Archive for the ‘patient satisfaction’ Category

Teach Back as an Effective Patient Education Tool

June 26, 2014

PatientTeachBack

by Edward Leigh, MA

A patient tells you they understand everything you said about their treatment plan.  You feel good about this patient visit and are ready to close the meeting.  The patient stated they understood, but did they really?

Problem with “Do you understand?” question

There are serious issues associated with the question, “Do you understand?”  Just because the patient says, “Yes,” does not mean they truly understand.  How can you be sure they understand? Use the powerful “teach back” method.

Teach back is a powerful communication tool to assess a patient’s understanding. After the professional shares new medical information with the patient, the patient is asked to “teach back” what they just heard, verbally or in the form of a demonstration. This allows the professional to correct misunderstandings and provide additional information, if necessary. (In some cases, the patient’s caregiver may be the person “teaching back” the information.)

Factors to consider

If the teach back strategy is not properly set up it could actually backfire leading to a worse patient experience.

Patients may feel you are questioning their intellectual abilities. I have interviewed thousands of patients regarding their experiences with healthcare professionals.  For example, I asked one patient if she was familiar with teach back. She stated she was not familiar with the strategy. She also asked, “Is that for people with learning disabilities?” Upon further discussion, she said if a healthcare professional asked her to repeat back what she heard, she would feel that they think of her as dumb. This example illustrates that the set up to the discussion is critical.  It is vital that patients know the strategy is useful for everyone.

This strategy is not a like a pop quiz you had in school. Don’t simply tell a patient, “Repeat back what I just said!”  This comment will put them on the spot and cause anxiety.  They will feel like a school kid who was just told to clear their desk for an unannounced pop quiz.

To avoid these potential issues, ask the patient certain types of questions. View sample questions in the next section.

Sample of open-ended questions to assess understanding

There are many ways to assess patient understanding via teach back. The questions below provide a friendly and comfortable manner to assess understanding.

Focus on “I” Language. It is important to remember teach back is a way to test our abilities at explaining. In other words, we are actually testing ourselves, not the patients. Using “I” language takes the stress off the patient.

  • “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
  • “Please show me how you will use the device, so I can be sure I have given you clear instructions.”

Focus on how they would tell other people in their lives.

  • “How would you describe your health condition to a friend?”
  • “When you get home and your spouse asks about your treatment plan – what will say?”

Possible reasons for patients not being able to teach back

If the patient is not able to repeat back their medical situation this may be an indication the professional needs to rework their teaching approaches. There could be several factors reducing the ability of a patient to teach back.

Excessive use of medical jargon. If patients do not understand what professionals are saying, they will not be able to repeat back what was said to them. Use everyday language.  For example, do not say, “NPO after midnight.” Rather, state, “Do not eat or drink anything after midnight.”

Too much information presented too quickly.  The “chunk & check” strategy is a tool to avoid this scenario. Provide a “chunk” of information and then “check” with the patient for understanding.

Patient anxiety.  Regardless of how skilled the professional is at explaining to the patient their medical situation, if the patient is very tense, the material will not be absorbed.  In this case, use empathy. Mention that you understand their feelings of anxiety.  You may want to engage in brief deep breathing exercises with the patient to help them feel calmer so they are better able to take in the information.  The exhale should be longer to achieve maximum relaxation. For example, inhale on a count of four and exhale on a count of six. A few deep breathes goes a long way!

If the patient was not able to repeat back, do not repeat – re-phrase.

Benefits of teach back

Improves outcomes. According to the Joint Commission, research indicates that the teach back technique is effective, not just for improving patients’ understanding, but also for improving outcomes. For example, patients with diabetes whose physicians assess their comprehension and recall with the teach back technique have significantly better diabetes control than patients whose physicians do not use the technique. (Schillinger D, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83-90.)

Can ultimately save time. Professionals often feel they have no time for the teach back method.  It actually does not take very long to assess a patient’s understanding.  Think of how much time it will take if the patient has to call back or visit again.

Enhances patient safety. If a patient does not understand their medical issue, they are at risk. A patient’s medical situation is not nice-to-know information, it is need-to-know information!

Unity Point Health, Des Moines University and other organizations collaborated to develop an excellent Teach Back Toolkit.  Click on the link for more information on this very helpful toolkit.

http://www.teachbacktraining.org/

After giving it – be sure they get it!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction, improving compliance and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in late 2014.  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Opening a Patient Interview: Part II, Your Powerful First Few Questions

March 6, 2013

by Edward Leigh, MA

PatientInterviewExcellentSitting

After you have greeted the patient / guest(s) and introduced yourself, now it is time for your opening questions / statements.

Start with a general question. The literature suggests that even if you know the exact reason for the patient’s visit (e.g., “upset stomach”), it best to still keep the opening question general, such as, “Tell me what brought you here.”  The initially stated chief compliant may not be the underlying reason for the visit.  This is especially true if the underlying reason for the visit is of a sensitive nature (e.g., substance abuse or sexuality issue).

BEFORE asking any details of the first issue, ask the patient, “What else?”  There may be no other issues, however asking this question in the beginning will reveal all the issues to avoid the dreaded late-occurring “Oh by the way” issues.  Excellent article on the subject:

“Two words to improve physician-patient communication: what else?” Link below http://www.meddean.luc.edu/lumen/meded/ipm/IPM1/TwoWordsBarrierArticle.pdf

Example

Clinician: “Tell me what brings you here?”

Patient: “I have been having stomach pains.”

Clinician: “What else?”

Patient: “Well, sometimes, my toes feel numb.”

(If the patient has no other issues, then ask about the stomach pains.)

Too many issues and not enough time. If the patient has multiple issues and there is not sufficient time to discuss everything, this situation has to be handled delicately to retain an excellent patient experience. Do not say, “I don’t have time to discuss all those items.”  Instead, use an “I wish” statement, such as by stating, “I wish we had time to discuss everything that is going on.  How about if we discuss two issues and schedule an appointment to discuss the other items? How does that sound?”

Mute Yourself.  Once you begin the information-gathering phase, DO NOT interrupt. MUTE YOURSELF! Give the patient 1-2 minutes to fully tell you their story and then ask for details. In the classic study by Beckman and Frankel, they found that physicians prevented patients from completing an opening statement 77% of the time and interrupted their patients in a mean time of 18 seconds. (Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984;101:692–6.)

Start your patient interview with impact through the use of powerful questions!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication. The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book, Engaging Your Patients, is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256

Opening a Patient Interview: Part I, What to Say BEFORE Your First Medical Question

March 5, 2013

by Edward Leigh, MA

NurseDoor

The first few moments of the patient interview sets the tone for the patient experience — what happens in the first 10-20 seconds makes or breaks the experience.

Sequence of events for seeing a NEW patient: (in chronological order)

(Before you walk in the room, take a deep breath to recharge yourself! One more item, if you just had an onion-filled sandwich, please pop a mint in your mouth!)

Say patient’s name (e.g., “Hello, Mrs. Smith”). If you are unsure of pronunciation — ask FIRST before attempting to state name.  You may also want to check with colleagues about pronunciation before entering the patient’s room.

State your name & role (e.g., “Hello, I am Mary Smith. I will be your nurse.”).  Recent research has shown that patients prefer hearing both the first AND last names of the professional.

Meet the guests.  If possible, ask patient to introduce you so you can learn relationships (e.g., “This is my daughter, Carol.”). Repeat name after meeting (e.g., “Hello Carol, a pleasure to meet you.”). Remind them to feel free to add information and ask questions. It is vital to establish a great relationship with the patent’s guests.

Provide your photo / business card, if applicable. It is important to provide the card at the beginning, otherwise part way through the interview, the patient may state, “So who are you?”  I have seen this happen many times.

Signpost.  This word means to tell people what’s coming next in the interview (i.e., providing direction). Explain to them what will be happening relieves their anxiety. For example, you can say, “Today, we’ll first talk about what brought you in, then I will examine you and discuss treatment options.”

What about the handshake?  There are many opinions on this subject, often divergent. Should you shake the patient’s outstretched hand? Should you initiate the handshaking gesture? Gregory Makoul and his colleagues at Northwestern University’s School of Medicine in Chicago wrote an article in the Archives of Internal Medicine on this subject. Of the patients surveyed, 78.1 per cent wanted physicians to shake their hands. This study seemed to indicate the handshaking is desired among physicians, however it is unclear if this behavior is desired among other healthcare professionals.  I look at this topic on a case by case basis. For example, a handshake would be more of an expected gesture for a middle-aged man as opposed to a teenaged girl. Overall, from a patient experience perspective, I would suggest shaking hands. A physician recently asked me, “I always gel up before seeing each patient. If I see a patient who I suspect has the flu, if they initiate a handshake, what should I do?”  I suggested they shake the patient’s hand and then quickly gel up again. Not shaking an outstretched patient’s hand will severely damage the relationship.

Look for Part II soon … “Your Powerful First Few Questions.”

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  The Center focuses on increasing patient satisfaction and decreasing the risk of medical errors. The Center offers high-impact training, consulting and one-on-one coaching. Edward Leigh’s new book is Engaging Your Patients is due out in the Spring of 2013. http://www.CommunicatingWithPatients.com or 1-800-677-3256