DOCTOR PATIENT COMMUNICATION

1. ENGAGING PHYSICIANS MAKING IMPROVEMENTS IN PATIENT EXPERIENCEFebruary 18, 2009 PHYSICIANS MEDICAL GROUP OF SANTA CRUZNancy Greenstreet, MDMedical DirectorLinda MuhoberacQuality Improvement

2. DOCTOR PATIENT COMMUNICATION • Teach principles of Agenda Setting •  2 Workshops on Improving Doctor Patient Communication • Dr. Dan O’Connell – workshop leader • Agenda Setting Article, Agenda Setting form • Buy-in – Set a tone of collaboration, be flexible • Teach one, try one, evaluate/praise, spread

3. EFFECTIVE TECHNIQUES • Demonstrator site meetings • Meet with one or two physicians at demonstrator sites •  Bring lunch •  Discuss CQC Collaborative and Agenda Setting   PMG is involved in a state wide collaborative and we are learning about some interesting things that can make a PCPs life easier. One of them is Agenda Setting. It is so cool. It’s a way of structuring the office visit so the patient and the doctor feel they accomplished something. Basically, most doctor visits are a doctor-centered visit, a patient- centered visit or a patient-centered visit with agenda setting. A patient centered visit with agenda setting is more like a partnership, rather than the patient or the doctor running the show. (tone of collaboration)

4. Review Agenda Setting http://www.aafp.org/fpm/20080300 • Promote Workshops • Soon, we are having an expert come to town to hold a workshop on a Saturday to talk in more detail about how to do Agenda Setting. If you think about this you will see how it can work for you. (buy-in) • What happened • One meeting was set up with 2 PCPs • 2 other PCPs decided they wanted in on the meeting – we all shared the food • Hint: bring plenty of food and extra handouts in case other PCPs ask to join (be flexible) • Repeat – Continue to meet with PCPs and introduce concepts of Agenda Setting

5. Workshops with Dan O’Connell • Improving Clinician/Patient Communication • Difficult Clinician/Patient Relationships • Marketing  Not enough PCPs could attend because of family issues (be flexible)  PMG opened the workshops to specialists as well.  Emailed and mailed invitations  Phone call follow-ups to non-responders  CME credit and $200 honorarium

6. Follow-up After Workshops • Email physicians about their success with implementation Keep in mind each person’s comments as to what first step they would take • Respond to email comments • When visiting offices for other reasons, ask PCPs how agenda setting is working for them to tie agenda setting into their every day work flow • One “Champion” sounds just like Dan O’Connell

7. ACCESS • Teach principles of Open Access • Dr. Neil Solomon Workshop on Open Access • Teach tools to track physician availability in office 3NA (third next available appointment) Open Slots/Fill Times • Meet with all physicians in one practice site • Share data and graphs • Buy-in by practice site • Look for champions

8. TOOLS FOR IMPROVING PATIENT EXPERIENCE

9. Re: Doctor/Patient Communication Workshop Dear Doctor: PMG and the California Quality Collaborative are sponsoring a workshop with 4.0 CME creditsANDa $200 honorarium for each physician who attends. Topic: Doctor/Patient CommunicationWhere: PMG Offices, 5200 Soquel Avenue, Suite 103When: Saturday, June 14, 9am-1pm (food provided)Register TodayThe number of attendees will be limited to make sure all your questions are answered. To save your seat, register with Nancy Greenstreet, MD, PMG Medical Director, via email ngreenstreet@pmgscc.com by June 9, 2008. About the PresenterOver the last 25 years, Dr. Dan O'Connell has worked as an educator, consultant, clinician, department chair and executive director in medical, behavioral health and educational settings. Dr. O'Connell teaches in the Residency Programs at the University of Washington School of Medicine and maintains a coaching and consulting practice. Discuss and use 4 components of good patient communication: Engage, Empathize, Educate, Enlist Happy Patients, Happy Doctors. Nancy Greenstreet, MD Medical DirectorPhysicians Medical Group of Santa Cruz CountyT: (831) 465-7819E: ngreenstreet@pmgscc.com

11. Available Appointment Tally Sheet

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13. Testimonials from PMGSCC Physicians “The (Dan O’Connell) workshop was wonderful. I have used it daily and it seems to work really well with most of my patients. Agenda setting works! It can be a challenge at times with those patients who like to talk, but not any more challenging than the prior interactions. What I have found is that I have to let go of my own Agenda unless ample time. This helps me feel less rushed/anxious/etc. I am Working on Embracing the Chaos!” “I have definitely used the agenda setting with many of my patients. At first I found it much harder than I thought it would be. It disrupts the normal conversation flow of the encounter- which I like to use to help people feel comfortable. The agenda setting makes me feel like I'm being abrupt, cutting them off. But it's getting smoother. People are at first taken aback by my new approach, but I explain it helps me make sure I don't miss anything they want to talk about. So when they come up with ‘just one more thing....’ I feel better about postponing the issue to another visit.”

14. Testimonials from PMGSCC Physicians “I've tried agenda setting with nearly all my patients. It seems to be good to learn their expectations up front. I certainly don't have the finesse that Dan possessed, but practice makes perfect. I've had less practice with the question/pause technique. As a young doc, I still talk more than listen (knowledge/ego/insecurity talks, -- wisdom listens).” “Dan O’Connell also helped me realize I talk too much. I need to give a brief answer and shut up while they process it. And I need to accept that I can't review all major issues at every visit. I have to trust that if they don't tell me about it, it's probably not acting up. I found that seminar incredibly helpful.” “I am trying agenda setting with all new patients and now on day four it is becoming easier and more rote and I don’t feel like I am reading a script. PSH (psychosocial history) I have been doing for some time now and patients really feel you do connect with them when you can remember a nonmedical fact about their last visit. ”