Choosing their words wisely: Patient communication skills pay off for Boulder Community Health

Editor’s note: Boulder Community Health, Boulder, Colo., earned MGMA “better-performer” distinction in patient satisfaction and accounts receivable.

Ben Keidan, MD, MGMA member, internist and quality improvement specialist, Boulder Community Health, Boulder, Colo., had a plan for making healthcare more efficient, effective and affordable while also providing a compassionate patient experience. 

Effective communication, he thought, could allow the practice to streamline work while strengthening the patient and care team experience.

"Initially when we took a close look at the patient experience, we were surprised and concerned that our patient satisfaction scores were lower than we had expected. This information had a strong negative effect, and many care team members felt powerless,” Keidan says. “Of course a patient’s satisfaction rating can reflect so many factors in her or his personal life it is easy to rationalize complaints: difficult patients, unrealistic expectations [and] ineffective systems out of our control. But an objective look at patients’ comments showed that our patients’ concerns tended to cluster around communication skills and listening.”

Keidan said his team neglected a simple fact – “that emotional well-being is an integral part of physical health and medical outcomes.  

“As we concentrate on optimal care, accurate diagnosis and the right treatment, we can sometimes get lost in the details and lose the human connection … that universal need to speak, be heard and understood,” Keidan says. “But recognizing the need, we decided to make communication our primary focus.”

Boulder Community Health began by inviting all primary care clinic staff to workshops to develop four communication skill areas: 

1.    Communicating with empathy 
2.    Improving the difficult patient interaction  
3.    Engaging patients’ families in care 
4.    Interviewing 

A certified motivational interviewing trainer led groups of about 20 in four-hour sessions. Each provider and registered nurse attended one session. Follow-up sessions to do additional question-and-answer sessions to strength skills were planned.

During the workshops, team members were encouraged to respond to underlying emotions being expressed before addressing medical concerns. They utilized key words at key times to convey concern and communicate that they were listening.

Initially, the team faced significant resistance, especially regarding using key words and scripting. For many people, learning to be emotionally literate – using the language of feeling – is not a simple change.

“It is too soon to be certain,” Keidan says, “yet it looks like our efforts are paying off. Patients tell us that we have improved roughly 10% in listening, concern and general communication.”

Keidan said one physician said that while scripting initially felt awkward, within one week he had realized that, in asking patients if they had other concerns, the scripting was helping him communicate what he felt with “gravity and connection.”

To promote a communication culture, Jamie Jensen, MGMA member, chief operating officer/Physician Clinic, Boulder Community Health, focuses on monitoring progress and hiring the right people with the right skill set for the job. “We get monthly surveys that specifically address aspects of communication,” Jensen says, “and we review them with the care teams quarterly. The information helps us make ongoing improvements.

“To establish a new cultural norm, we have to make an investment in hiring and in personnel development, yes, but we also have to identify and hire strong leaders,” Jensen added. “We look for physicians who are highly engaged and passionate about the mission at hand. Initially a physician may not recognize that she or he has the skill and ability to lead a cultural change. Yet the correct leader to improve patient satisfaction and the patient experience is not an administrator; it is a team of people supplying data and information to the physician leader who engages his or her colleagues to move the needle in a meaningful way.”