Physicians With High Productivity And Satisfaction Scores Employ Strong Patient-Centered Communication Skills


People are forever telling me that I am wasting my time talking to providers about the need to improve their patient communication skills.  Naysayers typically cite one of the following reasons for why things will never change:

Reason 1 – Every physician thinks they already have good patient communication skills.

Reason 2 – Physicians don’t get paid to talk to patients

Reason 3 – Physicians don’t have time to talk to patients

Reason 1 is relatively easy to debunk. After all, if all physicians were really such good communicators:

  • poor communications skills wouldn’t consistently top the list of patient complaints about physicians
  • patient non-adherence wouldn’t be so high since physician and patients would always agree on what is wrong and what needs to be done
  • patients would not be walking out of their doctor’s office not understanding what they were told
  • patients would not experience so many communication-related medical errors

Reason 2 requires a little straightforward logic:

Since physicians are paid to diagnose and treat patients presenting problems…and the accuracy of their diagnosis and treatment depends upon their physicians’ ability to elicit and listen to the patient’s story…then indeed physicians are already being paid to talk to patients.

Productivity QuoteReason 3 (physicians don’t have time) has always been hard to address. That is until now.

Most us tend to think about physician time on a zero sum basis.  Take the office visit for example.  Providers will argue that they either spend more time trying to be patient-centered (associated with great patient experiences) or they can use less time to diagnose and treat patients the way they have always done – but no way can they do both at the same time.

A recent published study conducted by HealthPartners in Minneapolis suggests that physician time is not a zero sum game – that providers can in fact be productive while at the same time creating a satisfying patient experience.

Individual productivity and patient experience scores were calculated and plotted for 22 HealthPartners physicians using a scatter diagram like that shown in Figure 1 (for demonstration purposes only). What the study found was that a relatively equal number of physicians fell into each of 4 quadrants – strong productivity/strong satisfaction, strong productivity/weak satisfaction, weak productivity/strong satisfaction and weak productivity/weak satisfaction.

Figure 1Productivity-Satisfaction

The researchers then looked to explain the difference between physicians in each of the quadrants. They ended up identifying a set of “behaviors and characteristics” to help explain why some physicians had strong productivity/strong satisfaction scores while others did not.

Physicians in the strong productivity/strong satisfaction quadrant exhibited the following behaviors and characteristics:

  • Focused on teaching and explanations
  • Conveys warmth from the start
  • Well-planned flow of visit with focus on patient’s agenda
  • Controlled script with clear parts
  • Extremely personable—connects with every patient
  • Always looking for buy-in from the patient that s/he fully understands
  • Recap the history: “I read your chart …”
  • Confident but not arrogant
  • Finishes dictation and coding each day
  • Clinic staff enters orders and prepares after-visit summary

Physicians in the weak productivity/weak satisfaction quadrant exhibited the following behaviors and characteristics:

  • Lack of “being there” emotionally
  • Lack of smiling
  • Abrupt actions
  • Behavior changes when not interested in the “case”
  • Patients kept waiting and wondering
  • No handshake
  • Sense of interrogating to get a diagnosis
  • No attempt to match the patient’s energy

What struck me about these lists was that were dominated by the presence (strong productivity/strong satisfaction) or absence (weak productivity/weak satisfaction) of communication-related “behaviors and characteristics.”

Perhaps not so surprisingly, the behaviors and characteristics of physicians in the strong productivity/strong satisfaction are consistent with those traits commonly associated with a patient-centered style of communications. This evidence belies the conventional belief among physicians that they will be less productive (rather than more productive) by adopting a patient-centered style of communications with their patients.

Based upon the evidence, HealthPartners has since gone on to provide its physicians with useful guidelines for how to improve their productivity and patient experience scores.

Take Aways Physicians and practice managers need to seriously reexamine:

  1. their assumptions about the value of and barriers to improving their patient communication skills
  2. the evidence in support of the adoption patient-centered communications skills and styles

Physicians and managers should consider assessing the quality and effectiveness of their existing patient communication skills. The last time most physicians focused on their patient communication skills was back in medical school.

Implement interventions and guidelines designed to improve the patient-centered communication skills of physicians and their care teams.

That’s what I think…what’s your opinion?

Sources:

Boffeli, T., et al. Patient Experience and Physician Productivity: Debunking the Mythical Divide at HealthPartners Clinics. The Permanente Journal/ Fall 2012/ Volume 16 No. 4.

3 responses to “Physicians With High Productivity And Satisfaction Scores Employ Strong Patient-Centered Communication Skills

  1. Steve,

    I am convinced that when we take the time to be present in our communications, regardless of the venue (Patients, colleagues, spouses, clients) the outcome and satisfaction for everyone is higher.

  2. Steve,

    Excellent information, thanks for sharing. I agree this is a false dichotomy of productivity vs. patient-centeredness. When I was with Andersen Consulting working in the organization change field we would hear the same from professionals in most every industry faced with change–from financial services, safety and engineering, telecommunications, you name it. This is one “face” of resistance. However, once they are convinced of the urgency for change, they begin to consider how they will need to change to succeed in the new environment.

    As Harvard’s John Kotter emphasizes, a sense of urgency is probably the most important predictor of change in small teams and large organizations. Once we get over this hurdle, then we can address what the individual needs to do to succeed in the new environment, in this case, be more patient-centered.

    In the past two decades we have found only one approach that can be used in very brief encounters, that works with patients who are typically the most “resistant,” across socioeconomic, cultural and ethnic divisions–and it is motivational interviewing. However, it can take months and years to be proficient at MI and MI proficiency is what is required to deliver the big gains in engagement and health behavior change. However, with very targeted training we have been able to build basic proficiency in MI for physicians, but this requires feedback based on a recording of their work with a patient, evaluated using a validated, standardized measure (we use the Health Coaching Performance Assessment which was is based on the latest health behavior change research and independently validated by Dr. Ariel Linden, health care services evaluator–the HCPA is now being used by organizations from Mayo, Stanford University Health Center, to the VA).

    At first MI does take more time, but soon enough physicians learn that it is MUCH more efficient and effective than the usual patient advice and patient education approaches. Research by Terry Moyers at U of NM who works with MI founder Bill Miller, has in fact found that the use of the traditional education and advice can reduce the prospect of patient change–yet that the method of “health coaching” and patient centered communications that is being routinely used by physicians, nurses, pharmacists and many behavioral health providers–and most telephonic wellness, disease management and care management programs. Using the wrong approach will certainly take more time or trying MI after reading about it in an article or attending a workshop.

    Without a sense of urgency and a commitment to change, and practical training, feedback and practice in the new skill-set, we can expect the the same mixed findings on the PCMH as we did with the disease management vendors–who also failed in most cases to adequately train and measure the proficiency and performance of their telephonic staff in these brief, highly effective engagement and health coaching approaches. We have embraced evidence-based medicine, now what about evidence-based health behavior change facilitation?

    Blake Andersen, PhD
    President & CEO
    HealthSciences Institute

  3. Medical care is 3D. Productivity and satisfaction are good. The third dimension is doing the right thing.

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