Communication Skills Pathfinder Gateway to the training and tools - PowerPoint PPT Presentation

Communication Skills Pathfinder Gateway to the training and tools that will improve clinician communication with seriously ill patients

Our Goal The overarching goal of the Pathfinder portal, and the new collaboration between Ariadne Labs, CAPC, and Vital Talk, is to enable every clinician to have high- quality conversations about what matters most to the seriously ill patients they serve.

We are changing the serious illness conversation Scaling best practices in improving clinician-patient communication—for both individual clinicians and health care organizations—is a new national strategy for accelerating improvement in the care of people living with serious illness.

Why the Need  High-quality communication is the root of trust, and trust is the basis for care that achieves patients’ most important goals  Expert communication is a key driver of quality, especially for people with serious illness  Physicians, nurses, and other clinicians have had little training in communication  Communication skills are essential to care delivery that is aligned with patient and family priorities, reduced suffering, and avoidance of unnecessary and often harmful medical interventions

What Happens Now  Little upstream conversation about goals and how they match to treatment options  Focus on procedures, tests, referrals > people’s personal priorities  High-stakes decisions made under stress in times of crisis

Clinicians Think They Know How to Do This Already . . . Patien ents d s don’t a agree. e. How their patients rated them How clinicians rate themselves Source: J Palliat Med 2012; 15: 418–426. 6

Patients Assume Clinicians Have Been Trained To Have Conversations About Goals of Care, But… >40 million 46 % 29 % Had Unsure of High-Need formal what to Patients training say Source: National Survey Conducted by The John A. Hartford Foundation, The California Health Care Foundation (CHCF), and Cambia Health Foundation (2016)

Though Physicians Agree That Conversations About Goals of Care Are Important . . . 71 % Source: National Survey Conducted by The John A. Hartford Foundation, The California Health Care Foundation (CHCF), and Cambia Health Foundation (2016) 24 % Don’t Don’t have a routinely place to document ask about these conversations goals in the EHR 8

If communi unication d n doesn’ n’t happen a ppen at all, o or happens ppens v very l late i in the cour urse o se of a ser erious i illness, t ss, the he resu esult i is suf uffering, , poor outcomes es, a and p d prev even entabl ble c e costs f for our sick ckest p patients a and t their f families. - Diane E. Meier, MD, FACP Source: National Survey Conducted by The John A. Hartford Foundation, The California Health Care Foundation (CHCF), and Cambia Health Foundation (2016)

What Best Predicts 30-day Readmissions? Poor communication Source: Harvard Business Review (Sept 2015)

We Know How to Fix This  Patients expect clinicians to initiate these conversations Evidence-based  training changes clinician behavior System and workflow  redesign changes clinician behavior System-wide strategy  scales and sustains new standards of communication

Communication is the Linchpin of Quality During the Care of Serious Illness Empirical evidence links communication to:  Improved quality of life and experience of care  Better patient and family coping  More goal-consistent care  Fewer readmissions and hospitalizations  More, earlier hospice care 12

High Quality Communication is Best Practice Communicati tion a about values es, go goals, a and c care e preferen ences i is endorsed ed b by:  National Academy of Medicine of the National Academy of Sciences  American Society of Clinical Oncology  Society of Hospital Medicine  The Joint Commission  American Hospital Association  American Medical Association  Many others…

Enter the Communication Skills Pathfinder

The One-Door Portal to  Identify your training needs Clinician  Access training and tools that fit your needs Communication  Embed local communication skills experts and Skills Training trainers  Raise the bar for quality communication organization-wide

How Does It Work? 1. Choose from a range of training options by audience, level of skill, and intensity/scope of the desired intervention 2. Implement and demonstrate training value

Who Should  Clinicians caring for people with serious illness Use the across, stages, ages, diagnoses, and care settings Portal  Hospitals, health systems, and payer-provider entities including risk-bearing organizations (e.g. ACOs), seeking to improve quality and efficiency of care for seriously ill patients  The portal can be adapted to any clinical setting, including inpatient settings, outpatient clinics, patient-centered medical homes, skilled nursing facilities, or home-based care.

Return on By building the capacity to improve the frequency Investment and quality of clinician communication with seriously ill patients, organizations can:  Improve measures of patient experience (CAHPS, likelihood to recommend scores)  Reduce readmissions  Reduce the total cost of care for patients in the last year of life  Reduce malpractice suits Sources: Thiedke CC. What do we really know about patient satisfaction? Family Practice Management, 33-36 (2007) Pressman, H. The Cost Consequences of Unsuccessful Patient Communication (2016) Smith, S., Evidence on the cost and cost-effectiveness of palliative care: A literature review (2013)

Return on Both clinicians and organizations will improve their Investment ability to:  Identify high-risk patients  Ensure reliable communication about achievable priorities for care as standard of practice  Develop care plans aligned with those priorities  Follow through to align actual care with people’s informed goals over time

Different Models of Training  Ariadne L e Labs offers training based on a structured tool−the Serious Illness Conversation Guide −combined with a systems-change program  CAPC APC provides an online CME and CEU curriculum and Designation status in communication skills for every discipline  Vit ital T l Talk alk offers intensive training and faculty development that enables clinicians to acquire new, sustainable, and more effective communication skills, and to avoid common pitfalls

Aria iadn dne L Labs bs—headed by Atul Gawande— launched the Ser erio ious I Illne ness C Care P e Progr gram More VitalTalk is a non-profit organization started (SICP) in 2011. Under the leadership of Erik by Drs. Anthony Back (University of Fromme, MD, the SICP program provides a Washington), Robert Arnold (University of systems-level approach to ensuring that About Us Pittsburgh), and James Tulsky (Dana-Farber patients receive the care they want and Cancer Institute) with a mission to train experience the best possible quality of life clinicians caring for seriously patients and as they live with serious illness. The program their families in the communication skills has demonstrated improvements in the critical to elicit patient values and discuss frequency, timing, and quality of goals of care. Based on expertise acquisition, conversations; reductions in rates of anxiety the unique VitalTalk system enables and depression; and high acceptability among clinicians to acquire new, more effective patients and clinicians. communication skills and to avoid common pitfalls that make them ineffective or even harmful when discussing goals of care. The Center to Advance Palliative Care (CAPC) is a national organization dedicated to increasing the availability of quality palliative Our collaboration has been made possible care services for people living with serious through generous funding by the Gordon illness. CAPC has contributed to rapid and Betty Moore Foundation. expansion of access to palliative care in the United States. Led by MacArthur award winner Diane Meier MD, CAPC provides health care organizations with the tools, clinical training, technical assistance, and metrics needed to support the successful implementation and integration of palliative care.

A new way to find communication training that’s right for you  Multiple options from trusted sources  Easy-to-follow pathways to mastery for both individuals and health  systems  Find it at: commu mmunication-skills ills-pathfinder.org

“For the secret of the care of the patient is in caring for the patient.” - Professor Francis W. Peabody, Harvard Medical School, 1925 Thank you!