The Stanford Patient-Physician Communication Project

1. The Stanford Patient-Physician Communication Project Graduate Medical Education Stanford University Medical Center Ann M. Dohn, MA Designated Institutional Office Nancy Piro, PhD Education Specialist / Program Manager

2. Why Are We Doing This? • Because we have to?

3. ACGME requires (IV.A.5.d).(4) • Residents must: • systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;

4. Why Are We Doing This? • Because we want to?

5. Patient Satisfaction Data • The Picker survey demonstrated need for better communication between physicians and patients…

6. Added factor New CEO….“Healing humanity through science and compassion, one patient at a time” C-I-C-A-R-E C - Connect with patients by addressing them as Mr./Ms. or by the name that they prefer I - Introduce yourself and your role C – Communicate what you are going to do, how long it is going to take, and how it will impact the patient A – Ask and anticipate patient needs, questions or concerns R – Respond to patient questions or requests with immediacy E – Exit courteously and/or with an explanation of what will come next (what you will do for them next)

7. The Charge to the Chief Residents: • Design and implement a quality improvement project that impacts or involves the majority of the residents and fellows. • 1% salary bonus as an incentive

8. Chief Residents and GME’s Collaborative Solution • Create “teamcards” to identify residents/fellows to patients • Develop a BRIEF training module on resident/patient communication • Pre Interview of Patients: Do they know their residents’ names?

9. Effectiveness Research • A sample of 300 Patients were interviewed prior to Teamcard Distribution and Implementation by GME and Process Excellence Staff

10. Data Sheet: Teamcard Chief Residents’ Project Data # PRE POST Age: Gender: Dx of Cognitive Impairment: YES No Is yes, DSM Dx: ______________ Do you know the name of your primary resident physician? YES No __________________________________ (Name Given) Additional Comments:

11. What did our PRE-Initiative Survey Show? • 98% of the patients interviewed did not know the name of their resident physician. • Many did however know their attendings’ names. • Many patients told us they thought it was a “great idea” …I can take home with me and it will help me remember my physicians’ names….. nurses need these, too

12. Chief Residents QI Project“Teamcards” Goals • To improve communication with patients • To better identify the care team • To improve patient engagement • To better connect with patients

13. Implementation Steps • Communicate Plan and Project Goals • Announce training • Distribute the cards and implement • Measure effectiveness of new model • Post Interview of Patients

14. Effectiveness Research • A second sample of 300 Patients will be interviewed post Teamcard Implementation to determine the impact/ effectiveness of using Teamcards.

15. ACGME Requires( IV.A.5.e) • Interpersonal and Communication • Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. • Residents are expected to: • communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;

16. Teamcards Implementation and Training GME Announced: All residents/fellows (including departing house staff) must take the Teamcards/C-I-CARE (3 minute) module on Healthstream before June 1, 2011 https://www.healthstream.com/HLC/Login/Login.aspx?organizationID=6a27bcaa-71bd-db11-bf7b-000423d6b5c1&bhcp=0 We required 90% compliance with course completion by ALL house staff to qualify for 1% salary incentive in late June D-E-M-O

17. Implementation Details • Residents/fellows on inpatient rotations at SHC started using their “teamcards” this month • “Kick-Off” Meetings were held and cards were distributed via the departments.

18. What in it for the residents?* INCENTIVE BONUS*

19. And when will the residents see the $$$? • Last paycheck in June or their final paycheck if they are graduating this year! • GME is keeping the residents updated on the progress toward the goal of 90% compliance with the training.

20. Obstacles We Encountered • The great LOGO debate… • How many pixels are required for a good photo? • Aren’t the residents always available for a professional photographer? • Can’t visiting residents get their pictures taken, too and get cards? • Are visiting residents like community physicians? • Once the initiative took off, it was no longer the Chief Residents’ Project • Faculty Teamcards, too

21. Even our Faculty Wanted Teamcards

22. Summary CICARE C-I-C-A-R-E

23. Questions? CONTACT INFORMATION ~ Ann M. Dohn, MA Designated Institutional Official adohn1@stanford.edu Nancy Piro, PhD Education Specialist/ Program Manager npiro@stanford.edu