Pause, power of the, 131
PCC (Physician Conduct Committee), 197–198
Peabody, Francis, 205
Peer coaching (see Individual peer coaching)
Perception(s):
in coaching, 130
of communication skills training, 180
of emotional cues, 212–213, 217
of nonphysicians by physicians, 163–164
Personal connections, 88
Pew-Fetzer Task Force on Advancing Psychosocial Health Education, 70
Phrases to eliminate, 214–217
Physician assistants (PAs), 164, 165, 171 (See also Advanced care providers [ACPs])
Physician Charter on Medical Professionalism, 193–194
Physician Compare, 11
Physician Conduct Committee (PCC), 197–198
Physicians, 9–10
bond between patients and, 181
disengagement of, 8–9
education level of, 171–172
in interprofessional training programs, 171–177
making communication skills resonate with (see Motivating clinicians)
patient satisfaction scores for, 174–175
perception of other professionals by, 163–164
professionalism in onboarding of, 200–203
residents and medical students (see Staff physicians)
staff vs. attending, 148–149
strategy for engaging, 13–19
trained separately from advanced care providers, 164–166
training ACPs separately from, 164–166
(See also Surgeons)
Platt, F. W., 77
Power differentials, 173–174
Power dynamic, 157
“Power of the pause,” 131
Professional Staff Resource Center, 204
Professionalism, 193–205
in acting as a unit, 196–198
Cleveland Clinic Professionalism Council, 198–204
concept map of, 204
as emerging concept, 193–196
organizational, 195
reinforcing communication skills and service excellence through, 203–205
Professionalism Council, 198–204
Professionalism Task Force, 198–199
Provider (term), 177
Psychosocial context of issues, 71
Raman, Ananth, 22
Rapport, 83, 130
Rastgoufard, Shirin, 22
RCC (see Relationship-centered care)
Reciprocal influence, 71
Recurring communication themes, 208–213
R.E.D.E. to Communicate Model, 29–37, 42, 67–86
in challenging conversations practice sessions, 111–123
Develop the relationship (phase II), 80–83, 133
Engaging the relationship (phase III), 83–85, 133
Establish the relationship (phase I), 75–80, 133
Foundations of Healthcare Communication, 29–31, 35–39, 42–43
in individual peer coaching, 132–142
for new residents, 159
and relationship as change agent, 72–75
for relationship-centered care, 71–72
for relationship-centered communication, 195
Train the Trainer, 29, 32–33, 40
Referrals, for coaching, 142–143
Reflective capacity, 135–136
Reflective competence, 16–17, 93–96
Reflective listening, 81, 92
Reinforcing feedback, 64–65
Relational leadership, 225
Relationship building:
among trainers, 33
effectiveness of, 211
nostalgia when focusing on, 161
for patient compliance, 186
for residents on rounds, 153–154
as stealth strategy, 218–221
Relationship-centered care (RCC), 33–34, 70
principles of, 70–71
professionalism and, 205
scholarship emerging around, 195
within training sessions, 71–72
Relationship-Centered Care Research Network, 70
Relationship-centered communication, 70, 72
for advanced care providers, 176–178
at Cleveland Clinic, 195, 205
commitment to, 228
for surgeons, 181–182, 191
(See also R.E.D.E. to Communicate Model)
Relationship-centered leadership, 226
Relationships:
of ACP vs. physicians with patients, 174–175
attending to, 132
in challenging situations, 108
in coaching, 132, 134–135
as essential to health and wellbeing, 67–68
healthcare, 74
inherent value of, 71
on rounds, 153–156
Residents:
challenging conversations for, 155–156
communication training for, 149
demographics for, 151–152
facilitating (see Staff physicians)
modeling skills for, 17
needs of, 150–151
nursing colleagues’ bullying of, 173
personal challenges for, 152–153
teaching responsibilities of, 156–158
Resilience, 222
Resistance to training, 45–46
overcoming, 60–65
rolling with, 92
by surgeons, 182–183
Respect, 70
conveying, 88
from facilitators, 158
in medical interview, 76–77
for patients, 158, 222
Respond with H.E.A.R.T., 6, 8, 203
Role-playing, 60, 137, 149 (See also Skills practice)
Rolling with resistance, 92
Rollnick, S., 92
Roosevelt, Teddy, 185–186
Rounds, relationships on, 153–156
Sacrifice, 219
Safety:
in admitting need for improvement, 46
as basic need, 87
in coaching, 139, 143, 144, 150
communication and, 16, 19
and environment of rounds, 154
improving, 13
in interprofessional training, 164–165
of learning environment, 56–64, 97, 100, 159, 164, 165, 169
perceived by participants, 170, 173
and power differentials, 173
psychological, 174
in skills practice, 159–160, 170
in surgeons’ training, 183
in surgical environment, 188
and trust development, 75
tying reimbursement to, 10
and vulnerability, 226
Same-day appointments, 3
S.A.V.E., 73, 80, 113, 117
Saying you don’t know when you don’t, 213
Self-assessment, in coaching, 144
Self-awareness, 128, 137, 158
Self-care, 220
Self-directed education, 91
Self-efficacy, 70–71, 128–129
Service excellence, 203–205
Service Fanatics (Merlino), 25
Setting boundaries, 114
Shadowing, 136–137
Short-term goals, 145
Silos, 3
Skills practice, 49, 51, 60
for advanced care providers, 166–170
for external perspective on behaviors, 137
fun in, 64
ground rules for, 62–63
for hospital administrators, 176
integrative, 100–102
overcoming resistance to, 60–65
for residents, 149
safety in, 159–160, 170
Small group facilitation skills, 52–56, 156–157
Socrates, 179, 181
Somatoform disorders, conversations involving, 120–123
SPs (standardized patients), 97–99, 177–178
Staff physicians, 147–162
basic needs of, 150–151
> communication training for, 149–150
differences from attending physicians, 148–149
facilitation with, 156–158
personal challenges for, 151–153
and relationships on rounds, 153–156
similarities to attending physicians, 148
strategic approaches with, 158–161
Standard cases, 167
Standardized patients (SPs), 97–99, 177–178
Story, Mr., 224
Storytellling, 198–200, 202
Stressors, 150, 220
Strong emotion, conversations involving, 118–120, 168
Structuring courses, 46–48
Suchman, A. L., 212, 213
Suchman, Anthony, 67
Surgeons, 179–192
communication skills training with, 182–184
connecting communication and leadership for, 184–186
and culture of surgery, 181–182
disruptive behavior by, 186
education of, 187–188
facilitator training for, 28–29
listening skills for, 190
relationship-centered communication for, 181–182, 191
and role of empathy, 189–190
“Taking Care of the Hateful Patient” (Groves), 109
Talking, physicians’ time spent in, 140
Taylor, David, 25
Taylor, Will, 94
Team care, 17, 18, 70, 188
Technical care, 196–197
Tension, in physician-ACP relationship, 172–173
Themes, communication, 208–213
expressing intention, 210
matching gravitas of emotion, 208–209
perceiving emotional cues, 212–213
replacing judgment with empathic curiosity, 210–212
saying you don’t know when you don’t, 213
360-degree evaluations, 136–137
Timco, Paul, 22
To Act as a Unit, 201
Train the Trainer (TTT), 29, 32–33, 40, 103
Transparency, 11–12, 25
Treatment plan, 84–85
Triple Aim, 10
Trust, 83, 134
TTT (see Train the Trainer)
Unconscious competence, 94, 95, 137
Understanding, 214–215
Unit, acting as a, 196–198, 201, 202
Unrealistic expectations, conversations about, 115–118, 156, 168
Value, conveying, 76–77, 88
Velez, VJ, 22, 25
Videotaping communication skills, 136–137, 149
V.I.E.W., 73, 82–83, 110, 113–114, 116–117, 210
Vital Talk, 24
Vogt, David, 22
Voice of the Patient Advisory Councils (VPACs), 3, 221
Voluntary participation, 57–58
Vulnerability, 207–228
of facilitators, revealing, 202
and phrases to eliminate, 214–217
power of, 221–227
and recurring communication themes, 208–213
and relationship building, 218–221
Walters, Rebecca, 24, 226–227
Warm-ups, for training sessions, 55, 101
“What else?,” 92–93
What Keeps Leaders Up at Night (Lipkin), 173
“What’s in it for me?,” 90–93
“Why Doctors Are Sick of Their Profession,” 218–219
Windover, Amy, 22, 23, 25, 26, 33–34, 227
Worry, 215–217
About the Editors
Adrienne Boissy, MD, MA, is chief experience officer of Cleveland Clinic Health System and a staff neurologist at the Cleveland Clinic Mellen Center for Multiple Sclerosis. In this role, Dr. Boissy leads the Office of Patient Experience and its initiatives to address and improve every aspect of a patient’s encounter with the Cleveland Clinic Health System—from patients’ physical comfort to their educational, emotional, and spiritual needs. The Office of Patient Experience is responsible for a range of programs and services across the hospital, including service excellence, communication skills training, spiritual care, bioethics, data intelligence, volunteer services, and the ombudsman’s office.
Dr. Boissy previously served as the medical director of the Center of Excellence in Healthcare Communication. Her team created a comprehensive program to strengthen physician and clinician communication skills throughout Cleveland Clinic and has trained thousands of staff physicians and clinicians to date.
Dr. Boissy chairs the Empathy and Innovation summit, the largest independent summit on patient experience in the world. She also guided the development of patient advisory councils across Cleveland Clinic Health System and currently serves as editor-in-chief of the Journal of Patient Experience. In addition, Dr. Boissy was awarded an Arnold P. Gold Foundation grant for humanism in medicine. She continues to care for patients with multiple sclerosis and also serves on the editorial board of the National Multiple Sclerosis Society’s Momentum magazine.
She has published extensively about relationships and empathy in healthcare and the communication challenges in clinical practice, which were highlighted in her 2015 TEDx talk “Seeing and Being Seen: A Call for Healing.” Dr. Boissy is frequently interviewed in the media as an expert in patient experience, physician communication, and transparency. Her quotes have appeared in the Wall Street Journal, the Washington Post, Forbes, and the Atlantic, among others. A Harvard Macy scholar, she has spoken extensively around the country about the patient and provider experience and the impact of effective communication on both.
Dr. Boissy attended Boston University and worked in neurobiological research at Brigham and Women’s Hospital, Boston. She completed her medical school training at Pennsylvania State University College of Medicine and finished her neurology residency and neuroimmunology fellowship at Cleveland Clinic.
Timothy Gilligan, MD, MS, is the former co-director of the Cleveland Clinic Center for Excellence in Healthcare Communication (CEHC), where he teaches communication skills, trains others to teach communication skills, and provides physician coaching. He directs the innovative peer communication coaching program within CEHC and holds workshops on physician communication at national and international conferences. He has completed communication skills training in the Oncotalk Teach program and AACH Facilitator-in-Training program. He is currently an AACH faculty member.
Dr. Gilligan is Vice-Chair for Education at Cleveland Clinic’s Taussig Cancer Institute and a medical oncologist specializing in cancers of the testicles, bladder, prostate, and kidneys. He is an associate professor of medicine at the Cleveland Clinic Lerner College of Medicine, with appointments in the departments of Hematology and Medical Oncology, Urology, and Bioethics.
Dr. Gilligan has published original scientific articles in peer-reviewed journals, written review articles and book chapters, and given lectures on genitourinary cancers and biomedical ethics. He has written and edited treatment guidelines and cancer information summaries for national and international organizations, including the National Cancer Institute, the American Society of Clinical Oncology, and UpToDate. He also works on quality initiatives with the American Society of Clinical Oncology (ASCO), for which he has served on the Quality of Care Committee, and chaired both the Subcommittee on Quality Measures and the Test Materials Development Committee. He is a faculty member of the ASCO Quality Training Program.
A graduate of Stanford University Medical School, Dr. Gilligan completed his residency in internal medicine and medical oncology at Brigham and Women’s Hospital and his fellowship at the Dana-Farber Cancer Institute.
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Communication the Cleveland Clinic Way Page 26