Effective communication between providers and patients in the hospital is essential for high-quality care. Communication quality metrics, including HCAHPS scores, are increasingly tied to hospital reimbursement, and public reporting of these metrics has raised the stakes for improvement. Substantial improvement has proven difficult in many settings, in part because effective solutions are likely to require alignment across care team members from disparate disciplines.
We applied an innovative method for discovering aspirational examples of provider-patient communication in order to build a multi-disciplinary roadmap for communication improvement strategies on a hospital geriatric unit.
During a seven-month period in 2013, we invited interdisciplinary care providers and former patients to participate in monthly discussions of excellent communication on an “Acute Care for the Elderly” (ACE) unit at our large academic hospital. Across seven one-hour events, 89 providers and 9 former patients conducted scripted interviews in pairs utilizing an Appreciative Inquiry (AI) methodology to elicit specific instances of stellar patient-provider communication. The majority (80%) of the paired interviews occurred across disciplines, and when within the same discipline, only three interviews were between providers at the same level of training. Twelve unique provider disciplines were represented in the events and included housekeepers, RNs, CNAs, therapists, pharmacists, attending physicians, resident physicians, medical students, and unit clerks. At each event, an Appreciative Inquiry expert facilitated group discussions following the paired interviews to highlight themes of excellent communication as well as elicit specific strategies for collective improvement. In post-event evaluations, 100% of participants felt the events “contribute to a positive unit culture,” 94% indicated that the events “will lead to improved patient satisfaction with communication,” and 89% felt that the events “will change the way I approach communication with patients.” From the AI events, we identified seven organizing themes and numerous basic themes to inform specific unit-based communication improvement strategies. In addition, public display of the identified themes near the unit quality dashboard augmented ongoing education efforts. In annual year 2014, the unit’s average percentage of top-box ratings for the HCAHPS communication domains with nurses and doctors have trended toward significant improvement.
Appreciative Inquiry interviews around patient-provider communication can engage patients and providers across disciplines in identifying contributors to excellent hospital communication. These events promote collegiality and can help set priorities for ongoing improvement efforts.
To cite this abstract:Kneeland P, Roles L, Hagman J, Cumbler E. Asking the Right Question: Cross-Discipline Appreciative Inquiry to Priortize Patient-Provider Communication Improvement Strategies. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 11. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/asking-the-right-question-cross-discipline-appreciative-inquiry-to-priortize-patient-provider-communication-improvement-strategies/. Accessed July 21, 2019.