Solutions for helping physicians develop better relationships with patients frequently have three major problems that set up the solutions for failure: 1) missing meaning – the ‘why’; 2) lack of skills; and 3) no supporting infrastructure.
When the meaning of partnerships or ‘why’ busy practitioners should pay attention to these skills is absent, tactics to improve seem like just one more thing to do – contributing to a sense of overload. We recommend Working Smarter. Working smarter directly connects to being clear about ‘why’, or the purpose of making changes. Working smarter means making it easy to do the things patients and physicians know is crucial to the best care. Even when physicians are clear on why and what they want to accomplish in their connections with patients, skills are often lacking or underdeveloped. Aiding skill development through an initial small set of behaviors makes working smarter easier to do.
However, working smarter is sustained only through supportive infrastructure.
What do we mean by infrastructure? Infrastructure includes being clear on what effective partnerships look like by describing the behaviors that matter to patients/families, understanding the patient journey to better meet patients and families where they are (not where we want them to be), transparent use of meaningful data at the individual and practice level, recruiting the right people, intolerance of and addressing disruptive behavior, ongoing coaching, and systems that work to support partnerships.
Working smarter is unsustainable without an infrastructure that helps physicians and team members do the right thing. Leaders are responsible for assuring supportive infrastructure for providers – physicians, nurses, and other team members. Key elements of the required infrastructure include:
- Clear behaviors for effective partnerships – extensive studies are clear on what is important in interactions. Patients want to be: listened to; treated with dignity and respect; able to ask questions and get clear answers – even if it’s “I don’t know but we will work on figuring it out together”; able to get clear information in ways they understand; and trusted for their knowledge of what is important to them. Translating these requests into specific behaviors such as asking open-ended questions then listening without interrupting, gives providers clear pictures of what success looks like in action.
- Understanding the patient journey – patients bring their expertise to all interactions. What they know about their health and healthcare, what values are important to them, or what worries them the most right now (which may not be anything to do with healthcare). Understanding what values, preferences and priorities they have right now supports partnerships that meet patients where they are. This provides a foundation for working together for improved healthcare outcomes.
- Transparent, meaningful data – when adopting new behaviors, individuals need fast data – real time feedback about how they are doing with new skills. Providers also want reliable data that demonstrates progress over time (e.g. CG-CAHPS). Avoiding data abuse, commonly seen in the interpretation of experience data, is a core element of meaningful data.
- Recruiting the right people – while coaching existing physicians to improve their skills, the most effective approach is to make sure those who value patient partnerships are the ones you recruit. Ways to assure this include: a) being explicit about partnership expectations and asking candidates to commit to those expectations; b) during interviews, pose scenarios that describe patient interactions and ask how they have addressed similar situations; then listen for partnership awareness and answers; c) asking for references that describe the candidates partnership behaviors.
- Intolerance of disruptive behavior – assuring disruptive behavior is identified early with effective interventions to aid physicians to restore their behavior to professional levels.
- Coaching – new skill development and ongoing advancement requires effective coaching. These coaching skills are not automatically part of leaders’ skill set and usually require specific development for improvement and to address problematic behavior.
- Systems that work to support partnerships – systems need to be designed to support the intended outcomes. Often, they do not. Systems that frustrate patients, keep them waiting, and treat them as secondary to the clinic’s routine can set up practitioners. The patients have formed their view of the whole practice by the time they finally see the practitioner. It’s all uphill from there. Other examples include - the hospitalist who is regularly interrupted or saddled with lack of teamwork will not be able to be their most effective in patient interactions; the clinic that aims to meet meaningful use level 3 through electronic portals but fails to demonstrate the value from the patients’ perspective. All will struggle to make gains.
In future blogs we will address the infrastructure elements in more detail.
We eagerly welcome your insights and experiences.