Communication the Cleveland Clinic Way
Page 25
15. A. B. Williams, “On Parallel Process in Social Work Supervision,” Clinical Social Work Journal 25, no. 4 (1997): 126–38.
16. F. W. Peabody, “A Medical Classic: The Care of the Patient by Francis W. Peabody,” Journal of American Medical Association, 88 (1927): 877; Medical Times 101, no. 10 (October 1973): 62–64.
Chapter 12
1. J. Halpern, “What Is Clinical Empathy?,” Journal of General Internal Medicine 18 (2003): 670–74.
2. A. L. Suchman, K. Markakis, H. B. Beckman et al., “A Model of Empathic Communication in the Medical Interview,” JAMA: The Journal of the American Medical Association 277 (1997): 678–82.
3. L. Del Piccolo, O. Danzi, N. Fattori et al., “How Psychiatrist’s Communication Skills and Patient’s Diagnosis Affect Emotions Disclosure During First Diagnostic Consultations,” Patient Education and Counseling 96 (2014): 151–58.
4. Boissy, A., A. K. Windover, D. Bokar, M. Karafa, K. Neuendorf, R. M. Frankel, J. Merlino, and M. B. Rothberg. “Communication Skills Training for Physicians Improves Patient Satisfaction.” [In Eng]. J Gen Intern Med (Feb 26 2016).doi:10.1007/s11606-016-3597-2.
Index
AACH (American Academy of Communication in Healthcare), 24
ACA (Affordable Care Act), 10
Accountability, 10–11, 141–142, 145
Accreditation Council for Graduate Medical Education (ACGME), 194
ACPs (see Advanced care providers)
Acting as a unit, 196–198, 201, 202
Active learning, 100–101
Adult learning theory, 50–51
Advanced care providers (ACPs), 163–178
education level of, 171–172
in interprofessional training programs, 171–177
patient satisfaction scores for, 174–175
replicating participants’ environments and challenges in, 166–167
training physicians separately from, 164–166
training process for, 166–171
use of standardized patients with, 99
Affordable Care Act (ACA), 10
Agenda setting, 77–79
AI (see Appreciative inquiry)
American Academy of Communication in Healthcare (AACH), 24
Andragogic theory, 91
Appointments, same-day, 3
Appreciative inquiry (AI), 198–200, 202, 205
A.R.I.A., 73, 85, 114, 117, 118
Arts & Medicine Institute, 3–4
Back, Tony, 24
Baile, Walter, 24, 226–227
Barnett, Kara Medoff, 1, 227
Beach, M. C., 70
Behavioral norms, 219
Benzel, Edward, 180–181, 221–222
Bias, of facilitators, 157–158
Bloom, Benjamin, 89
Boissy, Adrienne, 21, 179–180
Bosses, leaders vs., 185–186
Boundaries, setting, 114
Brady, Tom, 127
Breaking bad news, 168
Bullying, 173
Burning platform, 11, 13, 19 (See also Leveraging your burning platform)
Burnout, 38, 107–108, 218–221
Caregiver (term), 6, 177
Caring, expression of caring vs., 189–190
CCE (Cleveland Clinic Experience), 6–9
CEHC (Center for Excellence in Healthcare Communication), 41–42
Center for Excellence in Healthcare Communication (CEHC), 41–42
Centers for Medicaid and Medicare Services (CMS), 6, 10
CGCAHPS (Clinical Group Consumer Assessment of Healthcare Providers and Systems), 12, 38
Challenging conversations, 105–124
emotional impact of, 19, 124
for hospital administrators, 176–177
in integrative skills practice, 100–102
key principles for addressing, 108–111
lessons learned for, 123–124
R.E.D.E. practice sessions for, 111–123
for residents, 155–156
for surgeons, 181
training for, 47
Chief experience officer (CXO), 4–9
Chou, Calvin, 24, 25
Chronic pain, conversations about, 111–115
Cleveland Clinic, 196
acting as a unit at, 196–198
Patients First model at, 2–6
professionalism emphasis at, 198–205
relationship-centered communication at, 195 (See also R.E.D.E. to Communicate Model)
Cleveland Clinic Experience (CCE), 6–9
Cleveland Clinic Professionalism Council, 198–203
Clinical Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), 12, 38
Clinician(s):
factors in disengagement of, 69–70
motivating (see Motivating clinicians)
portrayal vs. reality of, 106–107
stress reduction for, 220
as term, 177
Closure, 85
CMS (Centers for Medicaid and Medicare Services), 6, 10
Coaching, 127–131 (See also Individual peer coaching)
Collaboration:
in decision-making process, 186
in developing treatment plan, 84–85
on integrated physician-support model, 203, 204
in setting agenda with patient, 77–79
Communication:
connecting leadership and, 184–186
dos and don’ts for, 208
lapses in, 186
models of, 24
negative HCAHPS comments about, 12, 25
professionalism and, 203
recurring themes in, 208–213
(See also Relationship-centered communication)
Communication skills:
coaching in, 129–131 (See also individual peer coaching)
content expertise in, 138–141
in hidden curriculum of medical training, 154
physicians’ need for, 15–16
reinforced through professionalism, 203–205
Communication skills training:
for advanced care providers, 171, 172
building community through, 218
chief experience officer and, 4–9
considerations when beginning, 39–41
culture for, 1–19, 41
developing program for (see Leveraging your burning platform)
disease- and setting-specific, 37
effective approaches to, 48–50
and healthcare environment, 10–11
launching (see Launching communication skills training)
myths about, 13–19
and Patients First motto, 2–4
perception of, 180
for physicians, 9–10, 171–172
for staff physicians, 149–150
stakeholders’ attitudes toward, 22
strategy for engaging physicians in, 13–19
with surgeons, 182–184
sustainability of, 36–37
time needed for courses, 60
transparency in, 11–12
Communication tasks, competence in, 138
Community, building, 218
Competence:
in communication tasks, 138
conscious, 94, 95
reflective, 16–17, 93–96
unconscious, 94, 95, 137
Conflict-resolution skills, 131
Conscious competence, 94, 95
Conscious incompetence, 94, 95, 137
Content expertise, 138–141
Coping mechanisms, 189
Core competences, medical, 194
Cosgrove, Toby, 1–4, 11, 25, 33, 197, 227
Cozolino, L. J., 67
Credibility, 45, 59
Criticism, 55, 63, 154–155
Crossing the Quality Chasm (Institute of Medicine), 10
Culture:
at Cleveland Clinic, 2–6, 195–205
for communication skills training, 1–19, 41
local, 57
physicians and, 9�
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of surgery, 181–182
transparency in, 11–12
Curiosity, 143–144, 173, 210–212
Curriculum:
for communication skills training, 89–90
hidden, of medical training, 154
for medical schools, 159
Cushing, Harvey, 191
CXO (chief experience officer), 4–9
Data, 38–39, 41, 209
Defensiveness, 63
Delayed gratification, 219
Develop the relationship (R.E.D.E. phase II), 73, 80–83, 133
Dialogues in Professionalism, 200
Difficult encounters, 107 (See also Challenging conversations)
Difficult patients, 211–212
Disengagement, 8–9, 69
Disruptive physician behavior, 186, 196, 197
Doctor-centered approach, 186
Donley, Brian, 224
“Don’t worry,” 215–217
Doubling, 101–102
Duffy, Bridget, 4
EHP (Employee Health Plan) Program, 167
Electronic health records, 79
Emotion(s):
in challenging conversations, 19, 124
matching gravitas of, 208–209
patients’ inquiries driven by, 216–217
strong, challenging conversations involving, 118–120, 168
vulnerability in sharing, 226
Emotion bank account, 75–76
Emotional cues, 212–213, 217
Empathic curiosity, 210–212
Empathy, 1–2, 16, 79
assessing, 38
blocking, 49
in challenging conversations, 106
in coaching, 130
demonstrating, 80
expression of caring in, 189–190
of facilitators, 91, 92
learning, 16–17
less effective behaviors in, 139, 141
in medical school and residency, 148–149
perceiving emotional cues for, 212–213, 217
in and for physicians, 9
for residents in classes, 153
in surgery, 189–190
“Empathy video,” 9
Employee Health Plan (EHP) Program, 167
Engagement:
of facilitators, 102–103
of patients, 83
of physicians, 13–19 (See also Motivating clinicians)
principles of, 87–89
Engaging the relationship (R.E.D.E. phase III), 73, 83–85, 133
Establish the relationship (R.E.D.E. phase I), 73, 75–80, 133
Experiential learning, 49, 93, 168
Explaining, less effective behaviors in, 139–141
Explanatory skills, in coaching, 130
Expression of caring, caring vs., 189–190
External perspective, in coaching, 136–138
Facilitator(s):
and integrative skills practice, 100, 102
investing in, 59
revealing vulnerabilities of, 202
surgeons as, 28–29, 183
sustaining engagement of, 102–103
unconscious bias of, 157–158
use of term, 157
Facilitator fatigue, 103
Failure bow, 227
Feedback:
from advanced care providers, 168–170
ground rules for, 62–63
from patients, 11–12, 25
perceived as criticism, 55, 63
reinforcing, 64–65
on skills practice, 61–62
structuring, 56
from training attendees, 27, 221
from trusted sources, 50
Fellows:
facilitating (see Staff physicians)
needs of, 150–151
teaching responsibilities of, 156–158
Foundations of Healthcare Communication (FHC) course, 18, 29–31, 35–39, 42–43 (See also individual groups, e.g.: Advanced care providers [ACPs])
Four Habit Model®, 24, 26
Gawande, Atul, 127
Gilligan, Tim, 22, 25
Goals:
in coaching, 128–129, 132, 134–136, 142–145
commitment to, 121
common, 123, 188
in learner-centered approach, 51, 56
of learning, 89
making skills relevant to, 90
of patients, 68, 116, 195
prioritizing, 93
in teaching relationship-centered communication skills, 43
Gottman, John, 75
Gravitas of emotion, matching, 208–209
G.R.O.W. coaching model, 129
Halpern, J., 209
Hancock, Kelly, 5
Haunting conversations (see Challenging conversations)
HCAHPS (see Hospital Consumer Assessment of Healthcare Providers and Systems)
Health Care Education and Reconciliation Act, 10
Healthcare environment, 10–11, 13, 15, 69
Healthcare relationship, 74
H.E.A.R.T. program, 6, 8, 203
Hidden curriculum, of medical training, 154
History of present illness (HPI), 81–82
Hospital administrators, 176–177
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), 6, 12, 18, 25, 26, 28
HPI (history of present illness), 81–82
“I don’t know,” 213
“I understand,” 214–215
Incompetence, conscious, 94, 95, 137
Individual peer coaching, 125–146
coaching process in, 142–145
purpose of, 127–131
R.E.D.E. in, 132–142
Individualism, 196, 197
Influence, 71, 184
Information:
in monologues vs. dialogues, 190
sharing, 83–84
Information overload, 69, 72, 140
Ingham, Harry, 95
Innovation, 196, 197
Institute of Medicine, 10
Integrative skills practice, 100–102
Intention, expressing, 210
International Leadership Board, 222–224
Interpersonal skills, on surgical team, 188
Interpersonal skills training, 171–172 (See also Relationship building)
Interprofessional training programs, 171–177
ACP advantages in, 174–175
education and background in, 171–172
with hospital administrators, 176–177
power differentials in, 173–174
tension in, 172–173
Interviewing for role, 101
Inui, T., 70
James, LeBron, 127
Johari window, 95–96
Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 188, 197
Judgment, replaced with empathic curiosity, 210–212
Kaiser Permanente, 24
Kirkpatrick, Donald, 89
Knowles, M. S., 51
Kohl, Stewart, 223
Labeling patients, 109–110, 212
Launching communication skills training, 45–66
adult learning theory, 50–51
effective approaches for training, 48–50
organizational success strategies, 56–60
overcoming resistance, 60–65
small group facilitation skills, 52–56
structuring course, 46–48
Leadership:
bossiness vs., 185–186
connecting communication and, 184–186
getting strong commitment from, 58–59
relational, 225
relationship-centered, 226
by surgeons, 184–185
surgeons’ perspective on, 187–188
vulnerability and, 224
Learner-centered approach, 51, 52, 91
Learning:
active, 100–101
domains of, 89
experiential, 49, 93, 168
goals of, 89
and painful memories, 110
passive, 100
self-directed or learner-centered, 51, 52, 91
Learning edge, 159
Learning environment, 55–56
Legitimacy, 45
Leveraging your burning platform, 21–44
data for, 38–39
and getting started with training, 39–41
initial rollout, recruitment, and messaging, 25–29
with R.E.D.E. to Communicate program, 29–37
task force assembly, 22–25
Levinson, W., 16, 190
Lipkin, N., 173
Listening:
in coaching, 130
less effective behaviors in, 139–140
reflective, 81, 92
by surgeons, 190
Long-term goals, 145
Luft, Joseph, 95
Maslow, A. H., 87, 150
Maslow’s hierarchy of needs, 87–88, 150
Matthews, Dale, 67
Medical interview, 76–77, 177
Medical students:
communication skills training for, 150
demographics for, 152
facilitating (see Staff physicians)
needs of, 150–151
Merlino, Jim, 4–5, 12, 21, 22, 25, 227
Miller, W. R., 92
Mistakes, in medical training period, 154–155
Modeling behaviors, 225–226
Motivating clinicians, 87–104
by answering “What’s in it for me?,” 90–93
curriculum creation for, 89–90
lessons learned for, 97–102
and move to reflective competence, 93–96
principles of engagement in, 87–89
sustaining facilitator engagement in, 102–103
Mutual respect, 70
Myths about communication training, 13–19
National Provider Identifier (NPI), 166
Needs:
Maslow’s hierarchy of, 87–88, 150
of residents and fellows, 150–151
Negotiating skills, 131
Neurological Institute Voice of the Patient Advisory Council, 221
New England Journal of Medicine, 172
NPI (National Provider Identifier), 166
Nurko, Saul, 25
Nurse practitioners (NPs), 164, 165, 171–173 (See also Advanced care providers [ACPs])
Nurses, 173
Observation skills, 130, 154
Office of Patient Experience, 4, 5, 197
Onboarding, integration of professionalism in, 200–203
Organizational professionalism, 195
Organizational strategies for success, 56–60
PAs (see Physician assistants)
Passive learning, 100
Patient compliance, 184–186
Patient Encounter form, 98
Patient Protection and Affordable Care Act, 10
Patient-centered care, 68–69, 195
Patients First model, 2–6