Focus on doctor-patient relations during redesign
May 1, 1997 3 minutes read
Focus on doctor-patient relations during redesign
Offer communication skills workshop
The most critical relationship in any health care facility is that between a doctor and patient but it is often the relationship that gets the least attention in redesign efforts.
Many doctors often resist efforts to improve physician-patient communication skills, saying their clinical skills are the most important factor in practicing medicine. But a recent study published in the Journal of the American Medical Association offers something about those relationships that few physicians can dispute data. (See related article on the JAMA study, p. 58.) Doctors who communicate better have happier patients. Further, doctors who relate well to patients spend less time with malpractice lawyers doing damage control with unhappy patients.
A critical part of your redesign should include physicians and communication skills.
"Many doctors may not even think they need communication training," says Neil Romanoff, MD, MPH, Cedars Sinai Medical Center in Los Angeles. "Let’s face it. There isn’t anything terribly surprising about this study. We should know that interaction always affects satisfaction and the speed with which patients get better. But every doctor thinks he or she is doing a good job."
To encourage your physicians to improve their bedside manner, begin by stressing the relationship between good communication and improved patient outcomes.
"If doctors start doing the right thing for the right reason that is, communicating with their patients to help them get better it will work," Romanoff says. "But if hospitals tell doctors that they need to be more communicative with patients just to raise satisfaction scores, it won’t be sincere. Patients are not dumb."
As always, remember physicians are impressed by good data, Romanoff explains. For example, one way to convince a problematic physician he or she must improve his or her communication skills is to use data from patient satisfaction surveys. But, you have to make sure the data are specific to the physician and not an aggregate score.
"We need to see satisfaction data specific to us and compared against our peers in the department," Romanoff explains. "If the survey data are not detailed enough, we need focus groups to provide more information for each doctor."
The surveys you use, though, need to be chosen carefully, cautions research team member Debra Roter, DrPh, a social scientist and professor in the department of health policy and management at Johns Hopkins school of hygiene and public health in Baltimore.
"I am not terribly enthusiastic about the measurement tools in the market now," Roter says. "There tend to be high positive skews in satisfaction ratings. I don’t think there are many satisfaction survey instruments out there that are sensitive enough to pick up on the subtle behaviors of practitioners. But I wouldn’t totally disregard the results. They can serve to open people’s eyes about potential problems."
Once you’ve convinced your physicians they may have a problem, you must then convince them to do something about it. They need to know that they can and should improve their skills.
"Doctors have respect for formal education," Romanoff says. "They need to be told that people are not born with good communication skills but that they can learn them."
They also need to know you and the hospital support them in their efforts to improve. Romanoff suggests incorporating communication classes into continuing medical education something all doctors must have to remain licensed.
"Training in the way we practice medicine and its impact on patient satisfaction is not a high priority for those doctors who would have to take unpaid time out of their practices to attend classes," Romanoff explains.
Adds Roter, "Doctors feel compelled to hone their technical skills, but keeping patients satisfied is as important as reading cardiograms."
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