanding with patients and families • Use key words • Teach-back to validate comprehension • Individualized Care - Care/White/Communication Boards • Nurse leader rounding on patients • Hourly Rounding • Bedside handover • Discharge process including post visit calls

23. Often Missing Key Piece - Validation • Nurse Leader Rounds – focused on communication and validating that our best practices are in place.Are we having the impact we expect from the patient and families perspective? • Shoulder-to-shoulder direct observation and immediate feedback to staff on implemented best practices. Are we coaching behaviors? • Whiteboard and Hourly Rounding® log checks – Have we fulfilled the promise? • Skill labs – Do you know with certainty the skills your staff demonstrate? Are you and your staff doing these things every patient, everyday – Always?

24. Often Missing Key Piece - Validation

25. Top Performers Use Key Words • During this hospital stay: • How often did the nurses treat you with courtesy and respect? • How often did nurses listen carefully to you? • How often did nurses explain things in a way you could understand • Staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. • When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. • When I left the hospital, I clearly understood the purpose for taking each of my medications.

26. How Do They Know? • We tell them… • “Do you mind if I sit while I explain the test you are going to have today?” • “ Mr. Jones, as I was listening to your wife, she has many questions about your new medication…” • “I was listening to you speak about your pain and it occurred to me that we could try….” • “I want to make sure I am listening to you so do you mind if I turn the TV off while we talk about your care?” • “I have to document in this electronic record but just know that while I may look away from you, I am listening to you.” • “Kathy does a great job explaining medicine side effects, can you tell me one of the side effects she taught you today?”

27. Hardwire AIDET® and Key Words at Key Times • Narrate the care – be more verbal in our approach with patients and families • Watch body language and avoid silent assessments • Do you really accomplish the objectives of AIDET® • Acknowledge/thank – courtesy and respect • Introduction – instill confidence • Duration/Explanation – reduce anxiety

28. Acknowledge A Acknowledge Key message: You are important • Eye Contact • Shake hands • Acknowledge everyone in the room • Sit 91% of patients want to be addressed by name and 78% of patients wanted their physician to shake hands YET physicians use the patients’ name less than 50% of the time. * Annals of Internal Medicine * Mayo Clinic Proceedings

29. Introduce I Introduce • Name • Specialty and what a Hospitalist is “ I am Dr. Beeson, I am a hospitalist, and hospitalists see patients in the hospital only, I am working with your doctor who sees you in the clinic” 75% of patients admitted to the hospital were unable to name a single doctor assigned to their care. *Archives of Internal Medicine

30. Duration D Duration Key Message: I anticipate your concerns • How long will the hospital stay be? • How long will the test, procedure, appointment or admission actually take? • How long will you be on service? • How long before you come back and see the patient? Patients’ rating of quality is more predicted by their rating of the quality of communication than technical care. * Annals of Internal Medicine

31. Explanation E Explanation Listen to the patient’s story – 2 minutes! • Clarifying questions • Empathy through words and body language Explain the treatment plan • Using language that patient and their family can understand with “teach-back” if appropriate 74% of patients are interrupted by physician within 17 seconds of giving their history. *J Gen Int Medicine, 2005

32. Thank You T Thank You Key Message: I appreciate the opportunity to care for you • Closing Key words • What other questions can I answer for you? • Thank you for your patience in our slight delay today.

33. Types of Communication: Verbal Language: Chief vehicle of communication. CLEAR & BRIEF The words we use: Abdomen vs Tummy vs Stomach Pacing Timing and relevance Humor Tone Examples of verbal @ SVH Nurse Advisor Intercom/Switchboard Room Service Walkie Talkies Appointments: SVPN Vocera HCAHPS Triage ER Report to Floor Huddles

34. Types of Communication: Written SIGNS WHITEBOARDS MENUS Emails/Texts Education handouts Medication Bottles Manuals, Orders Policies and Procedures EMR Patient complaints An interaction that makes use of the written word and at times pictures.

35. Written Communication

36. Written Communication

37. Written Communication

38. Hardwire the Use of Communication Boards • These are for the patient, not for the staff • Customize them for your facility or care area • Focus on the use of the information by the whole care team • Gaps in data on the board don’t fulfill the promise to patients and families

39. Hardwire Use of Patient/Family Tools • Orthopedic & Bariatric • General Admissions

40. Hardwire Use of Patient/Family Tools

41. Hardwire Bedside Shift Handover • Transitions in care have potential for medical errors • Research shows bedside shift report can improve: • Patient safety and quality • Improved communication • Decrease in hospital-acquired complications • Patient experiences of care • Time management among and accountability between nurses • Decrease in time needed for shift report • Decrease in overshift time

42. Addressing HIPAA concerns • Health information can be disclosed for: • Treatment • Health care operations • Payment • HIPAA acknowledges incidental disclosures may occur • Not a HIPAA violation as long as • Take reasonable safeguards to protect privacy • Disclose only or use the minimum necessary information Strategy 3: Nurse Bedside Shift Report (Tool 3)

43. Accelerator – Patient/Family as Advisors • Patient and family advisors help us provide care and services based on patient- and family-identified needs rather than our assumptions • Patient and family advisors offer • Insight on our strengths and areas where changes may be needed • Feedback on practices and policies that can help patients and families be active partners in their care • Feedback that is timely and gives a fuller picture of the care experience than standard patient and family satisfaction surveys Information to Help Hospitals Get Started

44. Accelerator – Patient/Family As Advisors • Formal – Advisory Council • Focuses on strategies, priorities, input on decisions • Informal – Spontaneity, convenience • Waiting rooms, bored families • Invite 2 families per unit to have lunch that day with the CNO (planned every other week) • Past employees who received care • “What rules did you have to break to get care?” • “What made you most/least proud of the care?”

45. Electronic Family Advisors

46. Accelerators: Every Department, Every Experience

47. Accelerators - Infrastructure • Senior leaders integrate family/patient engagement strategies into culture • Serve as role models for engaging in partnerships with patients and family members • Provide resources to support initiatives • Integrate into personnel policies and practices • Align incentives to results

48. Final thoughts • Our hospital is committed to patient and family engagement — everyone plays a critical part • Patients and families won’t engage if they believe that you don’t want them to—it is simply too risky for them • Your job is to make it safe for them to be involved, not just as patients but as partners in their care • How do they know ___ - you tell them • How do we know ____ - we ask