1. ENGAGING PHYSICIANS MAKING IMPROVEMENTS IN PATIENT EXPERIENCE February 18, PHYSICIANS MEDICAL GROUP OF SANTA CRUZ Nancy Greenstreet, MD Medical Director Linda Muhoberac Quality Improvement

2. DOCTOR PATIENT COMMUNICATION
Teach principles of Agenda Setting
 2 Workshops on Improving Doctor Patient Communication
Dr. Dan O’Connell – workshop leader
Agenda Setting Article, Agenda Setting form
Buy-in – Set a tone of collaboration, be flexible
Teach one, try one, evaluate/praise, spread

3. EFFECTIVE TECHNIQUES Demonstrator site meetings
Meet with one or two physicians at demonstrator sites
 Bring lunch
 Discuss CQC Collaborative and Agenda Setting
  PMG is involved in a state wide collaborative and we are learning about some interesting things that can make a PCPs life easier. One of them is Agenda Setting. It is so cool. It’s a way of structuring the office visit so the patient and the doctor feel they accomplished something. Basically, most doctor visits are a doctor-centered visit, a patient- centered visit or a patient-centered visit with agenda setting. A patient centered visit with agenda setting is more like a partnership, rather than the patient or the doctor running the show. (tone of collaboration)

4. Review Agenda Setting http://www.aafp.org/fpm/20080300
Promote Workshops
Soon, we are having an expert come to town to hold a workshop on a Saturday to talk in more detail about how to do Agenda Setting. If you think about this you will see how it can work for you. (buy-in)
What happened
One meeting was set up with 2 PCPs
2 other PCPs decided they wanted in on the meeting – we all shared the food
Hint: bring plenty of food and extra handouts in case other PCPs ask to join (be flexible)
Repeat – Continue to meet with PCPs and introduce concepts of Agenda Setting
This slide orients us to where what we are learning fits into the BTS engine
-the Point here; when is model for improvement is introduced - LS 1 and used during action period 4 4 4

5. Workshops with Dan O’Connell
Improving Clinician/Patient Communication
Difficult Clinician/Patient Relationships
Marketing
 Not enough PCPs could attend because of family issues (be flexible)
 PMG opened the workshops to specialists as well.
  ed and mailed invitations
 Phone call follow-ups to non-responders
 CME credit and $200 honorarium

6. Follow-up After Workshops
physicians about their success with implementation
Keep in mind each person’s comments as to what first step they would take
Respond to comments
When visiting offices for other reasons, ask PCPs how agenda setting is working for them to tie agenda setting into their every day work flow
One “Champion” sounds just like Dan O’Connell

7. ACCESS Teach principles of Open Access
Dr. Neil Solomon Workshop on Open Access
Teach tools to track physician availability in office
3NA (third next available appointment)
Open Slots/Fill Times
Meet with all physicians in one practice site
Share data and graphs
Buy-in by practice site
Look for champions

8. TOOLS FOR IMPROVING PATIENT EXPERIENCE

9. Re: Doctor/Patient Communication Workshop
Dear Doctor:
PMG and the California Quality Collaborative are sponsoring a workshop with 4.0 CME credits AND a $200 honorarium for each physician who attends.
Topic: Doctor/Patient Communication Where: PMG Offices, 5200 Soquel Avenue, Suite 103 When: Saturday, June 14, 9am-1pm (food provided) Register Today The number of attendees will be limited to make sure all your questions are answered. To save your seat, register with Nancy Greenstreet, MD, PMG Medical Director, via by June 9, 2008.
About the Presenter Over the last 25 years, Dr. Dan O'Connell has worked as an educator, consultant, clinician, department chair and executive director in medical, behavioral health and educational settings. Dr. O'Connell teaches in the Residency Programs at the University of Washington School of Medicine and maintains a coaching and consulting practice.
Discuss and use 4 components of good patient communication:
Engage, Empathize, Educate, Enlist
Happy Patients, Happy Doctors.
Nancy Greenstreet, MD Medical Director Physicians Medical Group of Santa Cruz County T: (831) E:

11. Available Appointment Tally Sheet

12. 3 NA

13. Testimonials from PMGSCC Physicians
“The (Dan O’Connell) workshop was wonderful. I have used it daily and it
seems to work really well with most of my patients. Agenda setting works! It
can be a challenge at times with those patients who like to talk, but not any
more challenging than the prior interactions. What I have found is that I have
to let go of my own Agenda unless ample time. This helps me feel less
rushed/anxious/etc. I am Working on Embracing the Chaos!”
“I have definitely used the agenda setting with many of my patients. At first I
found it much harder than I thought it would be. It disrupts the normal
conversation flow of the encounter- which I like to use to help people feel
comfortable. The agenda setting makes me feel like I'm being abrupt, cutting
them off. But it's getting smoother. People are at first taken aback by my new
approach, but I explain it helps me make sure I don't miss anything they want
to talk about. So when they come up with ‘just one more thing....’ I feel better
about postponing the issue to another visit.”

14. Testimonials from PMGSCC Physicians
“I've tried agenda setting with nearly all my patients. It seems to be good to
learn their expectations up front. I certainly don't have the finesse that Dan
possessed, but practice makes perfect. I've had less practice with the
question/pause technique. As a young doc, I still talk more than listen
(knowledge/ego/insecurity talks, -- wisdom listens).”
“Dan O’Connell also helped me realize I talk too much. I need to give a brief
answer and shut up while they process it. And I need to accept that I can't
review all major issues at every visit. I have to trust that if they don't tell me
about it, it's probably not acting up. I found that seminar incredibly helpful.”
“I am trying agenda setting with all new patients and now on day four it is
becoming easier and more rote and I don’t feel like I am reading a script.
PSH (psychosocial history) I have been doing for some time now and
patients really feel you do connect with them when you can remember a
nonmedical fact about their last visit. ”