Support Value-Based Care with Improved Communication

4 Quick and Easy Actions Providers Can Take Today
By A. Lane Therrell FNP-BC, RN, HTCP and Iris Grimm

In this article, a nurse practitioner and an executive coach team up to examine the importance of improving provider-patient communication in value-based care. The authors address some of the objections some providers may have to take a deep dive into the world of communication improvement and offer four quick and easy actions providers can use immediately to build successful partnerships with patients, all in the name of enhancing value-based care.

How important is your communication with patients? Whenever healthcare organization leaders focus on value-based care, patient communication is likely to emerge as the first and most critical piece of the entire provider-patient relationship. The key to providing value-based care is getting the patient actively involved in the care process from intake to discharge and beyond. While the most fundamental way to accomplish this is for providers to refine and improve their one-on-one communication skills, many providers resist putting effort into doing so because they do not fully appreciate the relationship between communication and value-based care, and they may think the time it takes to develop their interpersonal communication skills is time wasted.

Many healthcare providers consider their clinical skills and medical knowledge to be their most valuable assets. While skills and knowledge are indispensable tools, they become decidedly less effective when the conversations through which they are delivered fail to engage patients or earn their trust. Interestingly, skilled communication is the single most effective way to earn a patient’s trust and engage him or her in the care process.

Indeed, effective communication with the patient is the foundation for safe, effective, value-based care. Traditionally, the relationship between the healthcare provider and the patient has been defined by a top-down information flow. The provider is the expert who tells the patient what to do while the patient takes on a subordinate role and defers to the provider’s wisdom without question. This type of relationship is one-sided and tends to make the patient into more of a passive bystander than an active participant when it comes to restoring and maintaining their health.

Although it may be tempting for highly educated providers to believe they already know everything there is to know about communication, most providers are delighted to discover that their patients benefit substantially once a trusted partnership is established with their patients. When patients become engaged, as active participants in their own care, their outcomes improve. For providers to deliver value-based care, a relational shift from top-down to partnership is required. And what that means in everyday terms, is providers must begin to communicate with their patients differently.

If healthcare leaders have long acknowledged the value of improving interpersonal communication skills, why are these skills not given more emphasis by providers? One of the most common obstacles that prevent healthcare providers from committing to improving their communication skills is a misperception that quality communication requires an inordinate amount of time.

Time management is an understandable priority for providers when only 8-15 minutes are allotted for individual patient encounters, and running behind schedule is an unfortunate daily reality. On the surface, asking additional questions to the patient in further conversation may seem counterintuitive, if not downright counterproductive and stressful. The provider must wait for answers, and if the patient doesn’t have them, the provider must ask different questions. Meanwhile, the clock is ticking…

However, providers who continue to doubt the value of improving their interpersonal communication strategies are reminded that the number of patients seen per day does not define value-based care. The metrics of success are different when value-based care is the goal. Prioritizing value over volume shifts the approach to relationship-focused care delivery, which sets a good foundation for building successful provider-patient partnerships.

The great news for providers is that improving communication with patients does not necessarily mean spending more time with each patient during an encounter. Slight modifications to the approach to care are often all it takes to significantly improve communication. Here are 4 simple actions providers or anyone with direct patient contact can begin using right away to support value-based care through improving communication with patients.

1. Collect your thoughts and focus your intentions.
   Before you step into the room, check your own As Jill Bolte-Taylor, author of A Stroke of Insight, wrote, “You are responsible for the energy you bring to the room.” If you are stressed, annoyed, rushed, or overwhelmed, your patient will pick up that energy and automatically have a defense response. This may diminish the patient’s comfort level to an extent that prevents her from revealing critical information. Some patients may even internalize the feeling and jump to the conclusion that the provider is annoyed by them. Avoiding this scenario can be incredibly simple. Prior to each encounter, center your energy and focus your intention by taking a deep, focused breath, repeating a mantra, or simply glancing out the window for a moment. Choose a method that works for you and integrate it into your routine.

2. Acknowledge your own humanity.
   If you are running late for an appointment and fail to acknowledge that to the patient, the patient may be annoyed and feel his time is disrespected. The patient’s frustration may lead to negative evaluations on exit surveys. More importantly for the patient’s health, the patient may not feel safe to reveal critical information to you because he feels you cannot be trusted. Even if a lack of trust is not a fully-formed conscious thought on the patient’s part, the unnamed feeling can contribute to a lack of engagement.

3. Make Physical Contact.
   Both eye contact and physical contact are important in creating a bond with the patient. Eye contact becomes simple to achieve when you have implemented numbers 1 and 2 above. Physical contact implies either shaking hands or touching the patient appropriately on the arm or shoulder in the name of reassurance. Neuroscience has discovered that physical touch raises the oxytocin level. Oxytocin is an important bonding hormone that signals the body that the other person can be trusted … or not. As such, physical contact is the basic building block of trust. Throughout human history, many of our interpersonal gestures and communication rituals have anecdotally demonstrated their efficacy and value. Today’s advances in neuroscience provide the scientific evidence to support how and why they work so well.

4. Build rapport.
   One simple and effective way to continue building rapport after trust is established is to ask a light personal question or make a polite comment first thing, before diving into the substantive medical content of the encounter. Starting a brief conversation with the goal of finding something in common with your patient automatically builds trust. Discovering that you both like dogs, grew up in the same city, or enjoy the same hobby, not only creates an enjoyable interaction during the current encounter but sets the stage for meaningful conversation starters at future encounters. This has benefit for both the patient and the provider.

While an organizational commitment to value-based care does not require providers to add tasks to their overly busy workdays, it does require a more conscious approach to communication overall. Healthcare providers who embrace practices for improving their communication skills with patients are likely to observe that their contributions to the healing and well-being of their patients are more successful and more appreciated. Improved communication represents a win for all stakeholders because it not only supports compliance with administrative directives but can improve patient outcomes as well as providers’ job satisfaction.

Among myriad methods for improving communication, Conversational Intelligence (C-IQ) combines findings from cutting-edge neuroscience research with practical communication tools in a methodology focused on building trust and creating healthier conversations.

About the co-authors:
A.Lane Therrell is a board certified Family Nurse Practitioner in California and a clinical nursing instructor at Samuel Merritt University. She is a certified Conversational Intelligence (C-IQ) Coach, and a Healing Touch Certified Practitioner.

Iris Grimm is a healthcare leader and executive coach located in Atlanta, GA. She is also a certified Conversational Intelligence (C-IQ) Coach. For more information, visit http://CultivatePhysicianLeaders.com.