The largest study to date evaluating communications skills training for physicians, researchers demonstrated that a well-designed program can have significant positive impact on both physicians and patients.
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The observational study, comparing 1,537 attending physicians who participated in communications skills training with 1,951 physicians who did not, showed statistically significant improvements in empathy and burnout among physicians who completed the program. The study also showed improved patient satisfaction scores, assessed through inpatient and outpatient satisfaction surveys. Ratings for physician communication, particularly in respect, clear information, and know medical history showed significant improvement.
Neurologist Adrienne Boissy, MD, MA, Chief Experience Officer, along with colleagues in the Center for Excellence in Healthcare Communication published the research in the Journal of General Internal Medicine.
The course is a mandatory eight-hour program for all Cleveland Clinic physicians.
“By conducting this research, we hoped to provide evidence to back up this important program and be able to tell a story that would grab people’s hearts and minds,” says Dr. Boissy. “We hope our evidence proves helpful to other organizations, both large and small.”
Ready for R.E.D.E
The Cleveland Clinic course, R.E.D.E. to Communicate: Foundations of Healthcare Communication (FHC)SM, focuses on building relationship-centered communication. R.E.D.E., which stands for Relationship: Establishment, Development and Engagement, is co-facilitated by practicing clinicians. The training involves improv methods, interactive presentations, live or video-based skill demonstrations and a small group skills practice session, followed by time spent on the most frustrating communication challenges participants have actually experienced.
Physicians in the study completed a pre- and post-course survey, including self-assessment of communications skills, knowledge and attitudes; the Jefferson Scale of Empathy; and the Maslach Burnout Inventory.
Centers for Medicare and Medicaid Service (CMS) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) scores were used to assess patient satisfaction and physician communication. Researchers assessed the survey scores six months before and six months after the intervention. Differences in pre- and post-scores were adjusted for gender, race, years in practice and baseline scores.
Yes, it’s worth the time and effort
Physicians in the intervention group reported that the course was a valuable use of their time and that skills taught were both relevant and feasible to implement in their practices. The group reported significant improvement in empathy and burnout, according to measures of emotional exhaustion, sense of depersonalization, and personal accomplishment compared to controls (Table 1). Even when adjusted for type of physician and baseline scores, the course significantly improved outpatient satisfaction scores and the respect domain of inpatient satisfaction scores in the intervention group.
Training anchors physicians to meaning and purpose of work
“Our findings regarding the impact of communications training on burnout are particularly relevant in this day and age,” says Dr. Boissy. “We are asked to do more with less, and faster. And no space exists where clinicians can come together and talk about their greatest challenges, the moments that haunt them — people dying in their arms and not knowing what to say to the family. Or having to tell someone you’ve never met that they are going to die. Creating a space that helps draw out these issues and provides a safe, shared, facilitated experience to discuss them can relieve some of the pressure and actually be therapeutic.”
Dr. Boissy describes relationship-centered communications as a model in which clinicians and patients both bring value, share a common purpose or goal, and have reciprocal influence. While encouraging this type of communication, the course leverages what makes healthcare professions special — the unique and sacred relationship between practitioner and patient, Dr. Boissy says. “The course is really an attempt to anchor physicians back to the meaning and purpose of their work.”
Dr. Boissy recently recorded a podcast with NEJM Catalyst’s Thomas Lee, MD, MSc, that reviews 30 years of research demonstrating the importance of communication skills to everything from patient experience to preventing malpractice.
A new book published by Cleveland Clinic, Communication the Cleveland Clinic Way, edited by Dr. Boissy and Timothy Gilligan, MD, MS, a medical oncologist and Director of Coaching at the Center for Excellence in Healthcare Communication, describes the R.E.D.E. course and how to implement it.
Cleveland Clinic offers a multi-day Patient Experience Leaders Forum, covering topics ranging from building and operationalizing a patient experience strategy to sustaining and sharing a patient-focused culture across a multifaceted healthcare organization.