1. Effective Healthcare Communication: A Story in Three Parts Nagesh Rao, Ph.D. Director, MICA XVIII NATIONAL SEMINAR ON HOSPITAL & HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS AND CLINICAL RESEARCH May 6, 2016

2. A Story, Part 1: Communication is common sense, so why even bother?

3. Impact of Communication in a Hospital Patients – Greater patient satisfaction – Higher levels of compliance – Improves Patient safety – Lower levels of litigation Employees – Great job satisfaction – Lower levels of stress and burnout – Higher levels of productivity

4. Economic impact of Communication Inefficiencies in Hospitals (Agarwal et al., 2010) Wasted Physician Time$800 million Wasted Nurses Time$4.9 billion Wasted Time During Discharge TOTAL ANNUAL WASTE $6.9 billion $12.6 billion annually

5. A Story, Part 2: Why care?

6. Who was your first healthcare provider?

8. Healthcare versus Medical Care Healthcare aims to address the comprehensive and holistic health needs of a patient – physical, psychological, relational, religious/spiritual, and lifestyle dimensions. Medical care aims to cure a specific illness or disease.

9. 1.Communication is a rhythm. 2.Communication is strategy first and skill next 3.Fix home first

10. A Story, Part 3: Let’s start a new rhythm!

11. Nasreddin Hodja

12. T he Positive Deviance Approach The Mindset Flip by Nagesh Rao, Ph.D. President and Director Mudra Institute of Communications, Ahmedabad (MICA) nagesh@micamail.in

13. T he Positive Deviance Approach The Mindset Flip by Nagesh Rao, Ph.D. President and Director Mudra Institute of Communications, Ahmedabad (MICA) nagesh@micamail.in

14. A Case Study of Billings Clinic, Montana What if a jumbo-jet crashed and killed 275 people each day because the pilots were too busy to complete all pre-flight checks and, four times out of ten, in a hurry to take-off? On average, hospital acquired infections (HAIs) kill about 275 patients in U.S. hospitals a day, largely because hand hygiene, gowning, and gloving protocols are not stringently followed. HAIs are 100% preventable.

15. Methicillin Resistant Staphylococcus Aureus (MRSA) MRSA can live up to six weeks on environmental surfaces and transmits easily through contact. MRSA infections have increased 32-fold in the U.S. in the past three decades.

16. What happened at Billings Clinic? 2004 - Billings Clinic CEO Nick Wolter attends PD workshop conducted by Jerry and Monique Sternin. Wolter and Nancy Iversen, Director of Patient Safety champion PD in Billings Clinic

17. Key steps High levels of resistance, especially from surgeons Improv theater to create fun and dialogue 50 improv sessions for 500 staff in 2007, from all over the hospital Staff creates simple solutions

18. Act your way to change A physician stops wearing his tie, his white coat, and long sleeves, all vectors for the spread of MRSA infections. Many others adopt his practice. An ICU nurse disinfects a patient’s side rails several times during her shift to keep MRSA from being picked up and spread.

19. Please wash your hands before checking my dad

20. Declining MRSA infections at Billings Clinic 0.15 4 people infected 199920002001 200 2 200 3 200 4 200 5 200 6 200 7 CY 2008 Jan- Dec 0.6 0 0.4 0 0.2 0 0.0 0 0.3 2 0.34 14 people infected 0.44 20 people infected 0.75 33 people infected 0.85 38 people infected 0.77 34 people infected 0.30 14 people infected 0.13 6 people infected 9 people infected 0.2 1 Jan 2007 Active surveillance began in ICU Nov 2008 Surveilla nce began in IPM 1.0 0 0.8 0 May 2006 PD/MRS A Project Begins Jan 1, 2005 - Dec 31, 2008 84% reduction in Healthcare associated MRSA Infections p < 0.001

21. PD is about Small (invisible) acts that make a big difference that yield better outcomes

22. Positive Deviants Ordinary people who have found better (or even extraordinary ) solutions to existing problems – against all odds – without access to any extra resources.

23. Paradigm changers … What do we wish to provide - medical care or healthcare? Invest in communication strategically, starting within the hospital first and then focus on patients Flip the mindset – a positive deviance approach.

24. “The shortest distance between any two people is a story.” Patti Digh