1. The Teach-back Communication Method
An ‘Always Event’
Welcome to the evidence-based communication method known as teach-back. The training is divided into two parts – online training which you have already completed if you’re here today, and today’s training, which will review what you’ve already learned and focus on practicing teach back and plain language.
“Always events” are defined by the Institute for Healthcare Improvement as “aspects of the care experience that should always occur when patients, their family members or other care partners, and service users interact with health care professionals and the health care delivery system.”
Who thinks that effective communication with our patients/residents/families should always occur? Does it?
What do you hope to learn about teach-back?

2. Objectives
Have increased confidence and conviction to use teach-back and plain language
Demonstrate competency using teach-back and plain language
Utilize teach-back and plain language with patients, families and caregivers
At the conclusion of today’s training, we hope you:
Have increased confidence and conviction to use teach-back and plain language.
Demonstrate competency using teach-back and plain language
Utilize teach back and plain language with patients, families, and caregivers.

3. Teach-Back Review
Let’s start with a quick review of teach-back. For this, please refer to the handout provided titled, The Teach-Back Technique: Communicating Effectively With Patients, which will guide our discussion

4. What is the Teach-Back Technique? (page 3)
Teach-Back is a communication technique used to help patients remember and understand the important information regarding their diagnosis, treatment, or medication.
It involves asking patients to recall and then explain or demonstrate the important information discussed during an interaction with their healthcare team

5. Why Use the Teach-Back Technique? (page 3)
Poor communication between healthcare providers and their patients is a common problem.
Blah blah blah, blah blah.
Any questions?
What’s she saying? I sure hope my wife is getting this.
No, sounds good to me.

6. Discussion
Who dislikes taking their cell phone/laptop in for repairs? Or maybe your car in for service? Why?
Consider, it is very likely that someone will make a comment about not understanding the IT technician’s or mechanic’s explanation of the problem and the remedy. Emphasize the unfamiliar language that is used or lack of understanding of electronics or mechanics.
Facilitator Response: Some of your answers – your experiences – are similar to what our [patients/residents/clients] experience in our [facility/organization/ service, etc.]. There are a number of contributing factors.

7. Poor Communication Factors (pages 3 and 4)
Consider, asking a volunteer(s) to read or comment on several of the poor communication factors.
Teach-back, and other communication methods help to address these factors by giving patients the opportunity to explain their comprehension of what was just discussed.

8. How Do You Teach-Back? (page 5)

9. Open Ended Question Examples - Medications (page 5)
Tell me in your own words how you will take this medicine at home.
When you get home, how many pills will you take? What time will you take them?
What are some of the side effects to watch for with this medicine?
What should you do if the side effects become severe?
Tell me when you should refill this prescription.
Please show me how you will use the glucose meter.
When during the day should you take your medicine?
Because you have to take several of these pills, what will you do if you miss one of your doses?
When is the best time for you to monitor your blood sugar level? Show me how you will do that.
Please tell me how many other medicines you are currently taking and when you take them during the day
Consider, asking a volunteer(s) to select several questions from The Medication Treatment (pg. 5) as examples of how well the taught concept is understood.
Ask attendees for other examples of open-ended questions for common education provided by your staff (diabetes, CHF, advance directives, etc)

10. Common Mistakes (page 6)
Quizzing the patient at the end of the examination or conversation
Using medical jargon, highly technical terms or language that you think the patient will have difficulty understanding
Appearing rushed, annoyed or bored during these efforts
Asking patients questions that require only a simple yes or no answer, such as:
Do you understand?
Do you have any questions?
Do you know how to use the device?
Do you know when to take this medicine?
Are we clear on the treatment steps?
Consider, asking a volunteer(s) select several Cautions (pg. 6) for discussion.

11. Essential Teach-Back Elements
Did the educator…
Use a caring tone of voice and attitude?
Display comfortable body language, make eye contact, and sit down?
Use plain language?
Ask the patient to explain in their own words what they were told to do about:
Signs and symptoms they should call the doctor for?
Key medicines?
Critical self-care activities?
Follow-up appointments?
Use non-shaming, open-ended questions?
Avoid asking questions that can be answered with a yes or no?
Take responsibility for making sure they were clear?
Explain and check again if the patient is unable to use teach-back?
Use reader-friendly print materials to support learning?
Document use of and patient’s response to teach-back?
Include family members/caregivers if they were present?
Instruct participants that these elements are what the ‘Observers’ expect to see in the coaching session.

12. Plain Language Review http://www.youtube.com/watch?v=XiBZjpy3ibs
Let’s take a quick look at using plain language.
What caught your attention about using plain language?
How easy do you think using plain language will be for you?

13. Plain Language Activity
Form groups of 2-3 people
Complete Teach-Back – Plain Language Practice Worksheet
You have 10 minutes
Introduction: Health care professionals often find using plain language a challenge. We spend years learning and using medical terminology. Plain language requires thinking and planning. Plain language requires practice.
Instruct participants to form groups of 2-3 people.
Instruct participants to read the Patient Story on Page 1 of the Teach Back – Plain Language Practice Worksheet and with their partners identify plain language options for the listed medical terms on each page

14. Practice: Plain Language - 1
Medical Terminology
Plain Language
Acute
Chronic
Peripheral tissues
Fatigue
Edema
Hypertension
Cardiomyopathy
Heart failure
Review some of the answers provided.
Consider revising the Plain Language Practice Worksheet to meet the needs of the staff that you are training. Needs may vary based on discipline, unit, etc. It is critical to the success of your teach-back training that the plain language vocabulary and patient story are relevant to your participants. (Depending on the need, this activity can be modified by using a different scenario, diagnosis, or medical terminology to meet the specific needs of the participants.)
Resource:
Plain Language Medical Dictionary University of Michigan

15. Practice: Plain Language - 2
Medical Terminology
Plain Language
Deteriorate
Competent
Guidance
Cardiovascular resuscitation
Termination
Life support
Incompetent
Healthcare directive
Review each medical term asking for the plain language vocabulary identified by participants.
Resources:
Plain Language Medical Dictionary University of Michigan

16. Discussion How can you use plain language?
Which terms were the most difficult to make into plain language?

17. Teach-Back Activity Forum groups of 3-4 people
Roles – Rotate during activity
Educator – Provides education utilizing teach-back skills and technique
Patient – Receives the education and is asked to teach-back what was learned.
Coach/Observer – Provides coaching and feedback
Family/Caregiver (if >3 per group) – Receives the education and provides teach-back with the patient
Introduction: Throughout today’s training, we have discussed the reasons to use the teach-back communication technique, the elements of teach-back, and practiced using plain language. Now you will have an opportunity to practice using teach-back with your peers. Teach-back is a new skill and like any new skill, it will seem awkward and uncomfortable but as your expertise improves so will your comfort level using teach-back.
Consider forming groups within disciplines if possible (social workers in a group, nurses in a group, etc). It makes discussion more relatable to everyday practice.
Each individual will have a role within their group which will rotate throughout the activity
Educator – this will be the person providing the education and utilizing teach-back skills and technique
Patient – this person will role play the patient receiving the education and being asked to teach back what was learned.
Coach/Observer – will observe the Educator and provide coaching and feedback.
Family/Caregiver - if there are more than 3 in a group then the additional person can play the role of a family member or caregiver also receiving the education

18. Teach-Back Activity Use Teach-Back Observation Tool
{INSERT INFORMATION ON EDUCATION TOPIC(S)}
5 minutes for education/teach-back followed by 5 minutes discussion with coach/observer
Rotate and repeat
Introduction: The role of Coach/Observer is an important role. Using the Teach-back Observation tool the coach will watch for or coach effective teach-back technique. The Coach should place the name of the individual being observed and date on the top line of the Teach-back Observation Tool and the Coach’s name and time on the second line. This is how we will validate teach-back competency. Please leave the completed Observation Tools here when you leave.

19. Discussion
How did you feel as you rotated through each role? As a patient? Educator? Observer/Coach?
What was easy? What was challenging?
Large group discussion

20. Wrap Up Complete the Conviction and Confidence Scale

21. Discussion
We’ve covered a considerable amount of information today, and I want to make sure that I clearly explained the value of teach-back. What benefits does utilizing teach-back provide patients/residents?
What 2 or 3 things can you take from what you have learned about the teach-back technique and start applying today?
Large group discussion

22. Implementation Plan
{INSERT information on your organization’s next steps with teach-back}
Consider
Roll out
Measurement
Celebration
OPTIONAL

23. Discussion
How will you incorporate teach-back into your care for your patients/residents?
OPTIONAL
What are some ways that you plan to incorporate teach-back into how your care for your patients/residents?
What are some ways that you can help each other as you use teach-back?

24. Thank You!
FINISH LINE!!!
Thank you for participating in our teach-back training.
Please leave your completed confidence and conviction scales on the ___________.

25. Contact Information
Add
Your Contact Information
This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11S0W-GPQIN-ND-C3-79/1116 (Revised 09/19)