Physician communication coaching effects on patient experience

Improving Patient Experience With Provider Communication: Systematic Review of Interventions, Implementation Strategies, and Their Effectiveness

BACKGROUND

Provider communication with patients may be improved through training, shadow coaching, and other in-service interventions. We aim to synthesize these interventions, implementation strategies, and their impact on the patient experience.

METHODS

A systematic review of contemporary evidence (2015-2023). Six scientific databases, specialty journals, and snowballing searches identified training, shadow coaching, and other in-service interventions for improving provider communication with patients, evaluated by standardized patient experience measures. Studies without inferential statistics were excluded. Two independent reviewers assessed the studies' eligibility and methodological quality and mapped the implementation strategies against a widely used taxonomy of 73 strategies.

RESULTS

Of 1237 papers screened, 14 were included: 10 controlled studies (5 randomized) and 4 prepost. Nine studies were on communication skills training and 3 on shadow coaching; all but one of these used a train-the-trainer implementation strategy. Eight studies (controlled n=4) used 5.5-8 hours of communication training and showed significant improvements in selected experience outcomes. Brief (45 min) communication training showed no significant results. Two controlled studies showed that shadow coaching and recoaching achieve short-term improvements but eroded without booster sessions. The use of transparent surgeon masks improved selected communication outcomes, but periodic reminders sent to clinicians on communication etiquette did not.

DISCUSSION

In-service communication training (≥5.5 h) or shadow (re-)coaching by trained peers can improve patients' experience with provider-patient communication. To implement such interventions, organizations need to identify and train trainers/coaches, intentionally support the program, monitor effectiveness, and add boosters as needed. Brief communication etiquette training or simple reminders did not improve the patients' experiences with provider-patient communication.

Effectiveness of nursing interventions on patient experiences with health care: A systematic review and meta-analysis

AIM

To synthesize and evaluate the effects of nurse-led or nursing-focused interventions for improving patient experience with health care in hospitals.

BACKGROUND

Patient experiences have increasingly been highlighted as a key healthcare quality indicator in many countries with highly developed healthcare systems. It is critical to learn about the effectiveness of previously conducted nursing interventions since nursing care is reported to be the primary driver of patient experience.

METHODS

This systematic review and meta-analysis was conducted in accordance with the JBI Manual for Evidence Synthesis and followed the PRISMA statement guidelines. The PubMed, Web of Science, Embase, Cochrane Library, and CINAHL databases were systematically searched in May 2023. Randomized controlled trials and quasi-experimental studies that were led by nurses or focused on nursing care strategies were included. The JBI critical appraisal checklists were employed to assess methodological quality.

RESULTS

A total of 15 761 records were identified; 11 studies met the inclusion criteria. Nursing interventions focused on optimizing the approach to nursing rounds, enhancing communication with patients, improving patient education, and increasing interaction with patients. The meta-analysis showed that nursing interventions increased top-box responses in the communication about medicines and discharge information dimensions, as well as the overall experience dimension, including the overall hospital rating and willingness to recommend the hospital.

CONCLUSIONS

Although few studies were included, this meta-analysis showed that nursing interventions improved patients' experiences in communication about medicines and discharge information, as well as their overall experience. More rigorous studies are needed to better understand the effect of nursing interventions and examine which components may be most effective for improved outcomes.

IMPLICATIONS FOR NURSING PRACTICE AND NURSING POLICY

Owing to the powerful influence of nursing, strategies to engage nurses are a means of improving patient experiences. More attention should be given to patients' experiences of communication with doctors and nurses, and more randomized controlled trials are needed to provide high-quality evidence.

Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence

Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.

From Monologue to Dialogue: The Pursuit of Relationship Centered Communication Across a Large, Integrated Healthcare System

By listening to the "voice" of patients, Northwell Health, New York's largest healthcare organization, took an evidence-based approach to empowering physicians and advanced care providers. The Relationship Centered Communication course utilizes experiential learning to strengthen patient-centered communication and empathy skills to elicit provider-patient relationships grounded in partnership. This case study highlights (1) The pragmatic cultural journey requiring visionary leadership, strong collaborations, and an evolving educational strategy. (2) Over the course of 6 years, 3300+ providers were educated in this evidence-based communication course. (3) As a result, Northwell's Hospital Consumer Assessment of Healthcare Providers and Systems "Communication with Doctors" domain has increased by 22 percentile rank points, when compared nationally to peers, in addition to other notable patient experience metric improvements within ambulatory medical practice.

Automated Strategy Feedback Can Improve the Readability of Physicians' Electronic Communications to Simulated Patients

Modern communication between health care professionals and patients increasingly relies upon secure messages (SMs) exchanged through an electronic patient portal. Despite the convenience of secure messaging, challenges include gaps between physician and patient expertise along with the asynchronous nature of such communication. Importantly, less readable SMs from physicians (e.g., too complicated) may result in patient confusion, non-adherence, and ultimately poorer health outcomes. The current simulation trial synthesizes work on patient-physician electronic communication, message readability assessments, and feedback to explore the potential for automated strategy feedback to improve the readability of physicians' SMs to patients. Within a simulated secure messaging portal featuring multiple simulated patient scenarios, computational algorithms assessed the complexity of SMs written by 67 participating physicians to patients. The messaging portal provided strategy feedback for how physician responses might be improved (e.g., adding details and information to reduce complexity). Analyses of changes in SM complexity revealed that automated strategy feedback indeed helped physicians compose and refine more readable messages. Although the effects for any individual SM were slight, the cumulative effects within and across patient scenarios showed trends of decreasing complexity. Physicians appeared to learn how to craft more readable SMs via interactions with the feedback system. Implications for secure messaging systems and physician training are discussed, along with considerations for further investigation of broader physician populations and effects on patient experience.

Health literacy education programmes developed for qualified health professionals: a scoping review

OBJECTIVES

Both literature and policy have identified the need for health literacy education for qualified health professionals. This study aimed to identify and map health literacy competencies and health literacy related communication skills educational interventions for qualified health professionals. The research questions included: Of the qualified health professional education interventions identified, which are focused on diabetes care? What health literacy competencies and health literacy related communication skills are integrated into each programme? What are the characteristics of each education programme? What were the barriers and facilitators to implementation? What methods are used to evaluate intervention effectiveness, if any?

DESIGN

Scoping review, informed by the Joanna Briggs Institute guidelines.

DATA SOURCES

The following databases: OVID; CINAHL; Cochrane; EMBASE; ERIC: PsycInfo; RIAN; Pro-Quest; UpToDate were searched.

ELIGIBILITY CRITERIA

Articles were included if the education programme focused on qualified health professionals, in all clinical settings, treating adult patient populations, of all study types.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened titles, abstracts and full text articles that met the inclusion criteria. The third author mediated any discrepancies. The data were extracted and charted in table format.

RESULTS

In total, 53 articles were identified. One article referred to diabetes care. Twenty-six addressed health literacy education, and 27 addressed health literacy related communication. Thirty-five reported using didactic and experiential methods. The majority of studies did not report barriers (N=45) or facilitators (N=52) to implementation of knowledge and skills into practice. Forty-nine studies evaluated the reported education programmes using outcome measures.

CONCLUSIONS

This review mapped existing education programmes regarding health literacy and health literacy related communication skills, where programme characteristics were identified to inform future intervention development. An evident gap was identified regarding qualified health professional education in health literacy, specifically in diabetes care.

The Impact of Dynamic Real-Time Feedback on Patient Satisfaction Scores

INTRODUCTION

Providers' communication skills have a significant impact on patients' satisfaction. Improved patients' satisfaction has been positively correlated with various healthcare and financial outcomes. Patients' satisfaction in the inpatient setting is measured using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In this study, we evaluated the impact of dynamic real-time feedback to the providers on the HCAHPS scores.

METHODS

This was a randomized study conducted at our 550-bed level-1 tertiary care center. Twenty-six out of 27 hospitalists staffing our 12 medicine teams (including teams containing advanced practice providers (APPs) and house-staff teams) were randomized into intervention and control groups. Our research assistant interviewed 1110 patients over a period of 7 months and asked them the three provider communication-specific questions from the HCAHPS survey. Our intervention was a daily computer-generated email which alerted providers to their performance on HCAHPS questions (proportions of "always" responses) along with the performance of their peers and Medicare benchmarks.

RESULTS

The intervention and control groups were similar with regard to baseline HCAHPS scores and clinical experience. The proportion of "always" responses to the three questions related to provider communication was statistically significantly higher in the intervention group compared to the control group (86% vs 80.5%, p-value 0.00001). It was also noted that the HCAHPS scores were overall lower on the house-staff teams and higher on the teams with APPs.

CONCLUSION

Real-time patients' feedback to inpatient providers with peer comparison via email has a positive impact on the provider-specific HCAHPS scores.

HCAHPS: having constant communication augments hospital and patient satisfaction

BACKGROUND AND AIM

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) has become a standardised instrument to measure hospitalised patients' perception of care. Our hospital's HCAHPS scores for the 'communication with doctors' domain in medical service were suboptimal when compared with peer groups in December 2020. Our goal was to improve performance in the 'communication with doctors' domain to at least 50% from baseline over a 6-month period.

INTERVENTION

Orientation of house staff, nurses and attendings on the Acknowledge, Introduce, Duration, Explain, Thank you (AIDET) approach. Implementation of the afternoon rounds (with documentation) along with the morning rounds to summarise the plan and discuss updates throughout the day to enhance doctor-patient communication.

DATA ANALYSIS

HCAHPS domain scores for 'communication with doctors' with each subcategory were tracked monthly as well as the number of PM notes written as a measure of afternoon rounds.

RESULTS

'Communication with doctor' domain improved from 8% percentile rank in December to as high as 78%. 'Doctors treat you with courtesy/respect' improved from 24% percentile rank in December to as high as 90%. 'Doctors listen carefully to you' improved from 13% percentile rank in December to as high as 88%. 'Doctors explain in a way you understand' improved from 2% percentile rank in December to as high as 72%.

CONCLUSIONS

Our results suggest that HCAHPS scores in the 'communication with doctors' domain can be improved when employing the AIDET approach with each patient encounter and the addition of afternoon rounds. Sustainability is vital to the success of these interventions, as we observed in our results that there is a direct proportional correlation with the number of afternoon rounds performed with higher scores.

The Impact of a New Internal Medicine Residency Program on Patient Satisfaction Scores for Teaching Hospitalist Faculty Compared to Non-teaching Hospitalist

Introduction: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national survey sent to patients to measure their inpatient experience. Graduate medical education programs may affect a sponsoring institution in various ways, but there has been little research into the effect of teaching hospitalist faculty on HCAHPS scores in a community-based hospital. The aim of the current study is to evaluate if the introduction of internal medicine resident physicians would affect the HCAHPS scores of patients admitted by hospitalist faculty physicians.

Methods: This was a retrospective analysis of anonymous patient satisfaction survey data for internal medicine hospitalist teams from January 2019 to December 2019. Data were retrieved from the Press Ganey database. We compared two groups: teaching hospitalists (N = 12) and non-teaching hospitalists (N = 34). Data were divided into two time periods: January to June (pre-residents) and July to December (post-residents).

Results: From January to June (pre-residents), 646 HCAHPS surveys were returned. For the post-resident cohort (July to December), a total of 487 surveys were returned. The “Recommend” domain, showed a significant improvement in the mean pre-resident to post-resident (57% to 69%; p = 0.0351).

Conclusion: There was a significant increase in the mean rating of the “Recommend” hospital domain for the teaching hospitalists when compared to the non-teaching after the addition of a new internal medicine residency program.

From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings

RATIONALE, AIMS AND OBJECTIVES

It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices.

METHOD

We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020.

RESULTS

Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change.

CONCLUSIONS

Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.

Using crowdsourced analog patients to provide feedback on physician communication skills

OBJECTIVE

Effective physician-patient communication is important, but physicians who are seeking to improve have few opportunities for practice or receive actionable feedback. The Video-based Communication Assessment (VCA) provides both. Using the VCA, physicians respond to communication dilemmas depicted in brief video vignettes; crowdsourced analog patients rate responses and offer comments. We characterized analog patients' comments and generated actionable recommendations for improving communication.

METHODS

Physicians and residents completed the VCA; analog patients rated responses and answered:"What would you want the provider to say in this situation?" We used qualitative analysis to identify themes.

RESULTS

Forty-three participants completed the VCA; 556 analog patients provided 1035 comments. We identified overarching themes (e.g., caring, empathy, respect) and generated actionable recommendations, incorporating analog patient quotes.

CONCLUSION

While analog patients' comments could be provided directly to users, conducting a thematic analysis and developing recommendations for physician-patient communication reduced the burden on users, and allowed for focused feedback. Research is needed into physicians' reactions to the recommendations and the impact on communication.

PRACTICE IMPLICATIONS

Physicians seeking to improve communication skills may benefit from practice and feedback. The VCA was designed to provide both, incorporating the patient voice on how best to communicate in clinical situations.

Does Coaching Hospitalists in a Community Hospital Improve the Measured Experience of Care?

Hospitals initiate physician communication training programs expecting to improve patient experience measures. However, most efforts have relied on methods with limited attention to bedside physician–patient interactions. We conducted an intensive in-person hospitalist coaching program to improve patient experience in a community hospital. Full-time hospitalists were coached twice monthly by physician-coaches using a structured process featuring direct observation of care and immediate recommendations. Coach-observed care measures improved marginally. Difference-in-differences analysis of 1137 Hospital Consumer Assessment of Healthcare Providers and Systems surveys revealed no significant improvements by trained hospitalists in preintervention versus intervention comparisons, calling into question the strategy of using coaching programs to improve hospitals’ doctor communication measures.

Internal Medicine Resident Professionalism Assessments: Exploring the Association With Patients' Overall Satisfaction With Their Hospital Stay

PURPOSE

Successful training of internal medicine (IM) residents requires accurate assessments. Patients could assess IM residents in a hospital setting, but medical educators must understand how contextual factors may affect assessments. The objective was to investigate relationships between patient, resident, and hospital-encounter characteristics and the results of patient assessments of IM resident professionalism.

METHOD

The authors performed a prospective cohort study of postgraduate year 1 (PGY-1) IM residents and their patients at 4 general medicine inpatient teaching services at Mayo Clinic Hospital-Rochester, Saint Marys Campus in Rochester, Minnesota, from July 1, 2015, through June 30, 2016. Patient assessments of resident professionalism were adapted from validated instruments. Multivariable modeling with generalized estimating equations was used to determine associations between patient assessment scores and characteristics of residents, residents' clinical performance and evaluations (including professionalism assessments in other settings), patients, and hospital encounters and to account for repeated assessments of residents.

RESULTS

A total of 409 patients assessed 72 PGY-1 residents (mean [SD], 5.7 [3.0] patient assessments per resident). In the multivariable model, only the highest rating out of 5 levels for overall satisfaction with hospital stay was significantly associated with patient assessment scores of resident professionalism (β [SE], 0.80 [0.08]; P < .001). Hospitalized patients' assessment scores of resident professionalism were not significantly correlated with assessment scores of resident professionalism in other clinical settings.

CONCLUSIONS

Hospitalized patients' assessment scores of in-hospital resident professionalism were strongly correlated with overall patient satisfaction with hospital stay but were not correlated with resident professionalism in other settings. The limitations of patient evaluations should be considered before incorporating these evaluations into programs of assessment.

Impact of length of stay on HCAHPS scores following lumbar spine surgery

OBJECTIVE

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures.

METHODS

The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables.

RESULTS

Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control.

CONCLUSIONS

Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.

A Model for Sustaining Health at the Primary Care Level

As the healthcare industry in USA is changing from a fee-for-service to a value-based system, the need for a shift in how patients are treated is evident. Healthcare organizations are reimbursed based on value and quality of service. The system shift recognizes that each patient possesses differing medical needs moving care from generalized medical treatments to individualistic care. To deal with this change and attempt to increase quality and value, many healthcare organizations are adopting a team care approach through the development of Patient-Centered Medical Homes (PCMH). In many examples of the team approach, the Primary Care Practitioner (PCP) is viewed as the main coordinator of care. Having this responsibility can create added stress for practitioners, which can lead to a decrease in the quality of care. The proposed model, in this article, outlines an example of how individualistic care can be achieved and assembled in the PCMH with the PCP as the main coordinator of care to sustain patient health.

Enhancing Scientific Communication Through an Undergraduate Biology and Journalism Partnership

Scientific terminology presents an obstacle to effective communication with nonscientific audiences. To overcome this obstacle, biology majors in a general microbiology elective completed a project involving two different audiences: a scientific audience of their peers and a general, nonscientific audience. First, students presented an overview of a primary research paper and the significance of its findings to a general, nonscientific audience in an elevator-type talk. This was followed by a peer interview with a student in a journalism course, in which the biology students needed to comprehend the article to effectively communicate it to the journalism students, and the journalism students needed to ask questions about an unfamiliar, technical topic. Next, the biology students wrote a summary of their article for a scientific audience. Finally, the students presented a figure from the article to their peers in a scientific, Bio-Minute format. The biology-journalism partnership allowed biology students to develop their ability to communicate scientific information and journalism students their ability to ask appropriate questions and establish a base of knowledge from which to write.

Caregivers' misperception of the severity of hip fractures

PURPOSE

The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient's health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.

PATIENTS AND METHODS

We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient's caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.

RESULTS

Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland-Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.

CONCLUSION

This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient's social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual's care and assistance need to be assembled.