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Product Details
| ISBN-13: | 9781567938340 |
|---|---|
| Publisher: | Health Administration Press |
| Publication date: | 06/28/2016 |
| Series: | ACHE Management |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 176 |
| File size: | 2 MB |
About the Author
Read an Excerpt
CHAPTER 1
Nuts-and-Bolts Advice for Improving Interactions with Patients
When I Shadow and coach physicians, I see the same challenges over and over again. Having meaningful relationships with patients can be an art, but it's also a science. Patient interactions usually follow predictable patterns, and one can dissect and examine those patterns to identify specific behaviors to improve. Even doctors who are naturals at interacting with patients can improve at least a bit by having their eyes opened to a few new opportunities.
I've gathered the insights in this chapter from observing hundreds of physicians in situ — interacting with real patients. Here, I break down the patient interactions into a list of practical how-to items. This is the list for those who say, "I want to get better at this. Tell me what I need to do."
Is this you? If so, you're already interested and engaged. If you are also disciplined and follow through, you will be able to move the needle on your patient satisfaction scores a long way in the right direction in a short period of time.
THE DETAILS
In the following sections, I describe the most common opportunities for improvement I've identified for physicians interacting with patients (summarized in Exhibit 1.1). These opportunities have to do with awareness, first impressions, the phase I call "the meaty middle," and last impressions.
These practical tips are effective and easy to implement — if you master them one at a time, as demonstrated in Chapter 4. I offer them as a means to structure your analysis of your own performance — what you already do with your patients and opportunities you may not have considered before.
Awareness: The Tip That Tops All Others
No aspect of your performance is more important to your success than being aware that your interaction with the patient is very important. This consciousness places you in a frame of mind to win her confidence and make her feel fortunate that she has you as her doctor.
Awareness allows you to remind yourself before each encounter to consider what your patient might be thinking and likely is experiencing. See yourself as a helping partner, not just a clinical decision maker.
Over the years, I've watched many doctors improve their patient satisfaction scores before they analyze a single micro-aspect of their patient interactions. In fact, most doctors can improve their scores by simply stepping into the right state of mind before every interaction. And by the way, this is why doctors who are just naturally good with patients are that way — they're continually mindful of it.
This "right state of mind" includes paying attention to your sixth sense — your ability to perceive or intuit what is going on in certain interactions or circumstances. And yes, you do have this ability. Did your medical training teach it to you? Probably not, but your experience as a human being tells you it's real. Pay attention to it.
It's one thing to tell yourself, "With each patient today, I will pause and remind myself to be aware"— of yourself, the patient's needs, the immediate circumstances, and what that patient will reflect back on when he fills out his patient satisfaction survey or when he tells his bowling buddies about you. It's another thing to do it prior to each and every encounter. Practice the following tips until the approach becomes second nature:
• Before seeing a patient, pause and say to yourself, "I am going to care for this patient like he is a member of my family."
• Apply the principle behind the expression "The best judge of character is how someone treats a waiter when no one is watching." Pretend that your patient satisfaction coach — or better yet, the person responsible for renewing your contract — is monitoring you and taking notes. Or that your aunt (who thinks you walk on water) is watching. Don't disappoint her!
• Finally, understand that, in essence, you are always being observed: The patient satisfaction survey is always "watching."
This list is a general approach to being aware. Following is a discussion of specific types of awareness to practice in your patient encounters.
Self-Awareness
Feeling tired? Dealing with a difficult patient? Time to be on guard.
By being self-aware, you can often predict when you're headed for rough waters. Know your triggers — everyone has them. Then institute the following tips to make potentially stressful encounters go more smoothly:
• Before you see a patient who has been challenging in the past, say to yourself, "I know I could easily get snippy with this patient. I won't do that. I'm the professional in the conversation. I will not take the bait. I will not let this be the one patient who torpedoes my patient satisfaction scores this month."
• Take a deep breath in the middle of the conversation. Focus on being very controlled in your responses, being mindful of your triggers. Be gentle and strong at the same time.
• If a patient challenges a mistake by a colleague (your partner who rounded yesterday in your place, for example), don't feel the need to be defensive. Just move ahead with what you can do to help that patient today.
Awareness of Circumstances: When You're Out-of-Control Busy
Doctors tell me the biggest barrier to better patient satisfaction is not having enough time to spend with their patients because of their workload. I empathize with this — and don't have an easy answer. I know that most doctors struggle with this issue to varying degrees. However, I've worked with many doctors who have earned high patient satisfaction scores in spite of it.
The Broad View of Improving Patient Interactions: Three Key Concepts and One Important Truth
This chapter might seem to cover more tips than anyone can implement. Don't panic! Ease into this process by thinking about the three concepts introduced below. If these are all you take away from this chapter, you'll still be on your way to improving your patient encounters.
1. Be aware. Prior to every patient interaction, remind yourself of its importance. Prepare to be "on." Pause before entering the room to collect yourself and focus on having a great exchange with the patient. Pay attention when intuition tells you to.
Just being aware helps many doctors make small — even subconscious — adjustments in the way they interact with patients.
2. Make a great first impression. Knock and ask permission before entering. Say hello and introduce yourself. Tell your patient you've read her chart, but you'd like to hear what brought her in today (or, if she's an inpatient, how she feels today).
The point is to take a moment to establish a relationship and hear the patient's story before diving into "the doctor thing."
3. Make a great last impression. Summarize the main points both you and the patient have communicated. Cover next steps. Ask if he has any unanswered questions. Offer a warm goodbye.
The key idea here is to pause and take your time wrapping up the meeting. Make sure the patient is comfortable with everything you've covered before you leave the room.
Now, let's say you want to dive a little deeper. My one important truth is this:
Memorizing my list of tips won't be helpful for most doctors.
Trying to tweak every aspect of your routine with patients will be overwhelming and counterproductive. Trying to do too many things differently all at once will throw anyone off his game.
Instead, scan the tips and decide which presents your biggest opportunity to make one change that will have significant impact.
If you need some guidance on which to choose, feel free to jump ahead and (1) complete a self-assessment (see Appendix 5.1 on pages 60–62); (2) ask your physician colleagues, a nurse, or a medical assistant to observe you with patients and provide feedback (see Appendix 5.3 on pages 64–66); (3) work with a professional coach; or (4) rank-order your opportunities for improvement to pinpoint the one that will yield the most improvement (see Appendix 5.2 on page 63).
As described in detail later in the book, work on making only that one change. Keep at it until you have mastered it and it has become a natural part of your routine. Rewiring a brain can take several weeks or a month, so don't give up after only a few tries.
Once your first priority has been mastered, move on to your second-most-impactful opportunity. And repeat from there. Slowly mastering key changes based on your individual strengths and weaknesses will have a significant and lasting impact on your patients' satisfaction for the rest of your career.
Especially when your workload is incredibly high, I advise this: Your goal — as the professional — is to not let your patient see how busy you are.
Patients get anxious if they can tell that your workload is excessive. So remember the adage "Never let 'em see you sweat." Before you enter the room, say to yourself:
My job is to not let the patient see how crazy this day is for me. I will not use that as an excuse. I will not let that cause my patient any anxiety. I'm taking a deep breath and not letting my crazy day affect this patient's experience. I will not let my body language betray me. It's my job to protect this patient from the harried realities of the modern healthcare system.
There is no magic answer, but your best efforts to keep your wits on those super-hectic days are often noticed by your patients.
When you really can't spend much time, concentrate on giving the patient a great few minutes. Be fully present, and make sure you end the interaction positively. Ask for questions, even if you don't believe you have much time to answer. Ask if there's anything else you can do for the patient.
Remember that needing to get out of the room to see your next patient is different from seeming like you want to get out of the room to see your next patient. Your patients know you're busy. Don't underscore the point by checking your pager or forgetting to say goodbye. As discussed in detail in a later section, don't let your body language betray you.
First Impressions
Get the interaction off to a good start with each patient. It's crucial: The old adage about not getting a second chance to make a first impression is never more true than in your exam room. With the tips that follow, you can start building a relationship of communication and trust right away.
The Greeting
Begin an interaction with a patient — especially a new one — by knocking on the door, introducing yourself by name, stating that you are his doctor today, and shaking his hand, if appropriate.
Give the patient your full attention during the greeting. Maintain eye contact, and don't try to multitask. For example, instead of turning your back to the patient during your introduction to pull gloves out of a box on the wall, separate your actions with a phrase such as, "Let me put on my gloves before we talk further. I want to give you my full attention."
If the patient is an inpatient, ask if this is a good time to talk with him, perhaps saying, "May I come in now to talk with you?" In addition to being courteous, this question gives the patient some feeling of control (more on this later in the chapter).
Close the door or curtain for privacy — and tell the patient that's why you're doing it, so he gives you credit for it. In an inpatient setting, ask for permission to adjust the volume of the television: "May I turn the TV volume off so we can hear each other better?" Many physicians turn down the volume without asking. While their instincts are good, they are infringing on the patient's space without permission and they've just missed an opportunity to build the relationship.
Give Them Ways to Remember Your Name
Make sure your lab coat displays your name clearly in letters that are large and easy to read (no cursive). Anxious patients and family members often will not remember your name from your verbal introduction, or remember it accurately, if your name is more exotic than (or as common as) Smith or Jones. So make it easy for them to sneak a peek at your lab coat during the visit to see your name and cement it in their memory. This is information they want and need. If you're also wearing a name badge, so much the better. Affix the badge firmly so that it doesn't flip over backward.
Strongly consider using business cards. Some doctors have their pictures on their cards, which is incredibly helpful for patients and families. It will be hard for the patient to remember your name when you've just met for the first time, especially if the patient sees more than one doctor. A business card left at the close of a first interaction will make sure your patient has your name and a way to follow up with you if needed. It's a thoughtful gesture to wrap up with.
Do You Have an Achilles Heel?
Sometimes when I shadow physicians with middling patient satisfaction scores, I don't see any huge problems. But just when I start wondering why their scores aren't higher, I notice a single something. The issue might not arise with every patient, but it isn't long before I see it again — and then again.
The Achilles heel — that one big flaw that doctors don't recognize — tends to dilute their otherwise excellent performance. But once they fix the flaw, they become patient satisfaction superstars.
Some classic Achilles heel behaviors I've encountered in physicians include the following:
• Checking their watch or pager while the patient is talking
• Interrupting when the patient is trying to answer their questions
• Arguing with the patient (about anything)
• Excusing themselves from the room before they have answered all the patient's questions
• Speaking critically of other members of the care team, even if that criticism is deserved
Do you have an Achilles heel? How can you know? Follow the steps discussed in the previous sidebar in this chapter (pages 6–7). And you should also look at the verbatim comments your patients have given to the open-ended questions on your patient satisfaction survey.
Once you've found your Achilles heel, resolve to fix it — just it — no matter if you've discovered other little things you should change. Save those for later. For now, zero in on your single most patient-annoying behavior.
Tell your staff and your partners what you're working on. Sharing this information will make you feel more accountable for sticking with it.
Give Patients More Control: Two Magic Phrases
When patients feel they have more control, they will be more satisfied with their overall experience. Especially important at the beginning of the visit is using the words "May I …" to ask patients' permission before taking even mundane actions. The opportunity to grant permission gives them control and is likely to increase their respect for you. Opportunities to use these words early on in the visit include the following:
• Before entering her room: "Good morning, Mrs. Smith. May I come in and talk with you now?"
• Before beginning a physical examination: "May I examine you now?" (Often patients reply, "Why, of course. You're the doctor." If this happens, you can deliver the super-impactful, relationship-building statement, "No patient has ever told me 'no,' but I always ask before touching a patient. It's your body, and doctors need to respect that.")
Another way to give the patient control is to always ask, "Does that seem reasonable?" when recommending a test or course of treatment. Using this phrase leaves no doubt that the patient has been invited to participate in — and has assumed a measure of control over — her care.
Body Language and Positioning
To sit or not to sit. If your style is more businesslike and formal, or if you tend to move quickly on rounds, consider sitting on the side of the bed or pulling up a chair before beginning the substantive part of the conversation with your patient.
Some folks in our field prescribe sitting because it "forces" the physician to take the time to thoroughly communicate with the patient. I think the value of this advice is overstated. Many physicians are just fine standing; others need to sit to make a better connection. Use your sixth sense or get input from others to figure out which type you are.
Once you know your style, keep in mind the following guidelines for body language and physical positioning:
• If you stand, take care to not overpower the patient with your presence. Stand upright; don't hover over her if you're just talking. Most patients are uncomfortable when their physician stands too close, especially if you are tall. Be careful to stay in a spot where the patient can see you without effort. And if that isn't possible, give her permission to not look at you while you're talking. She'll give you credit for acknowledging her discomfort.
(Continues…)
Excerpted from "A Physician Guidebook to the Best Patient Experience"
by .
Copyright © 2017 Foundation of the American College of Healthcare Executives.
Excerpted by permission of Health Administration Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Preface,
Acknowledgments,
Introduction,
Part I: For Doctors Who Say, "Just Tell Me What to Do and I'll Do It",
1. Nuts-and-Bolts Advice for Improving Interactions with Patients,
2. What Patients Want (Or, It Helps to Know the Questions Before You Take the Test),
Part II: How Physicians Can Make and Sustain Behavior Changes,
3. The Science of Behavior Change,
4 Disciplines of Execution,
4. How to Make and Sustain Behavior Changes,
Part III: Resources for the Improvement Journey,
5. Tools for First Steps,
6. 16 Ways Your Organization Can Help You Improve,
7. If You Have to Go It Alone,
8. Journeying to 99th Percentile Patient Satisfaction — One Group's Story,
Part IV: For Skeptics,
9. A Dozen Reasons You Should Care About Patient Satisfaction,
10. Hard-to-Argue-With Responses to Common Objections,
Part V: Additional Advice Specific to Specialty or Practice Setting,
11. Advice for Emergency Medicine Physicians and Urgent Care Providers,
12. Advice for Hospitalists (and Other Providers Who Round on Inpatients),
13. Advice for Primary Care Providers (and Other Providers Who See Patients in an Office Setting),
A Final Word,
About the Author,
The Author Welcomes Your Feedback,