Use a checklist to improve communication in patient visits

Oak Street Health patient and doctor
Patients need doctors who can practice the art of healing. (Courtesy of Oak Street Health)

Just as doctors use a standardized checklist to improve safety in the operating room, they can use a checklist to improve the patient experience during office visits, a healthcare network in Hawaii discovered.

Hawaii Pacific Health, a nonprofit network of hospitals, clinics, physicians and care providers, saw its overall performance on physician communication scores on patient surveys improve dramatically after it used the checklist and a coaching program to improve some doctors’ communication skills. Indeed, the organization's scores jumped from the 54th percentile to 75th percentile over a one-year period for a group of 200 doctors, wrote Dale M. Glenn, M.D., a family medicine physician at Straub Medical Center and the physician lead for patient experience at Hawaii Pacific Health, in NEJM Catalyst.

Fifty of the doctors also received coaching to improve their communication skills.


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Physicians use the checklist of best practices to identify those they already practice and then add at least two more to their routine when they see patients. The checklist includes specific actions doctors can perform during a patient encounter that studies find foster feelings of trust and safety: items such as sitting down at eye level with the patient, making eye contact, being aware of nonverbal cues, practicing reflective listening, exercising good computer etiquette and making use of a patient agenda.

Hawaii Pacific Health started using the checklist in January, 2016, with best practices based on medical literature and observation of high-performing physicians.

In some cases, the health system modified exam rooms. For instance, it moved handwashing stations to just inside the door so doctors could take that first action upon entering the room. It also replaced fixed wall mounts with computer carts to allow physicians to sit facing the patient.

Improving communication skills is good for both providers and patients, Glenn said, as physicians with good relationship skills have lower rates of burnout, experience greater job enjoyment and can use the skills in building relationships with their colleagues and staff.

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