Open and Honest Communication Challenges the Status Quo

Helen Haskell, Rick Boothman and David Longnecker MD discuss emotional intelligence

The first day of our Telluride Roundtable on “Open and Honest Communication Skills in Healthcare” is now complete. After a full day of deliberative inquiry and exploration, some reflections come to mind:

  1. To start the day, students from medicine, nursing, public health, pharmacy and law attending the Roundtable watched the film “The Faces of Medical Error…From Tears to Transparency: The Story of Lewis Blackman” to start the day. After the film, Helen Haskell and Rosemary Gibson led an engaging and interactive discussion on the educational messages highlighted in the movie. The conversations were empowering and got us off to a great start.
  2. The students added an amazing dimension to our discussions on open and honest communication. Their excitement and passion was contagious; their ability to appreciate right from wrong without pre-existing cultural biases was refreshing.
  3. In the afternoon, Roundtable participants worked to build consensus regarding the relationship between emotional intelligence competencies and open and honest communication skills.
  4. Creating curricula around open and honest communication skills in healthcare (from informed consent through adverse events) remains challenging. Being open and honest to patients and colleagues seems easy; however long-standing cultural barriers make the task very difficult. It also does not align with current reimbursement drivers. Being open and honest when obtaining informed consent may mean losing a procedure and the income that comes from it for the caregiver and the health system; being open and honest when harm occurs may increase one’s medical liability risk. Caregivers are uncomfortable because they have been preconditioned by these financial incentives and fear.  Additionally, educators are uncomfortable with the domain because it doesn’t fit easily into pre-existing curricular models. Open and honest communication training challenges traditional scientific research approaches, “p” value outcome studies, licensing exams or assessment models used in healthcare. These are difficult obstacles to overcome when trying to create curricula.

Anne Gunderson leads Telluride Roundtable small group discussion

In the next four days, we need to figure out how to turn our uncomfortable feelings into a disruptive thinking approach that creates a constructive model for change.  As in previous Roundtables, I am confident we will move forward and create consensus related to open and honest communication in healthcare.

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7 Responses to Open and Honest Communication Challenges the Status Quo

  1. Pingback: Tweets that mention Telluride Breakouts on Emotional Intelligence « Transparent Health -- Topsy.com

  2. Tim McDonald says:

    Yesterday was a terrific day for learning at the 6th Annual Telluride Patient Safety Curriculum meeting. As in past years, the learning continued on well into the evening with students and faculty discussing the practical important to Emotional Intelligence in the clinical, legal and administrative arenas. The discussion went well beyond midnight and only ended because the students needed to get home to finish their homework!!! Today offers another great opportunity for inquiry and learning. -Tim

  3. Barbara Youngberg says:

    The truly collaborative nature of this group is forcing us to see complex patient safety issues from perspectives we often only minimally appreciate. Starting with the patient’s voice as we did yesterday is essential but as the dialogue continues today we are trying to incorporate the perspectives all all stakeholders (physicians, patients, nurses lawyers, pharmacist, IT professionals and educators) to begin to move the dialogue forward to produce some consensus statement on what open and honest communication really encompasses. We are all learning how difficult it is to shape dialogue which serves to advance our objectives.

    The work continues……….

  4. Peter Angood says:

    Hi everyone – sorry that I have not been able to make this year’s meeting as it is likely to become viewed as a pivotal year for the ongoing efforts from this group. A few thoughts towards informed consent…

    Patient safety evolved rapidly in the past decade but not at a pace which satisfies the demand for improvements. In fact, the 2008 National Healthcare Quality Report (NHQR) from the Agency for Healthcare Research and Quality (AHRQ) notes that certain measurements on patient safety showed an overall decline by 1 percent in the past year and that the median level of receipt of needed care was only 59 percent, while approximately one out of seven adult hospitalized Medicare patients experienced one or more adverse events. In the 2009 NHQR, of the 33 hospital measures related to safety, only 12 (36%) improved at a rate greater than 5% per year. In contrast, of the 19 hospital measures not related to safety, 16 (84%) improved at a rate greater than 5% per year. Still, more than half of safety measures showed some improvement. This trajectory, however, remains as unsatisfactory progress.

    The National Quality Forum (NQF) Safe Practices (SPs) are a set of voluntary consensus standards that serve as a tool for healthcare to identify and encourage practices that will reduce errors that might create patient harm. These practices are not intended to capture all activities that might reduce adverse events ; rather they focus on practices that: 1) have strong evidence they are effective in reducing the likelihood of harm; 2) are generalizable (i.e. may be applied in multiple clinical care settings and/or multiple types of patients); 3) are likely to have significant benefit to patient safety if fully implemented; and 4) convey information that is usable by consumers, purchasers, providers, and researchers.

    Of the original 30 SPs, 11 have now been retired or replaced, and the current 34 SPs have been updated utilizing a robust, contemporary evidence-base. Further updates are planned.
    The current 34 NQF Safe Practices are grouped into seven functional categories:
    1. Creating and Sustaining a Culture of Safety
    2. Informed Consent, Life-Sustaining Treatment, Disclosure, Care of Caregiver
    3. Matching Health Care Needs with Service Delivery Capability
    4. Facilitating Information Transfer and Clear Communication
    5. Medication Management
    6. Healthcare Associated Infections
    7. Condition and Site-Specific Practices

    I mention all this for background context for those of you in the early phases of learning about patient safety, While you may hear that progress is slow, there is indeed some progress. Two recent articles have been published in premiere surgery journals regarding beneficial outcomes from using the NQF SP regarding Informed Consent and useof “read-back” approaches. The positive outcomes from these articIes would not have been possible even a few years ago – as those of us from surgery, anesthesia,or peri-op nursing know full well. I encourage you to at least look at the abstracts for these articles detailing a large, prospective, randomized, multi-center study of the NQF-Endorsed Safe Practice of “teach back” (“repeat back”), published in the Journal of the American College of Surgeons and in Annals of Surgery (see links).

    The JACS paper found that two significant predictors of patient comprehension of a planned procedure were the length of time spent during the informed consent process and the use of the teach-back practice to gauge patient understanding. The Annals paper then documents that the use of Safe Practice 5 requires only an additional 2.6 minutes of provider time to complete a process that contributes significantly to patient comprehension. The “weakness” of this research is that both arms of the study employed a software tool – the iMedConsent™ application – which produces detailed, procedure-specific consent forms written in easy-to-understand language. It thus appears that the baseline understanding level for both the control and intervention groups was higher than one might otherwise expect. Nevertheless, NQF-Endorsed Safe Practice 5 clearly demonstrates a benefit.

    Perhaps too much to read while deep in think tank mode but I hope this is somewaht helpful not konwing the daily agenda. Enjoy a productive and highly unique opporttunity within the metaphorical blue-sky vistas that Telluride represents.

    Wish I was there – Peter

    • David Mayer says:

      Peter,
      Thanks for posting this information. The studies are nice examples of how technology can be used to support (not replace) open and honest conversations that lead to shared decision-making and better patient care. These types of conversations also help reduce the suprise factor for patients and families when care does not go as expected. Most medical malpractice cases result when patients and families were surprised by an outcome that was not part of their expectations.

  5. Peter Angood says:

    I see the links did not come through on those 2 articles i mnetioned – here they are again. Sorry about that.

    1) JACS: http://www.journalacs.org/article/S1072-7515(10)00177-8/abstract
    2) Annals of Surgery: http://journals.lww.com/annalsofsurgery/Abstract/2010/07000/Enhancement_of_Surgical_Informed_Consent_by.8.aspx

    Best – Peter

  6. Ed Casey says:

    My “stake” is in the support services specifically Sterile Processing. My hope is that momentum is building for changes in the culture of healthcare.

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