Posts Tagged ‘signposting’

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

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My Mother’s Recent Emergency Department Experience: Lessons for Learning

March 7, 2011

My mother, Julia, is part of a clinical trial, which involves monthly infusions.  The clinical trial protocol requires periodic blood work, scans, x-rays, etc.  Last week, the physician leading the clinical trial called me at my office and said that my mother has atrial fibrillation and they will not proceed with the monthly infusion. They also noticed that one of my mother’s legs was red and swollen; they were concerned about a possible blood clot. They suggested calling an ambulance and having my mother taken to the closest Emergency Department (ED). I agreed to this action. They then called the ED to inform them of the atrial fibrillation and possible clot.

I called the ED to mention that my mother is on her way and also told them that before leaving my office I will fax over my mother’s medical history information. I have a two-page summary of my mother’s pertinent medical information (e.g., medications, hospitalizations, allergies, etc.).  I told the ED that my brother and I would be there shortly.

Overall, everyone at the hospital was very friendly. However, there were several parts of the experience that could have been improved. This article is a summary of the issues with suggested changes.

Problems with hand off. When my brother and I arrived at the ED, we went to my mother’s room and the nurse told us that their tests did not find atrial fibrillation and that my mother was going to be discharged now.  I asked about the issue with mom’s leg.  They said, “What issue?” In spite of the fact that the clinical trial physician clearly stated the leg needs to be evaluated for a possible DVT, that information never made it to the ED records.  After discussing the leg issue, my mother was scheduled for an ultrasound.  (As an FYI, the ultrasound revealed no clots.) To avoid these botched communication episodes that could seriously harm patients, professionals should engage in “repeat back.” After the information is shared the receiver must “repeat back” the information to verify accuracy.

No partnership statements.  The relationship between the patient and professional is not about giving orders; it is about forming a partnership. Upon admission to the ED, all patients should be asked, “What would make this an excellent experience for you?” What does great care mean to you?” We need to immediately understand the patients’ needs. If we are to be truly patient centered, we need to understand the needs of the patient.  In order to work as a team, we need to understand the patients’ needs.  Working as partners leads to quality improvement and better clinical outcomes.  Of course, this partnership approach leads to higher patient satisfaction.

Use of medical jargon. The people at the ED did not know I was a healthcare professional. They often used medical jargon that I understood, but what if I was not in the field?  When they scheduled the ultrasound, we were told Mom was being evaluated for a DVT. The abbreviation, DVT, was never explained. This is a serious problem in healthcare — the constant use of medical jargon that patients often do not understand.  This is known as a problem with “health literacy.” (The term literacy could mean problems with reading, however it often refers to the ability to understand the language of medicine.)

No signposting. This is a communication strategy in which people are given an overview of what will take place during their stay.  Streets have posts with signs on them (street names) hence the term “signposting.”  These posts with signs give people direction; that is exactly what we want to do with patients, give them direction.  In other words, tell then what will be coming up in regard to their care. This could as simple as saying, “First we will assign you to a room, run some tests and have you seen by one of our highly-qualified doctors. Based on the results of the tests, we will let you know how long you will be here.”  Patients should also be told that we are here to help you and make your stay as pleasant as possible.  There was one significant fact not revealed to our family that could lead to serious damage with patient satisfaction scores.  After being in the ED for approximately 1 1/2 hours, I asked our nurse, “When do you think my mother will have the ultrasound?” She then smiled as though she was about to laugh!  She said the average time for an ultrasound is 4 1/2 hours, but it could be up to 8 hours! This fact should have immediately been told to us.  (As an FYI, we had the ultrasound done in about 3 hours.)

Lack of hourly rounding.  After my mother was in the ED an hour, I expected someone from the medical center to check in on Mom.  No one came to see how Mom was doing.  Hourly rounding is a critical tool for many reasons.  This process helps prevent potential falls by asking patients if they need anything, such as a trip to the bathroom.  Many patients are seriously injured each year because they have to use the restroom and no one is coming to check on them. They try to get up on their own and sometimes fall.  The rounding also has a psychological benefit in that you are reassuring patients that you are thinking of them and working on their care.

No empathy. Going to an ED is a very stressful experience. During my mother’s time in the ED not one person directly stated an empathic response.  I would have liked to hear at least one person say, “I know it is scary being here. However we are here to help you.”  This comment should often be followed by a partnership statement, such as, “We will work together with you to find out what is going on as soon as we could. We will periodically check on you, but if you ever need anything, please feel free to let us know. We are here for you.”

Directions — don’t just tell, show!  When I arrived at the ED, I asked the person at the front desk what room my Mom was in and they told me. I asked for directions. The directions were very complicated due to ongoing construction. The person at the desk said something to this effect, “Go down this hall, turn right at the first hallway, then make an immediately left, go down the corridor until you get to a desk, then make a slight right, etc. What? Huh?  I then asked, “Could you have someone take me there?”  They agreed. When people ask directions, don’t simply give directions; take them to their requested destination.  This is an excellent customer service tip all hospital staff should incorporate into their work with patients and their family members.

Teach back technique not utilized.  After the ultrasound was completed, we were given discharge instructions.  Being in healthcare, I understood all the directions, however what if I was not in the field? Saying to a patient, “Do you understand?” is not sufficient.  In order to determine if they indeed understand, you must use the communication technique called, “teach back.” Ask the patient to summarize the information you provided. This could be as simple as asking, “Tell me what you will do when you get home.”

In summary, all of the hospital staff members were quite pleasant.  However, there were some very significant problems that could have negatively impacted my mother’s health. Based on a poor hand off, the ED was unaware of the leg issue.  Fortunately, my mother did not have a DVT. But what if she did?  This medical center needs to have staff development training covering communications skills, rounding techniques, educational strategies and customer service. These techniques are more than “bedside manner” tips; rather they are skills to avoid potentially serious medical errors.

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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. We offer high-impact training, consulting and one-on-one coaching. Contact us today!  http://www.CommunicatingWithPatients.com or 1-800-677-3256

Edward Leigh’s new book, Engaging Your Patients, is due out in June 2011!

Signposting: An Effective Communication Tool!

April 3, 2009

signpost1

Definition of Signposting

The dictionary defines signposting as, “An indication, sign, or guide.” When we communicate with people we need to include these cues for effective dialogue.

Let’s say you are driving down the road in a strange city looking for a building and the streets have no signs. Assuming you didn’t have a GPS, you would feel completely lost. Signs are posted on streets to provide guidance. We need to have these signposts in our conversations to avoid people from feeling lost

Signposting is a technique to help people follow the meaning of what you are saying throughout a conversation. You also help people organize what you are saying to them. I am sure we all have had conversations where people seem to be going in all sorts of directions and we can’t follow them. They are NOT using signposting — they are not guiding us from topic to topic.

Signposting to Open Conversations

Rather than just abruptly starting conversations, signposting helps you make a smooth entrance. Here are some examples of using signposting to begin conversations:

* Today, let’s start by discussing the new project …

* First of all, we need to address the meeting with HR …

Signposting can also be used in the beginning to set the stage for the rest of the conversation:

* Today, we need to address three areas. First, we need to talk about the IT seminar. Next, we’ll address the issues with new office polices. Finally, we’ll review the agenda for the annual retreat.

* I will first talk about your stomach pain, then I will examine you. Afterwards, we’ll discuss treatment options.

Signposting as a Transition Tool in Conversations

Signposting can be used to make smooth transitions from one topic to another.

* It looks like we are now ready to begin discussing the updated employee benefit package …

* I have given you all the data regarding the XYZ project, now I am ready to move on to discuss our quarterly goals …

* Next, let’s review the proposal to add the continuing education programs to ….

Signposting to Close Conversations

This allows for cues that you are completing your comments. If you begin discussing closing remarks without letting people know you are finishing, they may be expecting more information. Here are examples:

* In conclusion, I believe we are now ready to implement ….

* At this time, I would like to summarize our discussion …

I will use signposting to conclude this article! In summary, we have seen that signposting is a powerful tool to help people follow what we are saying. Providing people cues allows for conversations that flow. Add signposting to all your conversations and become a master communicator!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  He is the author of the book, Communicating with Patients (due out in the summer of 2009). For more information about his high-impact communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256