Nardine Saad Riegels1, Emily Asher2, Joseph R Cartwright3, Jessica L Chow4, Elaine D Lee5, Matthew Nordstrom6, Allison N Schneider7, Madeline D Schwarz8, Margot Zarin-Pass9, Lindsay A Mazotti10. 1. Associate Clinical Professor at the University of California, San Francisco, the Clerkship Director for the Kaiser Permanente-University of California, San Francisco Longitudinal Integrated Clerkship Program, and a Hospitalist at the East Bay Medical Center in Oakland. nardine.s.riegels@kp.org. 2. Resident Physician in Psychiatry at Yale School of Medicine in New Haven, CT. emily.asher@yale.edu. 3. Resident Physician in Internal Medicine at the University of California, San Francisco. joe.cartwright@ucsf.edu. 4. Resident Physician in Emergency Medicine at the University of California, San Francisco. jessica.chow@ucsf.edu. 5. Resident Physician in Family Medicine at the University of California, San Francisco. elee@ucsf.edu. 6. Resident Physician in Pediatrics at the University of California, San Francisco. matthew.nordstrom@ucsf.edu. 7. Resident Physician in Obstetrics and Gynecology at the East Bay Medical Center in Oakland, CA. allison.schneider@kp.org. 8. Resident Physician in Pediatrics and Child Neurology at the University of California, San Francisco. madeline.schwarz@ucsf.edu. 9. Resident Physician in Internal Medicine and Pediatrics at the University of Minnesota Twin Cities in Minneapolis. mzarin@umn.edu. 10. Associate Clinical Professor of Medicine at the University of California, San Francisco, and the Assistant Physician in Chief of Education and Development and a Hospitalist at the East Bay Medical Center in Oakland. lindsay.a.mazotti@kp.org.
Abstract
INTRODUCTION: Physician communication is critical to patient care. However, integration of sound communication practice with clinical workflows has proven difficult. In this quality improvement initiative, medical students used the rapid improvement model to test interventions that could enhance patients' perception of listening by physicians as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. METHODS: Literature review and process analysis yielded 42 potential interventions, of which 24 were feasible for implementation. Small-scale testing established the 4 most promising interventions; pilot testing was subsequently undertaken on the entire Medicine service. Patient and physician feedback guided further refinement. The final intervention used a structured reminder embedded in the electronic health record to direct physicians to begin interviews by eliciting patient concerns. RESULTS: Patient concerns elicited after implementation included pain symptoms (28%), disease or treatment course (16%), and discharge planning (10%). In the Hospital Consumer Assessment of Healthcare Providers and Systems survey, physician listening scores rose from a 2014 average of 73.6% to 77% in 2015. DISCUSSION: Among 24 tested interventions, an open-ended question was most feasible and had the greatest perceived impact by hospitalists and patients. A structured reminder embedded in required electronic medical record documentation facilitated the behavioral change without being overly burdensome to physicians and established a mechanism to enact change in practice. CONCLUSION: Medical students used established improvement methods to promote patient-centered care and align patient and physician agendas, providing a strategy to improve hospitalized patients' perceptions of physician listening.
INTRODUCTION: Physician communication is critical to patient care. However, integration of sound communication practice with clinical workflows has proven difficult. In this quality improvement initiative, medical students used the rapid improvement model to test interventions that could enhance patients' perception of listening by physicians as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. METHODS: Literature review and process analysis yielded 42 potential interventions, of which 24 were feasible for implementation. Small-scale testing established the 4 most promising interventions; pilot testing was subsequently undertaken on the entire Medicine service. Patient and physician feedback guided further refinement. The final intervention used a structured reminder embedded in the electronic health record to direct physicians to begin interviews by eliciting patient concerns. RESULTS:Patient concerns elicited after implementation included pain symptoms (28%), disease or treatment course (16%), and discharge planning (10%). In the Hospital Consumer Assessment of Healthcare Providers and Systems survey, physician listening scores rose from a 2014 average of 73.6% to 77% in 2015. DISCUSSION: Among 24 tested interventions, an open-ended question was most feasible and had the greatest perceived impact by hospitalists and patients. A structured reminder embedded in required electronic medical record documentation facilitated the behavioral change without being overly burdensome to physicians and established a mechanism to enact change in practice. CONCLUSION: Medical students used established improvement methods to promote patient-centered care and align patient and physician agendas, providing a strategy to improve hospitalized patients' perceptions of physician listening.
Authors: Dennis Z Kuo; Laura L Sisterhen; Ted E Sigrest; James M Biazo; Mary E Aitken; Christopher E Smith Journal: Pediatrics Date: 2012-07-09 Impact factor: 7.124
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