Pointing out to physicians that they are not good at communicating with patients then offering (pushing, requiring) lots of content to help them overcome this gap results in overload for already weary practitioners. If logic, evidence, and an abundance of tactics were enough, effectively connecting with patients would not be a problem.
To these typically high-achieving, smart people, more evidence simply adds excess content without context or support for change.
We aim to challenge commonly held myths about improving physician communication:
· The belief that the right set of tools or tactics is the answer
· The belief that pay for performance or the right incentive plan will cure physicians disconnect from patients
Solutions for helping physicians develop better relationships with patients frequently have two major problems that destine the solutions to failure.
1. Missing meaning and skills. Physicians are often offered too much content with no sense of meaning, context, and inadequate skill development. Smart, busy people need clarity about why they need to improve communication, an understanding of how it all fits together with clinical care, and skill development that connects to the reality of daily practice. Often missing are the essential actions that makes it easier to start and easier to work smarter.
2. No supporting infrastructure. Even if a small set of actions are identified, adding new behaviors in an environment that lacks built-in support results in ‘random acts of goodness’ not behaviors that stick.
Let’s begin to review solutions to the problem of missing meaning and skills. The solutions are based on our work with physicians in a range of settings.
Working Smarter - motivation and skills
Our experience is that most physicians are committed to developing effective partnerships with patients. We also note that these skills are woefully neglected, squelched in practice settings, and need to be intentionally developed and nurtured.
Physicians are aware of some of the rationale for better connections with patients – improved healthcare outcomes, safer care, patients who are more equipped to manage their chronic conditions. Compounding those reasons is additional external pressures – Value Based Purchasing, employment or management contracts that include improved patient experience outcomes, reduced readmissions, and chronic disease management – all dependent on effective partnerships with patients and families.
Pushing more studies and exhorting them about the importance of partnerships is not the path forward. Weary, over-burdened practitioners need help to remember what brings them joy in their practice and a workable path forward. The clear path forward is based on their internal motivation to work smarter to develop partnerships and targeted skill development – involving both hearts and minds.
Working smarter often directly connects to being clear about ‘why’, or the purpose of making changes. The source of motivation may come from:
· A sense of wanting to do their best, of regaining that higher purpose of why they went into medicine. But physicians may not know what ‘doing your best’ looks like in developing partnerships with patients since it is over-looked in their skill development or diminished in the practice.
· A sense of burnout – that the current state is untenable. Some physicians are feeling forced into choices they don’t’ want to make – stay with the current condition and attempt to survive; develop a defensive posture that can lead to disruptive behaviors; or leave practice. One mid 40s physician described herself as burned out. She agreed to be part of a test of activities to engage patients as an attempt to both improve patient communication and regain some sense of joy in practice. Another physician was verging toward disrespectful behavior with patients and disengaged with colleagues – clear signs of burnout. When this behavior pattern was called to his attention, it was a breaking point – “I have to do something different”. This point of doing something different is another source of internal motivation. The ‘why’ can be whatever is pertinent to that individual – untenable current state, unconstructive behavior, and/or a desire to do better.
Working smarter means making it easy to do the things physicians and patients want. In one case study, we worked with physician champions to try four evidence-based behaviors in their interactions with patients. The impact was profound – the physicians found improved patient experience, improved work life, and renewed energy for their practice.
By combining motivation and skills with supportive infrastructure, rapid progress can happen. Starting with a clear path forward using a small set of behaviors helps physicians to develop skills quickly, see positive results in days, and the successes becomes self-reinforcing.
In future blogs we will describe what a supportive infrastructure looks like.