As I've researched an article for the December edition of H&HN on strategies hospitals are using to prepare for the inclusion of patient satisfaction data from the Hospital Consumer Assessment on Health Providers and Systems data in Medicare value-based purchasing payments, I've learned that an increasing number of providers are using scripted communication tools to standardize the way doctors and nurses talk to patients and their families. These tactics, which some liken to the spiel a diner might get from a waiter or sommelier at a high-end restaurant, are believed to improve patient perceptions of the hospital's communication with them — and, some hospital leaders say, relax the patient ahead of critical procedures or situations. In the context of HCAHPS, many hospitals are hoping the scripts will improve patient satisfaction around communication.
Leaders from several hospitals I've talked to use the AIDET communication model originally developed by the Studer Group, or Acknowledge, Introduce, Duration, Explanation, Thank You. This typically includes a detailed introduction from the clinician on their educational background, close listening to patients during the encounter — using phrases like "I want to make sure I understood you correctly" — and some sort of salutation at the end.
"Using AIDET effectively decreases anxieties, and decreasing anxiety decreases the patient perception of pain," Kimberly Bordenkircher, CEO of Henry County Hospital in Ohio, told me recently.
At Charlotte, N.C.-based Carolinas HealthCare System, employees are trained on AIDET and other communication tactics that include listening to patients for two minutes and using standardized keywords designed to connect with patients.
"They're building that relationship through careful listening," Patrick Ratchford, human resources manager for Carolinas HealthCare System, says.
There are skeptics, though. In researching the subject I found a trove of Youtube videos taking a more cynical view of scripted communications for clinicians. While I can't link to them because of the nature of some of the fictional patient encounters they describe, let's just say there are clinicians out there who are skeptical that scripted communication will resonate with difficult patients.
Other critics of scripted communication and conversational tactics say they simply aren't long-term solutions for the culture change needed to truly improve communication with patients. Greg Johnson, associate chief medical officer at Parkview Health System in Fort Wayne, Ind., says patient experience strategies around scripted questions and conversational tactics "are not sustainable."
Instead, Parkview's patient satisfaction strategy is centered around physician leadership — with selected clinicians taking up to 30 hours of class time to learn leadership principles, developed by LeadQuest, Inc., that include curiosity, accountability and authenticity. The physician leaders are then expected to model the behaviors for other clinicians, ultimately spreading cultural change throughout the organization. Johnson firmly believes that this approach to improving communication with patients, with its emphasis on leadership and empowerment, is more effective than simply handing doctors and nurses a script and telling them what to say.
"Physicians aren't … good with scripting," Johnson says. "With the 10 principles, we give them a tool they can practice and observe. It's all about behavior change."
Are you a scripting advocate or skeptic? Email your thoughts to firstname.lastname@example.org.