Care Transformation Through Communication Skills Training and Systems Change

By Tony Back, MD, Erik Fromme, MD, Diane Meier, MD

For people with serious illness, high-quality communication skills are essential to high-quality health care delivery. Why? Because good communication is the root of care quality—and the basis for helping patients achieve their most important goals.

Although some clinicians think they know how to communicate, patients don’t agree. In fact, research shows that while patients expect clinicians to be skilled in initiating conversations about care goals, the vast majority of physicians, nurses, and other clinicians have had little training in communication, and are unsure of what to say to seriously ill patients.

And while most physicians agree goals of care matter, 71% don’t routinely ask about such goals and 24% don’t have a place in the EHR for such information.

Complicating matters, there is typically little upstream conversation about patient goals and how they match to treatment options. Instead, clinicians tend to focus on procedures, tests, and referrals. High-stakes decisions are made under stress in times of crisis. Patients’ personal priorities are set aside and left unexamined. No training — plus no institutional system — adds up to poor or late communication, leading, in turn, to poor outcomes and unnecessary suffering.

The Answer: Communication Skills Training

There is one clear way to turn this situation around: making an investment in communication skills training. That’s why Vital Talk, Ariadne Labs, and the Center to Advance Palliative Care came together to establish the Communication Skills Pathfinder. This one-door portal leads to two essential offerings:

  • The most effective patient-centered communication skills training; and
  • Strategic system and workflow redesign, which scales and sustains new and improved standards of communication

Using the Pathfinder’s multiple options and evidence-based trainings from trusted sources, both clinicians and organizations will make positive improvements in the quality of care they provide to seriously ill patients.

Clinicians will learn to conduct meaningful conversations that increase trust, thus increasing their understanding of individual and family priorities and better aligning patient desires with goal-concordant care. By learning how to change common decision-making patterns, clinicians well trained in communication skills can turn ‘crash’ situations into planned processes that start early in a patient’s illness.

Health organizations will improve their ability to create easy and accessible documentation; and enable population management of high-risk, high-need patients.

Return on Investment

High-quality communication is not only best practice—it is the linchpin of quality care for seriously ill patients. It is positively transformative for both clinicians and health care organizations.

Empirical evidence links high-quality communication to:

  • Improved quality of life and experience of care
  • Better patient and family coping
  • More goal-consistent care
  • Fewer 30-day readmissions and hospitalizations
  • More and earlier hospice care

By building the capacity to improve the frequency and quality of clinician communication with seriously ill patients, organizations can:

  • Improve measures of patient experience (CAHPS, likelihood to recommend scores)
  • Reduce readmissions
  • Reduce the total cost of care for patients in the last year of life
  • Reduce malpractice suits
  • Improve the ability to identify high-risk patients
  • Ensure reliable communication about achievable priorities for care
  • Develop care plans aligned with those priorities
  • Follow through to align actual care with people’s informed goals over time

The Experts Agree

Many of the most influential American health care leaders endorse the need for quality communication about values, goals, and care preferences. Among them are:

  • National Academy of Medicine of the National Academy of Sciences
  • American Society of Clinical Oncology
  • Society of Hospital Medicine
  • The Joint Commission
  • American Hospital Association
  • American Medical Association

Finding Training That’s Right for You

The evidence is clear: Communication skills training is essential if we are to improve the care of seriously ill patients. For individuals and health systems alike, the Communication Skills Pathfinder provides the road to mastery.

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