The Key to Engaging the Patient- and the Physician
It’s a conundrum that crosses industry lines. Put the highly-skilled, socially-awkward person up against the friendly, less talented one, and it will be charm that wins over the consumers. While it’s an annoying scenario in the retail industry, in a health care setting the implications are more disturbing.
When a gifted diagnostician or clinician lacks the skills to put patients at ease, it can negatively influence whether a patient adheres to medical advice, jeopardizing a positive outcome.
How can hospitals break down this barrier? When it comes to personality-challenged care providers, the best patient engagement strategies might just require a combination of good manners and good patient data.
The Good Doctor versus the Good Listener
In a recent article, H&HN recounts a “Jekyll and Hyde” tale pulled from Johns Hopkins surgeon Martin Makary, M.D.’s book, Unaccountable. The story highlights the challenge of great talent versus great bedside manner.
One surgeon treats colleagues, nurses, hospital staff and patients equally — he’s insufferably condescending. He’s also the most successful surgeon in terms of technical skills and low complication rates. The other surgeon is universally adored, but has abysmal error and complication rates and a reputation for performing unnecessary procedures.
It might seem that the choice — for both patients and hospitals — is obvious. Who wouldn’t choose obnoxious but excellent over caring but questionable? Yet, as H&HN points out, perception sometimes trumps reality, noting that “…at least one study has found that a surgeon’s ability to project compassion translates, not surprisingly, to higher patient satisfaction.” And the words “higher patient satisfaction” make hospitals sit up and take notice, especially when 30 percent of Medicaid reimbursements for in-patient services rest on HCAHPS survey results.
Guided by the Hippocratic Oath, hospitals are unlikely to start hiring physicians with winning personalities over those with superior abilities, but they are looking at ways to inspire better bedside manners. Why? Because more than patient satisfaction scores are at stake.
Study results published in the March 2011 issue of Academic Medicine found that diabetic patients of physicians with high empathy scores maintained control of A1c and LDL-C levels superior to patients of physicians with low empathy scores by a margin of 15 percent or more.
The study confirmed a direct correlation between empathy, perceived clinical competence and patient outcomes. And it’s not the only study to do so.
One doctor writing in the Los Angeles Review of Books, notes “Researchers find that patients of empathic doctors are more likely to take their medications as prescribed and achieve better control of conditions like diabetes and asthma, and are less likely to initiate malpractice suits.”
Six Steps for Reviving ‘Old-Fashioned’ Etiquette
Unfortunately, studies have also found that the pressures of medical school and residency wrings the empathy out of young physicians. And experts disagree on whether empathy can even be learned, suggesting instead that it is a personality trait that you either have– or you don’t.
Good manners, on the other hand, can be taught.
Michael Kahn, M.D., a psychiatrist at Boston's Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School suggests that “a doctor who has trouble feeling compassion for or even recognizing a patient's suffering can nevertheless behave in certain specified ways that will result in the patient's feeling well treated.” Rather than attempting to force empathy, Kahn recommends taking these six steps when meeting with a hospitalized patient:
- Request permission to enter the room and wait for a response.
- Introduce yourself and present your ID badge.
- Shake hands, wearing a glove if needed.
- Sit rather than stand so you are at eye-level with the patient and smile, if appropriate.
- Explain your role in the patient’s care team.
- And ask the patient how he or she feels about being in the hospital.
These steps may not showcase a huge amount of personality, but they are an effective method for making patients feel like they are being heard.
Consumer Insights Identify Characteristics of High-Satisfying Physicians
My team at Procter & Gamble conducted extensive research on the drivers of patient satisfaction and consumers’ perception of the “Ideal Patient Experience.” We also pursued research on physician motivations and practice style. We were able to identify gaps between patient and physician expectations, and this translated to the words physicians used to describe their “Ideal Patient Experience.”
Physicians who focused only on the disease and not on the patient as a person dehumanized the patient. Physicians who considered the patient’s feelings and the total impact a disease may have on the patient’s daily life had a very different description of excellent patient engagement.
While collaborating with several large medical institutions (Cleveland Clinic, HealthCare Partners, Jackson Clinic), we interviewed many technically excellent physicians to see how they describe a satisfying patient engagement. Representatives from these institutions attended the focus groups armed with the participating physician’ patient satisfaction scores. My team tried to guess which physicians had high and low patient satisfaction scores based on their word choice.
We were very accurate in our predictions, impressing our medical institution guests with about an 80% hit rate. They asked how we knew, and we explained we had become fairly adept at analyzing word choice and comparing this to consumer insights regarding patient satisfaction. We hypothesized that we could use this information to develop a resource to help organizations identify physician candidates who were likely high patient satisfiers.
We developed the Physician Interview Tool, which could be integrated into an organization’s standard interview process with a small investment of time in training. The validation research for the Physician Interview Tool showed a 72% exact match rate between patient satisfaction and an interviewing team’s predictive assessment. The results of this work were reported in Recruiting Physicians Today, from the publishers of the New England Journal of Medicine.
For hospitals and other organizations that want to take patient engagement strategies even further, the consumer expertise of c2b solutions and the deep insights and market research available in the c2b Consumer Diagnostic can help health care providers better understand consumer motivations to increase patient activation.