Hands-on Skill Building for Improved Communication

1. Hands-on Skill Building for Improved Communication Deborah Deatrick, MPH MaineHealth Sue Stableford, MPH, MSB University of New England May 8, 2008

2. Why focus improving communication? • Increased quality measurement and reporting • Shift to consumer-driven health care • Growing burden of chronic disease • Changing demographics • Improved health status • Increased regulatory and licensing standards • Rising costs

3. Why focus on health literacy? Quality of Care Patient-centered Care Cost of Care

4. Learning objectives for this workshop: • Ability to describe the scope of the health literacy problem in the US. • Ability to identify and link key health care trends to health literacy. • Understanding of three evidence-based tools to improve communication. • Ability to apply the Teach Back Technique.

5. Communication is key to person-centered care and community-centered public health. Often, adults lack skills to understand and act–and professionals don’t know it.

6. The Institute Of Medicine2004 report “We envisage a society in which people have the skills that they need to obtain, interpret, and use health information effectively, and within which a wide variety of health systems and institutions take responsibility for providing clear communication and adequate support to facilitate health-promoting actions.” (p241)

7. Joint Commission reportFebruary ‘07 “Patient-centered communication is the linchpin of patient-centered care.” (p 31) “65% of sentinel events have been found to have communications failures as the underlying root cause.” (p 48)

8. AMA ReportFall 2007 “As self-care demands on patients increase, so does the importance of clear communication between the health care community and patients.” (p11)

9. The communication mismatch between professionals and consumers is profound.

10. For most adults, public health and healthcare are foreign countries. The language, territory (anatomy), and systems are unfamiliar.

11. Health literacy = using literacy skills to accomplish health-related tasks. • Health literacy challenges: • Media • Formats • Locations • Topics • Tasks Health literacy includes oral skills.

12. An added burden for nearly ½ of American adults  limited literacy skills. The 1992 National Adult Literacy Survey • Prose, document, and and quantitative tasks • Tasks and results scored in levels 1 - 5 • Levels 1 & 2, roughly reading grades 5 — 8 • = 90 million adults (48%)

13. The 2003 NAAL: results similar to 1992 Prose Literacy Skills of American Adults 28million 95million 63million 30million

14. Despite limited adult literacy skills, most health information 10th grade level+.

15. 2003 NAAL health literacy results:12% of adults have Proficient skills.

16. Health literacy challenges everyone.Demographic, health technology, and health delivery trends  clear communication need.

17. Tool No. 1: Health Literacy Environment Audit* • Structured assessment • Includes: • Navigation • Print Communication • Oral exchange • Technology • Policies and Protocols • Ratings • Not done • Needs Improvement • Done Well *The Health Literacy Environment of Hospitals and Health Centers; Rudd, et. al., 2004.

18. Tool No. 2: Ask Me 3* • Promotes three simple questions for patients to ask their providers: • What is my main problem? • What do I need to do? • Why is it important for me to do this? • Social marketing campaign • Brochures • Buttons • Stats at a Glance • PowerPoint • Words to Watch *National Patient Safety Foundation, 2008

19. Tool No. 3: Teach Back Technique • Clinicians take responsibility for teaching – do not appear to be rushed, bored, or condescending. • Does not result in asking “Do you understand?” • Instead, ask patients to explain in their own words or demonstrate what they will do. • If patients cannot explain or demonstrate, then use an alternate approach.

20. Yes –no Tell back collaborative Tell back directive “I’ve given you a lot of information. Do you understand?” “I imagine you’re really worried about this clot. I’ve given you a lot of information. It would be helpful to me to hear your understanding about your clot and its treatment.” “It’s really important that you do this exactly the way I explained. What do you understand?”* - Kemp, et al, JABFM, Jan – Feb 2008 Types of Physician Questions

21. Using Teach Back in Practice Mr. Dobbs is a 66 year old retired plumber with Type 2 diabetes and hypertension. Hypertension was diagnosed five years ago (was 160/90). BP control was gradually achieved but has risen since then. Mr. Dobbs’ blood sugar is also variable and appears to be worsening. He does not consistently monitor blood sugar at home and his most recent HbA1C’s have been rising. He came in today for a routine BP recheck. Next steps, as of the end of the visit, are for Mr. Dobbs to take his blood pressure medicine twice a day (not once), check his blood sugar daily, and consult with a nutritionist.

22. Role Play • Find a partner. • Decide on roles (Dr. Jones and Mr. Dobbs) • Look at the case study and next steps. • What happens at the end of the visit? • What does Dr. Jones say? What does Mr. Dobbs say? • How does it end?

23. What would YOU say? • Can you walk me through what we’ve just discussed? • Let’s summarize what we’ve talked about today. • Is there anything that you can think of that might keep you from doing what we’ve discussed? • Describe what you’re going to do tomorrow. • Other?

24. Implementing Teach Back • Try it out on a colleague or the last patient before lunch. • Start with patients you think will be receptive. • Find the “script” that works for you. • How do you envision implementing this on Monday?

25. Contact Information Sue Stableford, MPH, MSB Director, Health Literacy Institute University of New England sstableford@une.edu Deborah Deatrick, MPH Vice President, Community Health MaineHealth deatrd@mmc.org