Published in the December 2018 issue of Today’s Hospitalist
TO IMPROVE YOUR BEDSIDE SKILLS, Stefanie Simmons, MD, director of patient experience and clinician engagement for Envision Physician Services, has this advice: Make small talk everywhere you go, particularly where people don’t know you’re a doctor.
“Kids’ schools are great and so is the gym and the checkout line at the grocery story,” says Dr. Simmons, an emergency physician based in Ann Arbor, Mich. “Learn how to make people smile during your interaction with them, then transfer those skills to your clinical work.”
Eight years ago, Dr. Simmons helped pioneer peer coaching to boost clinicians’ communication skills at one Michigan hospital. She expanded that program to dozens of Midwestern emergency medicine and hospitalist groups as part of her work with Emergency Physicians Medical Group (EPMG), which Envision later acquired. Now, she plans to pilot peer coaching in Envision groups throughout Florida, Texas, Nevada and southern California, then roll it out nationally.
“The feedback program is fairly high touch, with each session taking about three or four hours.”
~ Stefanie Simmons, MD
Envision Physician Services
“We have about 25,000 employed or affiliated doctors and advanced practice providers in 1,800 sites of care,” says Dr. Simmons. “With 2.4 million hospitalist visits a year, we want to make sure they all have excellent communication with their clinicians.”
New hires to intensive coaching
The peer coaching program has three separate components. One targets new hires, with each newly-hired physician, PA and NP receiving peer observation and feedback. The goal is to reach 80% of all new hires within 120 days.
“How well you do depends on the people on the ground and the site champions,” Dr. Simmons says.
The second group being targeted is every member of Envision’s hospitalist groups. Once a year every year, they will participate in personal peer observation and feedback. Like peer coaching for new hires, “the feedback program is fairly high touch, with each session taking about three or four hours.” Given that some hospitals have 40 or 50 clinicians, “we have an army of volunteers at some sites.”
The third tier is intensive coaching for clinicians actively struggling with communication skills. They have received significant complaints or are “reliably scoring poorly on whatever metric the hospital chooses to use to measure performance.”
Peer coaches develop a performance improvement plan for these clinicians that can range from “better schedules if they’re going through a tough time in their personal lives to plugging them into employee assistance programs for counseling or financial planning,” Dr. Simmons says. Peer coaches also do clinical role-playing when these clinicians have trouble communicating around a specific issue.
“Opioid communication is a very common thread where people have complaints,” she points out. “You have to be able to both draw the line and use opioids appropriately with compassion for the patient.”
Another problem area: leaving against medical advice. “A clinician’s ego may get in the way and it turns into a tug-of-war,” she points out. “If you approach the situation collaboratively, you can often get people to stay.” About 1% of clinicians need intensive coaching, Dr. Simmons says, and “our success rate is better than 50%.”
What did you do well?
Peer coaches in the first two tiers are volunteers who receive four hours of training.
“We ask volunteers to commit to doing one observation every month or two,” Dr. Simmons points out. Those doing intensive coaching attend two workshops a year, receive stipends and dedicate about 20 hours a month.
The structured feedback in each tier encourages clinicians to evaluate themselves. After each patient interaction over the course of several hours, the coach asks the observed clinician how he or she feels that interaction went.
The peer coach then asks: What are two things that went well and what two skills did you use to make those go well? What were two areas that could have been improved, and what one item are you willing to commit to working on?
As for the coaches, “they are often in the same specialty as those they’re observing,” says Dr. Simmons. But clinicians from other specialties are “just as good at giving feedback, and NPs and PAs can give feedback to physicians and vice versa.”
There does tend to be a trend toward improved Press Ganey scores when coaching is in place— and one other big benefit is clear: “It’s a constant reminder that this is a critical part of the group culture.”
Better communication and connection also have a big impact on mitigating burnout. “It’s important to feel positive about your work every day,” Dr. Simmons notes. “That’s a great source of satisfaction.”
But while the company is working to improve communication skills, those skills aren’t tied to financial incentives. “I feel strongly that communication and patient connection should be formative, not compensation-based,” says Dr. Simmons. “I don’t want those to be about what you’re paid. I want them to be about why you go to work in the first place.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.
• Sit down! “The first advice I always give is to sit down with every patient,” Dr. Simmons says. “Docs need to be reminded of how important that is to patients.”
• Pay attention to body language. Clinicians are often unaware of what their body language, positioning in a patient’s room and facial expressions project. That’s particularly true at the end of an overnight shift.
“They look very uncomfortable, they have closed body language with their arms and legs crossed, and their expression isn’t open or friendly,” even when they’re trying to help patients, she points out. “We talk a lot about being mindful about how you present yourself.”
• Give patients time. Many clinicians need to be reminded to give patients enough time to talk or ask questions. They also need to really dial back on the medical jargon. “We forget that this is a language our patients don’t speak,” Dr. Simmons says. “Having another set of ears in the room can pick that up.”
• Engage. That means socially, not just clinically. “Have a brief conversation about the weather or the card a grandchild made,” she says. “You need to connect with patients as people, not just as a disease process or workflow.”
• To script or not to script? Scripts are fine, says Dr. Simmons—as long as clinicians develop them themselves in their own voice. “If I try to follow a script written for me by someone else, it’s always going to ring false,” she says. “I use the word ‘practice,’ not ‘script.’ ” And practicing with a friend or family member who doesn’t have a medical background “can be a great way to understand how you’re coming across.”