Physicians are navigating an increasingly complex environment that challenges the doctor-patient relationship. Medical education almost exclusively focuses on diseases and their treatments. In their eagerness to heal by finding answers to patients’ medical issues, physicians can sometimes forget that they are treating people, not just their diagnoses.
However, what patients need from their provider and healthcare experience has not changed. At Henry Ford Health System, we refer to a patient’s priorities as the Three C’s: Collaborate with me, Communicate clearly to me, Care for me as a person.
Using those priorities to guide us, we have implemented programs that train doctors to clearly communicate diagnoses, treatment plans, and medical instructions with empathy and an appreciation for the points of view of patients and family members. We are taking a creative, proven, and more holistic approach to address some of the shortcomings in the culture of medicine.
This approach acknowledges imperfection and ultimately recognizes that the practice of medicine must promote compassion, hope in patients, and resilience in care providers.
About the Center
The Physician Communication & Peer Support (PCPS) Center, which launched in July 2016, offers research-based resources to help physicians enhance their communication skills in a learner-directed way. The goal is to improve the care experience for patients while increasing physician resilience.
The core team members of the PCPS Center are physician communication consultants, who are not clinicians but rather experts in communication and leader development. They partner with physician champions who have demonstrated excellent communication skills.
The Center’s programs and interventions are offered in a safe, transparent, and respectful environment that allows our providers to explore new behaviors and share their successes and struggles. We use a structured role-playing framework that allows participants to try new skills without feeling that they need to be perfect.
In addition to traditional classroom training, we offer one-on-one, confidential communication coaching; real-time feedback through a shadowing program; and structured peer story-telling and mentoring.
The principles of Henry Ford’s CLEAR Conversations® model—CLEAR stands for Connect, Listen, Empathize, Align, Respect—are woven throughout all PCPS programs and resources. The Center currently offers three programs to providers across our health system:
- CLEAR Fundamentals provides education and practice on the fundamental skills needed to communicate with patients.
- CLEAR Shadowing offers “elbow support” to physicians on an individual basis. Confidential feedback from a physician communications consultant after a shadowing session allows providers to identify behaviors that enhance the patient’s perception of their quality of care and their care experience. The shadowing process also allows us to assess how effectively providers are implementing the CLEAR principles into their actual patient encounters.
- CLEAR Advanced Conversations focuses on toolkits and roadmaps for difficult conversations, including those about end-of-life issues. This program, the cornerstone of the PCPS Center, was started by three physicians who were trained by Vitaltalk, a nonprofit organization that conducts research and teaches clinicians how to engage in conversations that support patient-centered care. This program, using professional improvisational actors to create an experiential and case-based learning opportunity, focuses on the most fraught conversations in any specialty.
Our Implementation Strategy
Each of the three CLEAR Conversations programs was developed and piloted with voluntary early adopters. Positive feedback from participants and immediate improvements in patient satisfaction scores quickly increased demand for these programs.
To meet this demand in the most effective way, we roll out all three programs at one time to a given specialty. This approach has created communities of practice within and among our specialties.
The success of our CLEAR Conversations programs has moved the PCPS Center beyond its original goal of helping our physicians interact more empathically with patients. This work is igniting cultural change across our health system. It is proving that we can change the culture of medicine, one conversation at a time.
Kelley Dillon is director, Physician Communication & Peer Support, Henry Ford Health System, Detroit.
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