The No. 1 thing patients want: 5 steps to improve the physician-patient relationship

Patients are demanding more from their physicians than ever before.

Patients visit their physicians when they are most vulnerable, and they need to have trust and confidence in their physician, especially when they discuss some of the most intimate details about their lives and families.

However, when it comes to the patient-physician relationship, the two parties are not always aligned.

"Often physicians don't understand what their patients want from them. It's really quite simple — the No. 1 thing patients want from their physician is to be respected and listened carefully to," says William Maples, MD, executive director and chief experience officer of The Institute for Healthcare Excellence and CMO of Professional Research Consultants.

When physicians build a trusting relationship with patients, it ultimately improves outcomes. On average, 50 percent of patients treated for chronic disease do not take their medicine as prescribed, a study on the success of high blood pressure treatments reported. And many times, that decision to take or skip a dose is significantly influenced by the patient-physician relationship.

"If you're not really engaged with somebody and don't trust them, and they recommended that you do something, would you do it? Would you follow through?" Dr. Maples says. "We jeopardize our patient's safety and our patient's outcome if we do not develop a trusting, healing relationship between patient and physician."

Here are five ways for hospitals to improve patient-physician communications, according to Dr. Maples, who has worked with some of the nation's top hospitals on these very efforts.

1. Understand how patient experience impacts quality, safety and efficiency. Hospital leaders need a deeper understanding and awareness of the impact the patient experience, both on patient experience scores and the culture of the organization. According to Dr. Maples, that understanding is critical. "It's way more than a score. It's way more than reimbursement for [scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey]. It's really about how we show up to work each day and the conversations between our patients and each other," he says.

Patients want a transformation from a provider-centered approach to a patient-centered, team-based approach. Although physicians and caregivers work in teams, each and every decision often is not made with consideration to the patients' perspective. According to Dr. Maples, putting the patient at the center of every decision will improve their experience, as well as their outcomes.

"The culture of our organization is determined by the moment-to-moment conversations we have with patients and with each other," says Dr. Maples. "By focusing on communication skills that foster presence and mindfulness, reflective listening, efficient gathering of accurate information and connecting with patients and each other by recognizing emotions and responding appropriately, we can close the gaps in what patients want and what they receive."

2. Invest in providing physicians and caregivers skills. Learning about communication in a skilled-based learning format, where physicians and caregivers are actually practicing skills they need, can position a healthcare organization for improvement on all levels.

"We have no problem investing in a new machine, or a new technology, a new training, but the thing that's the most fundamental to what we do — communicating and connecting with patients and each other —we just assume that's going to happen. And we can't assume anymore. We have to make an investment in developing communication skills for our providers," Dr. Maples says.

Without addressing these foundational skills, he says an organization's transformational journey will be slow and ineffective.

3. Engage physician leadership. Physician leaders are not always part of the conversation on how to improve the patient experience, but it is necessary to invite them to lead this effort.

"How in the world can we change a system if we don't engage the leaders?" Dr. Maples says. "Engage physician leadership and believe in them...Their desire to help others, to improve a patient's life, is really at their core. It's why they went into medicine in the first place and it's what they really want to deliver."

The key to a successful communication initative, says Dr. Maples, is identifying physician leaders who support the effort to rekindle relationship-based communication tools. Once identified, train them to facilitate skills-based work with their colleagues to enhance the entire team's communication skills. Respected physician and allied health facilitators creating a safe place to practice and nurture communication enhances the learning and helps incorporate these skills into everyday conversations.

"There is no shortage of physicians and caregivers who are willing to help improve the patient-physician relationship, as long as they know that leadership embraces the work and there is a commitment to supply the resources needed to do the work. We just have to nurture that and bring it forward," Dr. Maples says.

4. Be patient. There is often a need for immediate gratification when it comes to improving patient experience scores or creating a positive culture change. Healthcare leaders want to see scores go up next month and witness the shift to a patient-centered, team-based culture, but neither of these are brisk tasks.

"We are talking about a culture change, which takes time, and you need to plan this work so it can take root and be woven through the fabric of the organization," Dr. Maples says. "It is not an overnight weave. It's a planned, methodical implementation over a few years. Be patient, be diligent and put the patient at the center of every decision, and you can watch patient experience scores and quality metrics improve.

Dr. Maples says it takes once an organization invests in the cause, it takes about six to nine months to observe a meaningful sustained gain. Providing peer-to-peer communication training for nurses, allied health professionals and others with direct patient and customer contact further strengthens a culture where the patient-physician relationship can improve.

5. Plan to engage every single person on the caregiver team. This includes employees from the business office and environmental services to nurses and physicians. "This is about how people will show up and act as a team," Dr. Maples says. Healthcare organizations "need physicians to lead the team, but must also have people on the team begin to hold people accountable for how they show up and put the patient at the center."

The in-house leaders must promote internal sustainability. Each new employee needs to participate in communication training. Curriculum addressing specific needs of an organization should be developed to incorporate the communication skills and allow for continued reinforcement of these skills, according to Dr. Maples.

"We can be great technicians, but unless people know how much we care, they don't care how much we know. That's our challenge. It's the moment-to-moment conversations. It's the way we interact. These are the things that let people know we care," Dr. Maples says. "By creating an exceptional experience, we create a culture of safety. As a culture of trust and teamwork grows, patient-adverse events decline."


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