The Patient Experience—It’s Your Bottom Line, Part II

Posted on 13 Apr, 2018 |comments_icon 0|By Elizabeth
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A happy patient—one well pleased with the patient experience—is a practice builder.

How’s your patient roster holding up? Are you obtaining new patients? Are your existing patients satisfied?

Improving patient satisfaction starts with the provider. While it certainly doesn’t end with the provider, as each member of your staff plays an integral role, the patient-provider relationship is the keystone of the patient experience.

Let’s begin to unfold the daunting objective of delivering a consistently positive patient experience throughout the patient touchpoints within your practice with a look at physician-centered strategies.

Empathy: The Human Connection

We’ve all been sick, and most of us are aware of that childlike need for nurture when we feel vulnerable. It’s no surprise, then, that patients need, and even expect, empathy from their doctors.

Empathy, though, is often underserved in medicine, given the time constraints on physicians, as well as their training to practice a cognitive empathy, or empathy with detachment, as a means of emotional preservation.

“It goes without saying that physicians cannot fully experience the suffering of each patient,” writes Jodi Halpern in What is Clinical Empathy?. “However, the point of saying that the physician does not ‘experience that state oneself’ is, presumably, to emphasize that empathy is an intellectual rather than emotional form of knowing.”

Halpern continues, “The function of empathy is not merely to label emotional states, but to recognize what it feels like to experience something. That is why empathy is needed even when it is quite obvious what emotion label applies to a patient.”

Consider physician empathy from another angle. People go to their doctors because they have a health concern. They want their conditions treated or their health maintained, but concern is what brought them to the office. They’d have managed on their own, for better or worse, if not for concern. It follows, then, that they’re looking for “treatment” of both concern and medical condition.

How does one treat patient concern? Information, knowledge is power. This is especially true for patients attempting to understand, accept, and respond to conditions affecting them. Foremost, though, concern responds to concern.

“The patient will never care how much you know, until they know how much you care,” said Terry Canale in his American Academy of Orthopaedic Surgeons Vice Presidential Address. Patients want—and even need—to know you care for them.

According to the HCAHPS: Patients’ Perspectives of Care Survey, empathy is the gold standard in the patient experience, weighing in with more positive influence than any other contributing factor.

But time doesn’t favor empathy. Time is in short supply for physicians, with pressure to keep to the schedule often causing them anxiety. Empathy and anxiety clearly do not mix.

Slow down, advises Halpern, which seems counterintuitive. But, she says, “Listening can make care more efficient.”

In a cohort study lead by Wolf Langewitz, “The average patient visiting a doctor in the United States gets 22 seconds for his initial statement, then the doctor takes the lead.” Halpern advocates for ninety seconds. It usually takes less time for a patient to speak without interruption, and this set the tone for trust and disclosure.

A posture of empathy, or emotional attunement, helps physicians appreciate the personal meanings of patients’ words. An emotionally attuned doctor picks up on words that are loaded. Alongside the verbal meanings conveyed in conversations is an ongoing flow of emotional meanings. “By attuning to another person, one follows this flow with much more ease than if one were to try to get at all this meaning through asking questions and consulting checklists,” says Halpern.

To enhance the expression of empathy toward patients, Bhanu Prakash, in his article Patient Satisfaction, suggests the following:

  1. Recognize that patients expect a personal relationship demonstrating compassion and care.
  2. Listen and encourage patients to talk about their concerns.
  3. Step into your patients′ shoes to see through their eyes and hear through their ears.
  4. Measure your tone in response to your patient’s emotions.
  5. Treat the whole person, not just the patient.
  6. Give your undivided attention.

 

In the list above, which depicts the posture of empathy, you can see how these suggestions apply equally to staff, in addition to providers. As your staff focuses on extending empathy to your patients, you’ll see a dramatic improvement in patient experience among your patient population.

Let’s not forget eye contact. Simply by looking in someone’s eyes when they’re speaking helps them to feel heard.

While it seems almost unnecessary to state that eye contact is important, particularly in medicine, it’s easy to lose sight of (no pun intended) in a multi-tasking environment. Eye contact competes with the computer screen, according to a JAMA Internal Medicine study entitled Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics.

When the computer screen gets more of the provider’s face-to-face than the patient, care ratings drop. “Concurrent computer use may inhibit authentic engagement, and multitasking clinicians may miss openings for deeper connection with their patients,” the study explained, emphasizing the need for physicians to put down their iPads and engage their patients.

Communication: The Art of Medicine

Doctor-patient communication is a clinical function and prerequisite in the practice of medicine. After all, it is via communication that the physician gathers information to determine a diagnosis and to counsel a patient.

But communication plays a bigger role in the whole of medicine, or rather, in the holistic view of the patient.

Communication was shown to be a top factor influencing the positive patient experience in the HCAHPS survey, and significantly nurtured trust among patients.

Several studies show that clear, empathic, two-way communication with respect for patients’ concerns help to regulate patients’ emotions, facilitate patients’ comprehension of medical information, and enhance physicians’ identification of patients’ perceptions, needs, and expectations. In doing so, it also leads to better adherence to medical treatment. Patients take responsibility for their health when providers invest time to explain prescribed treatments. This establishes a ‘therapeutic alliance,’ opening the door for patients to participate in the decision-making process.

Good communication is empowering. Engagement, choice, and sense of control over the environment are all associated with higher patient satisfaction levels. As Lisa Platt, Director of Business Product Development at Planetree, points out, “There is now a shift from doing things for patients to doing things with patients.”

“As patient trust grows so does the dialogue, the sharing, the storytelling. The transparency. The exchange of ideas and information with one another,” writes Andy DeLao in Is Healthcare Designing the Wrong Patient Experience?. “Patients may have time to read a recent article that a physician doesn’t due to time and interest. The sum of us is still greater than any of us.”

But are doctors, as communicators, as good as they think? Not according to a 2010 Ochsner Journal review, which reports that physicians tend to overestimate their communication abilities.

The review cites several barriers to good communications, such as patients’ anxiety and unrealistic expectations, as well as doctors’ burden of work. While overcoming these obstacles falls to the physician, perhaps the operative word to depict good provider-patient communication is partnership. The physician’s aim, then, is collaboration.

Consider the following “bedside” strategies to facilitate better provider-patient communication:

  • Assess what the patient already knows, as well as what the patient wants to know.
  • Ask open-ended questions.
  • Adopt an exploratory approach to understand and appreciate the patient’s perspective.
  • Watch the patient’s body and face for nonverbal tells expressing what he or she is unable or unwilling to say.
  • Don’t shy away from addressing the emotional and social impact of the patient’s problem.

“Simple choices in words, information depth, speech patterns, body position, and facial expression greatly affect the quality of one-to-one communication between the patient and physician,” says John Travaline in Patient-Physician Communication: Why and How.

Travaline also points out that physicians who communicate in a slow and deliberate fashion create time for patients to absorb information. A slow delivery gives the listener time to formulate questions, which then guides the physician to provide needed information. Both physician and patient walk away with a deeper understanding.

It’s key, as well, to welcome family members into the conversation. “We make sure we are always listening to the family, given that we realize the family members may be in charge of that patient’s care 360 days out of the year, versus the 5 days that we may be in charge of their care,” says Jon Rozenfeld, President of SSM St. Mary’s Hospital.

Expanding patient engagement to include family heightens the experience of empathy and creates an exchange where both patients and their families feel valued and cared for.

Your Bottom Line

Patient experience is clinically important. “A patient’s liking the doctor has a lot to do with the patient getting better,” says Stephen Brown, author of Patient Satisfaction Pays: Quality Service for Practice Success.

Ensuring positive patient experiences throughout the continuum of care is your top priority. It improves more than patient outcomes. It reduces costs and increases your profitability margins.

As patients approach their healthcare as consumers, medical practices must adapt by creating high-quality patient experiences to attract and retain patients for the long term.

Learn More

For more insights to safeguard your practice’s financial health through effective patient engagement, pick up TCI’s Ready, Set, Engage: How to Create a Patient-Centered Practice.

References:

DeLao A. Is Healthcare Designing the Wrong Patient Experience?. The Health Care Blog. 2015. Available at: http://thehealthcareblog.com/blog/2015/05/26/ishealthcare-designing-the-wrong-patient-experience/.

Ha, J. F., & Longnecker, N. (2010). Doctor-Patient Communication: A Review. The Ochsner Journal10(1), 38–43.

Halpern, Jodi, MD, PhD. What is Clinical Empathy? J Gen Intern Med. 2003 Aug; 18(8): 670–674. doi:  10.1046/j.1525-1497.2003.21017.x. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494899/

Langewitz, W., Denz, M., Keller, A., Kiss, A., Rüttimann, S., & Wössmer, B. (2002). Spontaneous talking time at start of consultation in outpatient clinic: cohort study. BMJ : British Medical Journal325(7366), 682–683.

Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–287.

Ratanawongsa N, Barton JL, Lyles CR, Wu M, Yelin EH, Martinez D, Schillinger D. Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics. JAMA Intern Med.2016;176(1):125–128. doi:10.1001/jamainternmed.2015.6186

Travaline JM, Ruchinskas R, D’Alonzo GEJr. Patient-physician communication: why and how. J Am Osteopathic Assoc. 2005; 105(1): 13-18.

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Elizabeth


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