1. Department of Graduate Medical Education (GME) The Stanford Patient-Physician Communication Project Graduate Medical Education Stanford University Medical Center Ann M. Dohn, MA Designated Institutional Office Nancy Piro, PhD Education Specialist / Program Manager

2. Department of Graduate Medical Education (GME) Why Are We Doing This? Because we have to?

3. Department of Graduate Medical Education (GME) ACGME requires (IV.A.5.d).(4) Residents must: –systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement;

4. Department of Graduate Medical Education (GME) Why Are We Doing This? Because we want to?

5. Department of Graduate Medical Education (GME) The Picker survey demonstrated need for better communication between physicians and patients… Patient Satisfaction Data

6. Department of Graduate Medical Education (GME) Added factor New CEO…. “Healing humanity through science and compassion, one patient at a time” C-I-C-A-R-E C - Connect with patients by addressing them as Mr./Ms. or by the name that they prefer I - Introduce yourself and your role C – Communicate what you are going to do, how long it is going to take, and how it will impact the patient A – Ask and anticipate patient needs, questions or concerns R – Respond to patient questions or requests with immediacy E – Exit courteously and/or with an explanation of what will come next (what you will do for them next)

7. Department of Graduate Medical Education (GME) The Charge to the Chief Residents: Design and implement a quality improvement project that impacts or involves the majority of the residents and fellows. –1% salary bonus as an incentive

8. Department of Graduate Medical Education (GME) Chief Residents and GME’s Collaborative Solution Create “teamcards” to identify residents/fellows to patients Develop a BRIEF training module on resident/patient communication Pre Interview of Patients: Do they know their residents’ names?

9. Department of Graduate Medical Education (GME) Effectiveness Research A sample of 300 Patients were interviewed prior to Teamcard Distribution and Implementation by GME and Process Excellence Staff

10. Department of Graduate Medical Education (GME) Data Sheet: Teamcard Chief Residents’ Project Data # PRE POST Age: Gender: Dx of Cognitive Impairment: YES No Is yes, DSM Dx: ______________ Do you know the name of your primary resident physician? YES No __________________________________ (Name Given) Additional Comments:

11. Department of Graduate Medical Education (GME) What did our PRE-Initiative Survey Show? 98% of the patients interviewed did not know the name of their resident physician. Many did however know their attendings’ names. Many patients told us they thought it was a “great idea” …I can take home with me and it will help me remember my physicians’ names….. nurses need these, too

12. Department of Graduate Medical Education (GME) Chief Residents QI Project “Teamcards” Goals – To improve communication with patients – To better identify the care team – To improve patient engagement – To better connect with patients

13. Department of Graduate Medical Education (GME) Implementation Steps Communicate Plan and Project Goals Announce training Distribute the cards and implement Measure effectiveness of new model –Post Interview of Patients

14. Department of Graduate Medical Education (GME) Effectiveness Research A second sample of 300 Patients will be interviewed post Teamcard Implementation to determine the impact/ effectiveness of using Teamcards.

15. Department of Graduate Medical Education (GME) ACGME Requires ( IV.A.5.e) Interpersonal and Communication –Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. –Residents are expected to: communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds;

16. Department of Graduate Medical Education (GME) Teamcards Implementation and Training GME Announced: All residents/fellows (including departing house staff) must take the Teamcards/C-I-CARE (3 minute) module on Healthstream before June 1, 2011 https://www.healthstream.com/HLC/Login/Login.aspx?organizationI D=6a27bcaa-71bd-db11-bf7b-000423d6b5c1&bhcp=0 We required 90% compliance with course completion by ALL house staff to qualify for 1% salary incentive in late June D-E-M-O

17. Department of Graduate Medical Education (GME) Implementation Details Residents/fellows on inpatient rotations at SHC started using their “teamcards” this month “Kick-Off” Meetings were held and cards were distributed via the departments.

18. Department of Graduate Medical Education (GME) What in it for the residents? * INCENTIVE BONUS*

19. Department of Graduate Medical Education (GME) And when will the residents see the $$$? Last paycheck in June or their final paycheck if they are graduating this year! GME is keeping the residents updated on the progress toward the goal of 90% compliance with the training.

20. Department of Graduate Medical Education (GME) Obstacles We Encountered The great LOGO debate… How many pixels are required for a good photo? Aren’t the residents always available for a professional photographer? Can’t visiting residents get their pictures taken, too and get cards? Are visiting residents like community physicians? Once the initiative took off, it was no longer the Chief Residents’ Project Faculty Teamcards, too

21. Department of Graduate Medical Education (GME) Even our Faculty Wanted Teamcards

22. Department of Graduate Medical Education (GME) Summary CICARE C-I-C-A-R-E

23. Department of Graduate Medical Education (GME) Questions? CONTACT INFORMATION ~ Ann M. Dohn, MA Designated Institutional Official adohn1@stanford.edu Nancy Piro, PhD Education Specialist/ Program Manager npiro@stanford.edu