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Healthcare reform has placed a premium on patient satisfaction. Under Medicare’s value-based purchasing program, bonuses and penalties are tied in part to patients’ satisfaction with their physicians. So how can healthcare leaders help physicians improve their interactions with patients?
Researchers at the Kansas University Medical Center (KUMC) have found that increasing physicians’ emotional intelligence can help increase patient satisfaction scores. Their research highlights practical ways to work with physicians to improve the care experience and boost organizational performance.
“Emotional intelligence can be defined as how you manage your emotions with self and others to improve performance,” says James Dugan, PhD, a psychologist who has researched emotional intelligence (EI) for more than a decade. In 2005 he and the leadership team of the KUMC Department of Otolaryngology began looking at how EI could improve healthcare delivery.
“A few years earlier, the Institute of Medicine came out with its report that up to 98,000 patients die each year because of medical errors,” Dugan says. “A lot of the root cause analysis pointed to communication breakdowns among providers.”
To improve communication, Dugan and colleagues devised an EI training program for otolaryngology residents and faculty. The program featured annual offsite faculty-led training sessions incorporating high-stress simulations.
“Our goal was to help physicians develop greater awareness for managing their stress and emotions in high-pressure moments,” Dugan says. Key skills include empathy, assertiveness, and emotional self-awareness. The emphasis is on strengthening emotional attunement and developing positive “internal scripts” —the narratives that run through a person’s mind as they face difficult situations.
Dugan and colleagues designed a prospective study to track the initiative. Physicians’ emotional intelligence was evaluated using the Emotional Quotient Inventory (EQ-i), a standard assessment tool. Patient satisfaction was measured with the Press Ganey Patient Satisfaction Survey.
The results showed that EI training made a real impact on physicians. For the department as a whole, the mean EQ-i score jumped from 104.29 (the average range) to 113.15 (high average) in just three years.
Even more important, increases in physician EI corresponded to gains in patient satisfaction. Before the EI training, the department’s Press Ganey patient satisfaction percentile ranged from 85-90 percent. After the training, patient satisfaction jumped to a range of 92-99 percent.
Dugan shares several tips for developing effective EI physician training programs.
Lead with physician champions. “At KUMC, we had a core group of internal champions that consisted of the department chair and two residency program directors,” Dugan says. “These physicians basically stood up and said there is more to being a good doctor than technical knowledge.” The three leaders not only encouraged residents and faculty to take part in the training program, they participated actively themselves. “Without their support, this program probably wouldn’t have gone anywhere.”
Keep score. “When we first gave the EQ-i test, some faculty and residents got an average score, and some were even below average,” Dugan says. “These are people who have never been told they’re ‘average’ in anything. So I think seeing those scores really motivated them to improve.”
Use simulations. “Too much talking about EI is like listening to a lecture about tennis versus playing tennis,” Dugan says. The KUMC program relied heavily on interactive simulations. “The scenarios we created were kind of impossible, like a blocked airway in the OR [operating room] where everything goes wrong. The goal was to get people beyond their comfort zone so they had to face their frustration.”
Let participants work in teams. “When you debrief the simulations, you want people to ‘shoot from the hip’ and talk about their initial reaction, but that can be hard because everyone wants to look good,” Dugan says. “So we put the residents in groups and asked them to come up with a group response to specific moments in the simulations. That way, it doesn’t put anybody on the hot seat, and it gave the residents a chance to build a little teamwork.”
Leverage mentors. “During the debrief discussions, we asked the faculty to share their knowledge and talk about how they manage their internal stress,” Dugan said. “When a training session was over, faculty would continue to coach residents about how to keep developing EI competencies. This ongoing mentoring would take place right at the bedside and in the operating room.”
Pitch EI as “non-technical skills.”Early in the training, program leaders began getting pushback. “Some residents thought it was getting a little too ‘touchy-feely.’ So we reframed EI skills as ‘non-technical’ skills,” Dugan said. “It’s the same content, but it’s more comfortable for this group. And logically it makes sense to say you have a set of non-technical skills that complement your technical skills.”
Build an emotional connection. “Early in the training session, we showed a video made by the mother of Josie King, a young patient who died at Johns Hopkins several years ago, largely because of failures in teamwork,” Dugan said. “A lot of the residents and faculty have kids themselves, so they can identify with this in a visceral way. I think this kind of emotional appeal helps people move beyond their natural resistance and say, ‘We need to do this better.’”
Make it manageable. “Logistics is the main obstacle to this kind of program,” Dugan says. “It’s hard to get everybody off-site at the same time.” Dugan and other co-workers are currently examining strategies for providing EI training in a more time-efficient way.
Have fun. “You’ve got to have fun when you’re doing this, otherwise it wears people out, especially if you do the training every year,” Dugan says. At one session, residents and faculty were placed in teams to compete for prizes in golf putting matches. The residents were fitted with heart monitors. “Teams were encouraged to distract other teams, and we monitored to see if amidst the deliberate distractions the residents’ heart rate increased. Participants had a lot of fun, and it helped them think about how to keep calm even when everyone is stressing you out."
Physician EI training not only helps improve patient satisfaction, it can help doctors grow as members of a care team. “Years after we began this training, former residents started coming back to me and saying, ‘You know, I couldn’t figure out why we were doing this until I got out into a fellowship program and had to work with other faculty. Now I understand how valuable emotional intelligence training is.’”
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Robert Fojut is a freelance writer based in Wisconsin.
Quoted in this article: James W. Dugan, PhD, is director of counseling and support services, Kansas City University of Medicine and Biosciences, Kansas City, Mo.
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