Editor's note: This popular story from the Daily Briefing's archives was republished on March 4, 2019.
The results of a Medscape poll show that over 80% of clinicians think they do a great job listening to their patients, but the results of a separate study published in the Journal of General Internal Medicine suggest that's not always the case, Marcia Frellick reports for Medscape.
Nurses and physicians think they're great listeners
Active listening during a medical visit can benefit the clinician and patient experience, and the Medscape poll, which included responses from more than 1,000 nurses and advanced practice registered nurses (APRNs) and 172 physicians found the vast majority of respondents were confident in their listening skills. According to Frellick, 89% of nurses and APRNs and 87% of physicians rated their listening skills as high, while 9% of nurses and APRNs and 10% of physicians said they were unsure of how to rate their listening skills.
According to Frellick, clinicians' ratings of their listening skills varied between specialties. For instance, nurses working in mental health and psychiatry fields consistently rated their listening skills as high, while critical care nurses were less likely to do so. Frellick notes that 96% of mental health nurses and APRNs said they had good listening skills, compared with 87% of critical care nurses.
Separate research shows clinicians have room to improve
However, the poll results conflict with a study published July 2 in the Journal of General Internal Medicine, which found that clinicians often fail to practice active listening with their patients, Frellick reports.
That study, which analyzed 112 recorded clinical encounters between doctors and patients at general practices in Minnesota and Wisconsin, including Mayo Clinic and its affiliates, found clinicians interrupted patients in 67% of the recorded encounters. The study found clinicians listened to their patients for a median of 11 seconds before interrupting them, with some providers interjecting within three seconds and others waiting up to 234 seconds.
How doctors and nurses can be better listeners, according to clinicians
The Medscape poll prompted clinicians to choose the most effective ways to improve their listening skills from a set list. Among physicians, over 50% said they should allocate more time for visits, 40% said they should increase their focus on listening, and 34% said they should undergo communications training, Frellick reports.
Among nurses and APRNs, 51% said they should increase their focus on listening, 38% said they should decrease their use of EHRs during appointments, and 37% said they should have longer appointments with patients and fewer tasks.
Clinicians in a comment section also shared what they thought prevented some nurses and physicians from being active listeners. According to Frellick, clinicians in the comments most commonly cited the use of EHRs and short appointment times as barriers to active listening.
A physician in pulmonary medicine in a comment wrote that "asking [patients] to prepare their own lists of concerns" before the appointment "and asking them for their goals of the visit are very helpful."
One RN wrote that active listening is largely clinicians' responsibility. "The patient's perception of care is all important. If they perceive that they are receiving good care, then they are," the RN wrote (Frellick, Medscape, 12/4).
Advisory Board's take
The point this article makes about the value of active listening has been strongly reflected in our research. When we interviewed nearly 2,000 patients about their relationships with their personal physicians, we found that communication was one of the main factors driving patient loyalty. In particular, patients who say their "PCP respects me" and "explains possible causes of illness," and those who say "the staff are patient and helpful," are more likely to stay with, follow, and recommend their physician.
Better physician communication does not necessarily require much more of the physician's time. Rather, small gestures that reassure the patient and communicate that their concerns have been heard can have a significant impact.
“This 'exemplary' interaction greatly improved the patient experience—and only took seven seconds longer.”
For instance, we spoke with one 500-bed-not-for-profit medical center in the Southeast that used simulated exercises to help physicians improve their patient interactions. They had physicians simulate a 'normal interaction,' entering the room and delving right into their communication or a 'exemplary' interaction, where the physician knocked, entered the room, and introduced him or herself before launching into the visit. They found that this later interaction greatly improved the patient experience—and only took seven seconds longer for physicians.
A comprehensive approach to improving service involves support for physicians in need, as well as those who are already meeting service expectations. Crystal Run Healthcare provides shadow coaching to new physicians, low performers, and any physicians who request additional support. A service excellence team of trained nursing leaders observe physicians in clinic and provide them with immediate feedback on their service. The program has been well received by physicians, with 90% feeling the process was helpful and 92% recommending the program to others.
Crystal Run supplements this time- and resource-intensive coaching with a simpler online training platform. Physician can take quick "Practicing Excellence" online modules at their convenience. To increase participation, leadership emails "modules of the month" to physicians and awards bonus points for module completion that are tied to financial incentives.
To learn more about how to make the case to physicians about the need to engage in patient experience initiatives, read our report on Engaging Physicians in the Patient Experience. Then, to learn more about how to leverage data to strengthen physicians' communication skills, read our report on Partnering with Frontline Physicians on Medical Group Consumer Strategy.
Our Physician Executive Council team is kicking off new research in 2019 on the physician's role in patient experience. To participate in the research, email Sarah Evans at EvansSa@advisory.com.
Engage physicians in improving the patient experience
Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.
Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief." Here are the tactics you need to engage them in patient experience initiatives.