Improving the communication skills of clinicians and nurses builds rapport and trust with patients.
Communication between staff and patients is a crucial component of patient experience at hospitals, the founder of a communication-focused patient experience training program says.
Making hospitals more consumer-friendly for patients has been a focal point of efforts to reform U.S. healthcare, with the emergence of online reviews and widespread adoption of formal instruments to measure patient satisfaction such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient survey.
Vidalia, Georgia–based Meadows Health, which features 70-bed Meadows Regional Medical Center, understood the importance of boosting clinician and staff member communication skills to improve the patient experience, so they began a focused training effort in December.
"We are the regional referring center, but we have limitations—we don't have an education department and we don't have the resources to fully develop a communication program. We wanted to take a programmatic approach to provider and nurse communication, so we reached out to several organizations to see who could help us the most," says Jeffrey Harden, BSN, MBA-HCM, chief nursing officer and vice president of patient care services at Meadows Health.
Anthony Orsini, DO, a practicing neonatologist and president and founder of The Orsini Way in Windermere, Florida, says communication training achieves cultural change at hospitals. Orsini has seen this come to fruition through his communication training program for healthcare professionals.
"The important thing is we are not just putting Band-Aids on the way doctors and nurses communicate. We are rewiring them and changing cultures at hospitals. Communication is not hard to learn, but it is a specialized technique and most physicians and nurses have not been trained in this area," he says.
Communication training generates positive results, Orsini says. "We have achieved significant improvements in HCAHPS scores and patient satisfaction scores in every program we have done so far. We had one hospital that achieved a 60% improvement in their overall HCAHPS score ranking."
In intensive care nurseries, he says the training program has achieved a 50% improvement in overall patient satisfaction, and 100% improvement in the subset of the HCAHPS survey for physician communication. In emergency room settings, he says the training program has resulted in 70% improvement in overall patient satisfaction.
Training at Georgia hospital
Meadows Health chose The Orsini Way for its training because the emphasis was not on HCAHPS score improvement, but how to better communicate, Harden says. "We found out the Orsini program focuses more on communication as a whole, how communication can make your day-to-day job easier, how communication improvement and certain skills can help avoid burnout, and how all of those factors can lead to improved outcomes and improved relations with the patient."
At Meadows Health, the training program has focused on the emergency department, he says. "Over the past couple of years, we have been working toward improving our emergency department patient satisfaction, and we knew one of our big opportunities was going to be communication."
Although Harden hopes to extend the training throughout Meadows Health, the ED was a logical place to start, he says. "If you look at the number of patient grievances that we have, about 70% of them come from the emergency room."
The primary training program at The Orsini Way is called "It's All in the Delivery." The program has three elements.
1. Series of three-hour workshops: Most hospital staff members participate in the workshops, including doctors, nurses, receptionists, and therapists. The workshops teach staff members how to build rapport and relationships with patients in a timely manner.
2. Digital learning: Hospital staff members complete a digital course over eight to 10 weeks. Through text messages or email, participants receive a training technique every week that is highlighted in a five-minute video. Participants are then asked to put the technique into practice.
3. Improvisational role-playing: Professional actors role-play with hospital leaders, who eventually become on-site trainers. The role-playing is videotaped and reviewed by Orsini instructors, who replay the videos with the hospital leaders to see how they performed. Instructors comment on verbal and nonverbal communication techniques in the videos to teach the hospital leaders how to train staff members.
Some hospitals choose not to conduct the role-playing component. The cost of the training ranges from $50,000 to $100,000 per hospital.
Meadows Health decided not to utilize the improvisational role-playing, Harden says. "We took advantage of the lectures with Dr. Orsini and the digital platform, which has been great for employees who could not get to a lecture but wanted access to the program. The digital platform provides reminders, tips, and check points to see whether the tips are being used."
So far, the results have been promising, Harden says.
"Even though we just started the training in December, we have seen some improvement in satisfaction scores. What we have seen in the ED is the biggest result for me. I'm not hearing from any ED nurses or providers that they are too busy to be polite. For the ED nurses and providers, the program has done a good job of highlighting that communication is just as important as a clinical component of their jobs—communication is a clinical tool."
The effort is well worth the investment, Harden says. "As a community hospital that is surrounded by three larger systems within a 30-minute drive, the way the community perceives us and the way we treat our patients is major. I need everybody in my organization from the frontline staff to the executive team thinking this way."
Communication training approaches
A key component of the training program workshops is teaching specific communication techniques as well as verbal and nonverbal language skills, Orsini says.
For example, Orsini encourages clinicians and nurses to sit down as soon as possible when they enter a patient's room. "The most common mistake physicians and nurses make when they go into a patient's room is speaking while standing up. The nonverbal message that is being sent is that they don't have the time to spend with the patient."
Other communication techniques are designed to build rapport and trust with the patient, he says. "Multitasking while you are visiting a patient such as typing into the electronic medical record sends a nonverbal message that the patient is not the most important person in the room."
Nurse managers can build trust with their patients while conducting rounds, Orsini says. "They should not just poke their head into patient rooms and ask whether they need anything. I teach nurse managers to go into the room, introduce themselves, and say they like to get to know their patients. Then they can ask the patient how it is going."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
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