1. Insert hospital logo here Communicating to Improve Quality Training
[Hospital Name | Presenter name and title | Date of presentation]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
As people enter the room:
Ask people to sign in (it is helpful to have a sign-in sheet that includes contact information to keep track of attendees).
Introduce yourself, ask their name, and ask them to fill out and put on a name tag.
Give each attendee a copy of the session handouts (see below).
Open the session by welcoming people.
Introduce yourself and copresenters: name, position or title, and role. Thank patient and family advisors for participating in this session.
Depending on the number of attendees, ask people to go around the room and very briefly (no more than 30 seconds) introduce themselves and share:
Their name.
Biggest challenge they face when communicating with patients and family.
Handouts for the patient and family that accompany this presentation:
Tool 1: Be a Partner in Your Care
Tool 2: Tips for Being a Partner in Your Care
Tool 3: Get to Know Your Health Care Team
Tool 5: Communication Competencies for Clinicians
You may also wish to have on hand:
Printouts of this PowerPoint presentation
Tool 4: We are Partners in Your Care Poster/Flyer
How Patient and Family Engagement Benefits Your Hospital
Strategy 2: Communicating to Improve Quality Training (Tool 6)

2. Today’s session What is patient and family engagement?
What is the patient and family experience in our hospital?
Communicating to Improve Quality strategy and tools
What are we asking patients and families to do?
What are we asking you to do?
Practice exercises
We will begin today by talking about how engaging patients and family members helps us improve the quality and safety of care we provide.
Then we will talk about how the patient and family experience care in our hospital.
We will also discuss the Communicating to Improve Quality process and tools that we are putting into place at our hospital.
Then, we will be doing some practice exercises.
Questions are welcome at any time.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

3. What is patient and family engagement?
To set the stage for our conversation, I’d like to talk about the importance of patients and families as partners in ensuring and improving the quality and safety of care that we provide.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

4. What is patient and family engagement?
Creates an environment where patients, families, clinicians, and hospital staff all work together as partners to improve the quality and safety of hospital care
Involves patients and family members as:
Members of the health care team
Advisors working with clinicians and leaders to improve policies and procedures
The ultimate goal of patient and family engagement is to create a set of conditions where patients, family members, clinicians, and hospital staff are all working together – as partners –to improve the quality and safety of care. This partnership is important, because health care quality and safety have a direct effect on patients and families. It makes sense that we should ask patients and family members to take part in changes and improvements.
On one level, patient and family engagement means providing day-to-day care experiences that welcome and engage patients and family members as members of the health care team. For example, in our hospital, we provide opportunities for patients and family members to be involved in their care by:
Making sure from the beginning that we invite patients and family members to partner with their health care team throughout their stay.
Doing change of shift report at the bedside, where patients and families can participate.
Involving patients and families in discharge planning and plans for safe care at home.
[Insert other examples of how your hospital provides opportunities for true partnership and engagement during the hospital stay]
On another level, patient and family engagement means that patients and family members are involved beyond their own care as organizational partners, or advisors – for example, working together with staff, clinicians, and leaders to improve policies, processes, programs, facility design, and education for hospital staff, clinicians and trainees in the health professions.
Patient and family engagement is NOT
Getting patients and families to do what we want them to (it is a shared partnership where we listen to each other and decide on the best plan of action)
Getting patients and families to like us (it is about improving quality and safety by communicating and partnering more effectively)
Handing patients and families a brochure (a piece of paper alone will not get patients and families engaged)
Abandoning our critical judgment (as clinicians, we work with the patient and family to help them choose what is right for them. We bring our clinical judgment to the table – it is important perspective as part of the health care team. But, not the only important perspective).
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

5. Patient- and family-centered care
Patient and family engagement is an important part of providing patient- and family-centered care
Core concepts of patient- and family-centered care:
Dignity and respect
Information sharing
Involvement
Collaboration
Patient and family engagement is an important part of providing patient- and family-centered care. According to the Institute for Patient- and Family-Centered Care, the core concepts of patient- and family- centered care are:
• Dignity and respect, which means listening to and honoring patient and family ideas and choices and using patient and family knowledge, values, beliefs, and cultural backgrounds to improve care planning and delivery.
• Information sharing, which means communicating and sharing complete and unbiased information with patients and families in useful ways. Patients and families receive timely, complete, and accurate details so they can take part in care and decision making.
• Involvement, which means encouraging and supporting patients and families in care and decision making at the level they choose.
• Collaboration, which means inviting patients and family members to work together with health care staff to develop and evaluate policies and programs.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

6. Why patient and family engagement?
[Adapt to hospital]
Include story from leadership about the importance of patient and family engagement and the goals for the effort
Include specific goals and data for the hospital
Refer to or adapt the information as needed from “How Patient and Family Engagement Benefits Your Hospital,” which is included in the Guide resources under” Information to Help You Get Started”
[Discuss specific hospital goals related to patient and family engagement, including how they relate to initiatives to improve hospital quality and safety.]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

7. Why focus on communication?
Foundation of all interactions with patients and families
Research shows patient-centered communication can improve:
Patient safety
More than 70 percent of adverse events caused by breakdowns in communication
Patient outcomes, including emotional health, functioning, and pain control
Patient experience
[Insert hospital goal / data related to communication]
Various studies indicate that the effects of engaging patients and families translate into measurable improvements in quality and safety:
• Improved patient safety. Better communication, realized through patient and family engagement, has a direct impact on patient safety. For example, one study found that more than 70 percent of adverse events are caused by breakdowns in communication among caregivers and between caregivers and patients.1 In addition, studies show that patients who are informed and engaged can help improve safety through “informed choices, safe medication use, infection control initiatives, observing care processes, reporting complications, and practicing self-management.”2 When patients and families are engaged in their care, an extra set of eyes and ears is available to help catch and prevent safety issues.
• Improved patient outcomes. Adopting patient-centered care strategies and engaging patients actively in their health care also has the potential to improve health outcomes. In a review of the literature, Debra Roter found that patient-centered care, realized through effective communication, had a positive effect on patient outcomes — specifically, emotional health, symptom resolution, functioning, pain control, and physiologic measures such as blood pressure and blood sugar levels.3
• Improved scores on public reports of patient experiences of care. The Centers for Medicare & Medicaid Services (CMS) publishes hospitals’ patient experience scores on its public Web site ( The scores are based on a standardized survey known as the CAHPS® Hospital Survey. Many of the measures from the CAHPS Hospital Survey — particularly those related to patient-provider communication, pain management, and the provision of discharge information — reflect key elements of patient and family engagement. Hospitals that have implemented strategies to improve patient engagement and the patient centeredness of care have seen subsequent improvements in patients’ ratings of care.4
References:
1. Sentinel event root cause and trend data. Improving America’s hospitals: the Joint Commission’s annual report on quality and safety; Available at Accessed July 23, 2010.
2. Coulter A, Ellins J. Analysis: effectiveness of strategies for informing, educating, and involving patients. BMJ 2007;335(7609):24-7.
3. Roter D. Which facets of communication have strong effects on outcome: a meta-analysis. In: Steward M, Roter D eds. Communicating with medical patients. Newbury Park, CA: Sage; 1989.
4. Iacono S. Planetree philosophy: a study on the relationship of patient satisfaction and utilization of a Planetree model in care delivery. PlaneTalk; 2001.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

8. What is the patient and family experience at our hospital?
Now we would like to talk a bit about what it is like to be a patient or family member at our hospital.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

9. What is it like being a patient?
Clinicians and hospital staff
Patients and family
Know how the hospital works and how to get things done
Are strangers in this environment
Don not understand the system or culture
Know about their body and life situation better than hospital staff
Know who hospital staff are and what they do
Do not know who different staff are and what they do
May want family or friends to support them
Are busy and under a lot of stress
Are often in pain or uncomfortable, vulnerable, or afraid
Are worried and want to do what they can for the patient (family members)
Aware that hospital staff are busy and may not want to bother you
Want to provide high-quality and safe care
Trust hospital staff to provide safe and high-quality care
Adapt this slide to include concerns patients and families have at your hospital.
Hospital staff and patients know about different things in the hospital and may not always be on the same page. One is not better than the other – there is no right or wrong, but it is important to acknowledge the differences as we move forward to work together as partners.
Read slide and note differences between hospital staff and patients.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

10. What is it like being a patient? (continued)
[Insert 1 to 2 experiences from real patients or family members:
Live presentation or story
Video
Vignette or quote]
[This is an opportunity for hospitals to invite patient and family advisors or other patients and families to share their stories. They can do this in person, via taped presentation, or in a written story.]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

11. Communicating to Improve Quality
Strategy and tools
Communication between the patient, family, and clinicians is a critical component of high quality, safe care and the foundation of effective partnerships. The Communicating to Improve Quality strategy and its tools help to facilitate this communication.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

12. What is the communication packet?
Give three tools to the patient and family prior to or at admission:
Tool 1: Be a Partner in Your Care
Tool 2: Tips for Being a Partner in Your Care
Tool 3: Get to Know Your Health Care Team
Refer to Tools 1-3
Patients who we are expecting (scheduled admissions) will, whenever possible, get the packet at home. Patients who arrived unexpectedly will get the materials after they arrive on the unit.
Be a Partner in Your Care: Emphasizes importance of being a partner and describes scheduled times they can interact with the health care team
2. Tips for Being a Partner in Your Care: Encourages people to:
Tell doctors and nurses about their health
Check their understanding of information clinicians provide
Ask questions until they understand the answers
Tell doctors and nurse the family members or friends who should participate in conversations about their health
Get to Know Your Health Care Team: Describes members of the health care team and what they do
On the day of admission, make sure the patient has the materials and has looked at them. Highlight main points and invite them to be a partner in their care
Tell the patient and family that they are the expert on the patient
Invite the patient and family to ask questions, share concerns, and tell us what they want and need
For example, you can say
We hope you will feel like a part of our health care team – we may be medical/nursing experts, but you are the expert on YOU
Please ask if you ever have any questions.
If I am not being clear enough please let me know – we want to make sure you understand what’s happening in your care
We know we often look really busy or even preoccupied, but we need to hear from you
Do you have any questions about who will be working with you and what they will do for you?
Remember, we are not just doing this to be nice. This is a quality and safety issue. The patient and family may have important information that we need to ensure the quality and safety of their care.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

13. What will you need to do? Before you enter the room:
Read the patient’s chart
When you enter the room:
Make eye contact with the patient
Smile, if appropriate
Introduce yourself by name and role
Introduce new people in the room by name, role, and what they will do
Have conversations at eye level
Before you enter the room, be sure to read the patient’s chart so that when you enter the room, you are able to make eye contact with and greet the patient rather than focus on the chart. The first time you enter the room, introduce yourself by your name and provide your role. It is also helpful to provide a brief explanation of how you will be helping to take care of the patient. One important way in which you can help put patients at ease is to have conversations at eye level, rather than standing above the patient.
[Refer to Tool 5: Communication Competencies for Clinicians]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

14. What will you need to do? (continued)
When you first assess the patient:
Ask how the patient prefers to be addressed
Identify family who should be partners in care
Highlight main points of communication tools
Invite the patient and family to use the white board to “talk” with clinicians
The first time that you assess the patient, ask how he or she prefers to be addressed. Also ask which family members the patient would like to be involved in his or her care. Remember that patients should define who their family is. To ensure that patients and family members are aware of the communication tools, take a moment to point out the brochure, poster, and handout that describes the members of their care team. Also point out the white board and note that it is a tool the patient and family can use to communicate with the care team.
[Refer to Tool 5: Communication Competencies for Clinicians]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

15. What you will need to do throughout the hospital stay?
Include the patient and family as members of the health care team:
Welcome the patient and family and acknowledge their expertise
React positively when people ask questions, volunteer information, share concerns, or want to take part in treatment decisions
Throughout the hospital stay, invite and welcome participation from patients and their family members. Listen carefully to concerns and respond in a positive manner when they ask questions or share information.
[Refer to Tool 5: Communication Competencies for Clinicians]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

16. What you will need to do throughout the hospital stay? (continued)
Ask about and listen to the patient and family’s needs and concerns:
Use open-ended questions
Try to see the experience through their eyes
Listen to, respect, and act on what the patient and family say
Help them articulate their concerns when needed
When talking with patients and family members, it is helpful to ask open-ended questions. For example, ask “What questions do you have?” instead of “Do you have any questions?” Remember that the hospital is an unfamiliar environment for many patients and family members. By learning about their concerns and anxieties, you can help them successfully navigate the experience.
[Refer to Tool 5: Communication Competencies for Clinicians]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

17. What you will need to do throughout the hospital stay? (continued 2)
Help the patient and family understand the diagnosis, condition, and next steps:
Give timely and complete information
Take every opportunity to educate the patient and family
Use teach back to make sure you explained clearly
Find out how much information they want to know
Speak slowly
Use plain language
Invite them to take notes
Find someone who can answer a question if you cannot
Make sure that patients and family members have complete information about their care. This means giving information in clear, simple language. It also means using teach back to determine how well patients and family members understand the information you have provided.
[Refer to Tool 5: Communication Competencies for Clinicians]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

18. What is teach back?
An opportunity to assess how well clinicians explained a concept, and, if necessary, re-teach the information
Ask the patient and family to repeat back in their own words what they need to know or do to be sure you explained things well
Tips for teach back:
Start slowly
Do not ask yes or no questions
Chunk information when explaining more than one concept and use teach back after each concept
We have mentioned Teach Back several times today. Let’s take a moment to stop and talk about this technique. Some of you may have seen it, or already been using it. Can anyone explain what it is?
Teach Back is a chance to assess how well you explained a concept to the patient and family, and if needed, re-teach the information. It is not a test of the patient, but of how well you explained a concept.
You ask the patient and family to repeat back in their own words what they need to know or do to be sure you explained things well. Some examples of what you can say:
“I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”
“What will you tell your wife about the changes we made to your medicines today?”
“We’ve gone over a lot of information about how you need to take care of yourself when you get home. In your own words, please review what we talked about so I can be sure I explained things clearly. How will you make it work at home?”
Some tips for Teach Back:
Start slowly – try on 1 or 2 patients, maybe toward the end of your shift to see how it goes. Ask your supervisor or colleague to give you feedback
Do not ask yes/no questions like “Do you understand?” or “Do you have any questions?”
For more than one concept, chunk the information so people can more easily remember it. Explain the 2-3 points for the first concept and check understanding using teach back. Then, move on to the next concept.
[As you would like, you could show the following examples from YouTube of Teach Back]
NC Program on Health Literacy with 2 examples:
 Project BOOST:
Intro:
Poor discharge example:
Correct discharge:
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

19. How do these tools benefit you?
Help make sure your patients have better outcomes
Help improve quality and safety by making sure patients and families share important information
Ensure the patient and family have a better transition from the hospital
As we talked about earlier, patient- and family-centered communications helps to improve patient outcomes like emotional health and functioning
Communication improves patient safety by making sure you get information that only patients and family members have about their:
illness;
symptoms;
health history;
usual medications;
willingness and ability to do what professionals recommend;
circumstances at home; and
cultural values and beliefs, etc.
As the patient and family will be going home without us, it is important they have the tools and knowledge they need to make sure they can continue recovering at home.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

20. Practice exercises
Now, we have a couple of practice exercises to get everyone comfortable using these tools and techniques.
For this first exercise, let’s break into pairs.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

21. Vignette 1
Jack has just been wheeled into his room in the med-surg unit after having a TURP (transurethral resection of the prostate. He is very happy about finally getting through the surgery and being on this unit, but he is still in pain and uncomfortable and wants to see his wife Emily as soon as possible.
The first person who comes into his room is his bedside nurse, Angela. In this exercise, Angela comes in to do her initial nursing assessment, but Jack interrupts to ask her who she is and what can she do about his pain and discomfort. He also wants to know when his wife can visit him. He is clearly a bit nervous.
After people form pairs, read the vignette and provide these additional instructions.
As you play out the scene, the objectives are to make sure that Jack:
Learns who Angela is and her role in his care
Learns that his wife can visit him anytime
Gets some initial support for relieving his pain and discomfort (verbal and/or actual physical and medication assistance)
Feels reassured that Angela is there for him, will answer his questions as best she can and connect him to anyone else who can help him better than she can
Feel as if he has been “invited” to be a member of the team
Make sure Angela gets her nursing assessment finished!
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

22. Vignette 1 (continued) Debrief Angela and Jack:
What did Angela and Jack say to each other?
How did you each feel during this interaction?
What went really well?
What could have been done differently?
Anything else?
[Get reactions from different pairs’ perspectives. Provide an overall summary of what the groups said.]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

23. Tips for effective engagement
Speak slowly
Use plain language
Reassure the patient and family by giving information
Thank the patient and family for calling attention to any issue they raise and do not act annoyed
Invite them to continue asking questions
Remember that nonverbal communication says just as much as verbal communication
As we work through the next practice exercise, here are some tips [read slide].
For the next exercise, let’s form groups of three.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

24. Vignette 2
The attending physician, John Gladstone, after hearing from Angela about Jack’s pain and discomfort, has just told Jack that he is putting him on a stronger dose of a different pain medication.
Jack expresses worry because he had bad side effects from a similar medicine in the past. Emily, Jack’s wife, who is there at the time, reinforces that experience.
[After people form groups, read the vignette and give the following additional instructions]
The objectives as you play this out are as follows:
Jack thinks he did the right thing in sharing his concerns
Jack and Emily feel as though Jack’s symptoms and concerns were taken seriously
The doctor learns as much as needed about the previous medication problem
The problem of what to prescribe is resolved to the satisfaction of everyone
Jack and Emily understand what is going to happen next
Jack knows he should let Angela know how he is responding so she can let Dr. Gladstone know
Take 5-8 minutes for this exercise
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

25. Vignette 2 (continued) Debrief: What was said during the interaction?
How did each of you feel during this interaction?
What went really well?
Did you use any of the tips? If so, which ones and how did they work?
What could have been done differently?
What’s your biggest take home from these exercises?
[Get perspectives from different groups. Provide an overall summary of what the groups said.]
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

26. Final thoughts
Our hospital is committed to patient and family engagement – everyone plays a critical part
Patients and families won’t engage if they believe that you don’t want them to—it is simply too risky for them
Your job is to make it safe for them to be here, not just as patients but as partners in their care
We would like to end by reiterating how important patient and family engagement is to our hospital. Clinicians and hospital staff play an important role in inviting and support patients and families as full partners in the health care team. By doing this, we can work together as partners to improve care experiences for everyone.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)

27. Thank you! For questions or more information
[Insert name, phone number, and ]
Thank you for your time today. If you would like additional information after this presentation, please feel free to contact me at any time.
Strategy 2: Communicating to Improve Quality Training (Tool 6)
Strategy 2: Communicating to Improve Quality Training (Tool 6)