Relationship-Centered interactions in your career? Care leads to - PDF document

Relationship-Centered Communication 2014 Disclosures Relationship-Centered Communication All proceeds from I M P R O V I N G P A T I E N T A N D C L I N I C I A N sales go directly to E X P E R I E N C E S the Academy of C A L V I N C H O U , M D , P H D Communication P R O F E S S O R O F C L I N I C A L M E D I C I N E in Healthcare U C S F The Most Com m on Procedure • How many patient Relationship-Centered interactions in your career? Care leads to > 200,000 in a lifetime • Less training, practice, and Better Outcom es… feedback than other less common procedures AACH 1

Relationship-Centered Communication 2014 For Clinicians & Team s For Patients  Diabetes  Pain management  Engagement  Adherence to  Satisfaction medications  Workload stress  Satisfaction with  Medical malpractice care experiences Safran et al, J Fam Pract 1998; Stewart et al, J Fam Pract 2000; Levinson et al, Health Affairs 2010; Dwam ena et al, Cochrane Database Syst Rev 2012; Hojat et al, Acad Med 2013; Kennedy et al, Pat Experience Levinson et al, JAMA 1997; Krasner et al, J 2014 JAMA 2009 For Institutions Like any procedure…  Skills can be learned and  H/ CG-CAHPS taught  Work Environment  Mastery requires deliberate practice and  Job Satisfaction feedback Ericsson, Acad Med 2004; Tulsky, J Pall Med 2005; Dwam ena et al, Cochrane Database Syst Rev 2012; Archer, Med Educ, 2010 AACH 2

Relationship-Centered Communication 2014 Specific Skills to Adopt Collaborative Agenda-Setting  Elicit a LIST of all items  Set a specific agenda: state your goals and ask  Collaborative agenda- the patient to prioritize setting  Great for  Empathic statements  Patients: more concerns  Teach-back voiced; better physical and behavioral health outcomes  Providers: decreased door- knob questions; higher Alam o, 2002; Brock 2011; Heritage, 2007; patient ratings Mauksch, 2001; Kaplan 1989 Em pathic Statem ents Em pathic Statem ents  Partnership  Empathy  Appreciation  Respect  Legitimization  Support Chou and Cooley 2018; Epstein 2017; Hart 2006; Kinsm an 2010; Riess 2012; Roter 1995 AACH 3

Relationship-Centered Communication 2014 Em pathy Saves Tim e The ART of Teach-back  ASK the patient to Addressed Didn’t em otional address summarize cues em otional  REFLECT or reinforce cues what the patient says Internists 17.6 min visits 20.1 min visits  TELL any additional Surgeons 12.5 min visits 14 min visits necessary material Schillinger et al, 2003; Schenker et al, 2011 Levinson et al, JAMA 2000; Hojat et al, Acad Med 2011 Where to hone these skills Recap  UCSF: Center for  Collaborative Enhancement of agenda-setting Communication in Healthcare (CECH)  Empathic  ZSFG: Improving Patient statements Experiences Through Communication  Teach-back  Perhaps your own  Great for patients institution and for us  National courses through the Academy of  Can be taught and Communication in practiced Healthcare AACH 4