Shared Decision-Making and Open, Honest Communication Change Outcomes

Rick Boothman sharing insights on open and honest communication related to adverse events.

What an amazing and invigorating second day of discovery and consensus building at our Telluride Roundtable on “Open and Honest Communication Skills in Healthcare”. The high altitude and beautiful mountain valley scenery have ways of opening up creative thought processes that lead to amazing new ideas. Some reflections from day two:

  1. Our second day focused on what patients and family expect related to open and honest communications in the domains of (a) informed consent and (b) when harm occurs from our care. Rosemary Gibson and Helen Haskell led the morning session which quickly evolved from the concept of informed consent to one of shared decision-making. David Longnecker talked about the “partnership” between patients and their caregivers when decisions on care need to be made and stressed that open and honest communication must go both ways in those critical discussions.  Cliff Hughes from Australia and Rick Boothman from Michigan both highlighted that open and honest conversations between patients and caregiver is not only the first component in transparent care, it is one of the best risk management strategies an organization can put in place because open and honest conversation reduces the “surprise factor” that can occur later if care does not go as expected. The morning ended with the consensus conclusion that “open and honest conversations can change outcomes” when it comes to true informed consent and shared decision-making related to patient care.
  2. The afternoon session was devoted to building curricular models around open and honest communication when harm occurs. Rick Boothman and Tim McDonald led small group break-outs that put together a curricular model on the current medical-legal environment and how a “principled approach” to unanticipated harm reduces medical liability, improves patient safety and helps restore trust. The students were totally engaged and worked alongside patients and healthcare leaders to put together an outstanding curricular model that will help educate inter-professional caregivers and attorneys on the importance of open and honest communication in healthcare.

David Pierce sharing his small group work from one of the break-out sessions.

Day two was a remarkable day – everyone broke from our traditional mental models that held us back on Monday and focused all creative and disruptive energies on the topic at hand. The student’s active participation in both our small group breakouts and large group consensus building sessions added great insights. Their ability to see issues related to open and honest communication in healthcare without pre-existing biases brought emphasis to right from wrong.

A solid foundation for a curricular model on open and honest communication skills is now in place. I am confident participants will build on this foundation in the next three days and produce a solid product by the end of the week.


5 Responses to Shared Decision-Making and Open, Honest Communication Change Outcomes

  1. Trish Jansta says:

    How exciting is the notion of “partnership” between patient & caregiver! As a 64 yr old, I grew up thinking of Doctors as some kind of god-like persons who had all the answers. But as I’ve grown older, I realize that not only are Doctors human in every sense of the word, but they are truly “practicing” medicine. Even with all their education and experience, medicine is constantly evolving and for these professionals, learning is continuous. As a patient, mother, former nursing assistant, I have come to understand that patients cannot expect an immediate and irrevocable answer/cure to every health issue. What a patient should be able to expect, however, is honest discussion of treatments that are successful and are not and shared responsibility for choices that are made. Respect for the needs of all concerned implies answers to questions, even if the answer is, “I don’t know,” or “I can’t promise 100% success.” I believe that Doctors should not have to “operate” in fear of legal action when they are doing all that is humanly possible to add to quality of life for their patients. If we change our expectations to be more realistic, then acceptance and shared-responsibility can be possible. I aplaud what you are doing and hope that you continue to open the doors of our minds to embrace more positive ways of thinking, which in turn will open more doors. . .

  2. Trish Jansta says:

    Please add me to your mailing list. Thanks much, Trish Jansta

  3. Kelly Smith says:

    I wanted to thank the students for engaging in a discussion on open and honest communication yesterday. I also want to thank those students who are actually willing to practice the knowledge, skills, and attitudes that were established yesterday during the homework debrief. In particular, I want to acknowledge and applaud Naomi for “speaking-up”. You are a brilliant young mind and I for one believe that your peers should all take a notes – You are the future of patient safety.

  4. The Tuesday morning session generated important discussion and ideas about the elements of informed consent. It brought home the point that honest and open communication around medical decision making is the first part of the full disclosure process.

    Cliff Hughes pointed out the importance of eliciting from patients their goals of care and treatment. It reminded me of lessons I learned from palliative care physicians and nurses about the process of eliciting patient’s understanding of their condition and what is important to them in their life. In this way, the goals of care can be consistent with one’s preferences. Bob Galbraith raised the question about the quality of data on outcomes and complications, noting that in many instances the data are not that informative. Even this information should be known to patients/families contemplating an important medical decision.

  5. I hope that the doctors-in-training are being made aware of the recent spate of class action lawsuits from failed implanted medical devices (e.g. metal-on-metal hips and surgical mesh). Much open communication between doctor and patient is needed to root out the educational bias of medical training that is overtly or covertly sponsored by pharma/medical devices and legislation that is responsive to lobbying by these for-profit corporations that limits patient protections and access to justice when harm occurs. Doctors can easily become complicit in harm and the aftermath re-vicitmization of patients who cannot access justice.

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