NAVAAM
Poster 9/1/99
Using Patients' Perspectives to
Develop an Intervention
to Improve Patient-Clinician
Communication
Authors
Cynthia Russell, PhD, NP; Carolyn
Drumwright, MSN, NP; Sandra Harrison, MSN, NP; James Holt, PharmD; Lawrence
Madlock, MD; Linda Morris, MD; Roger Smith, MD; Margaret Sousoulas, MSN, CS of
Memphis VAMC
Background
-
Surveys
have identified communication with clinicians and staff as a concern for
outpatients.
-
Surveys
do not provide details of specific concerns or methods to correct concerns.
-
VISN-funded
study supported by Memphis VAMC administration.
Purpose
M
ethod
Sample
N
= 6 groups
(psychiatric,
SCI, geriatrics, womens, general medicine)
N
= 52 patients, 5 spouses
Average
of 9 patients/group
Range
of 90 - 150 minutes/group
Procedure
Introduction
to background of project
Discussion
of confidentiality and ground rules
Personal
introductions of each participant
Specific
questions with each person commenting
Summary
of discussion and feedback
Wrap-up
question
Thank
yous
Q
1: Recent Positive Outpt. Experience
a.
Health care providers
- professional, caring, competent, thorough, concerned, responsive, "like
old friends"
b.
Firms - easier
to get appts., decreased wait to see provider, reminders appreciated,
pharmacies a good change
c.
Ancillary areas
- positive comments about ER, hematology, urology
d.
General VAMC -
suggestions for change appear implemented, "feel part of a family
here"
Q
2: Recent Negative Outpt. Experience
a.
Health care providers
- no consistent patterns in responses, lengthy follow-up on diagnostic test
results, time spent reading charts
b.
Other personnel
- attitude problems, cold, talk down to patients, unresponsive to patient
needs
c.
Ancillary services
- long waits for appts. Or to receive services
d.
General VAMC -
parking, chart availability, constant changes
Q
3: Indicators Providers Understand
Listening,
responding, asking & answering questions, giving undivided attention,
expanding on what pts. say, taking care of issues with other clinics, dealing
with pt. concerns as a priority, responding to pt.'s agendas and lists of
concerns first, knowing pt.'s history and unique situations
"I
feel validated when they look at my concerns as being the most pressing and
they take care of me first."
"If
she's writing or looking at the computer and I ask her a question, she stops,
she looks at me, and I know she's listening to what I'm saying."
Q
4: Indicators of Negative Experiences
not
having read pt.'s charts, unsure of reason for pt.'s appt., not listening
& merely looking at charts, receiving or responding to telephone calls and
pages while with pts.
"It
bothers me when they don't know me as a patient and they're asking me
questions that show they don't know me."
"The
residents get paged in the middle of a conversation and, all of a sudden, they
pick up the phone and start dialing. It's like, 'I thought we were talking'
and they'll say 'Excuse me, ma'am. I've got this page.' It makes you feel like
you're a little bit like call waiting."
Q
5: Feel like a Partner in Care AND Q
6: Know me as a Person
Virtually
all pts. felt as if they were partners in the decisions about their health
care within their respective firms. They also overwhelmingly felt as if their
primary care providers knew them as a person.
However,
in the specialty clinics and while inpatients they did not have these same
feelings of being partners and being known as a person.
Summary:
One minute of advice
a.
Know me and my needs
- have & review charts prior to visits; know problems & diagnoses;
ask about follow-up of prior reported problems
b.
Respect me and my individuality
- treat with respect, understandable language, sensitivity to privacy
c.
Listen to me when I talk to
you - active listening and acknowledgement of being heard
d.
Communicate with me
- communicate about benefits, rules, lab results, medications, good jobs of
employees
e.
General recommendations
- make changes to improve service delivery, supervise residents better, use
technology better, get an advocate for pts. who need help
Summary
Focus
group methodology worked well for this project.
Pts.
were readily able to identify general and specific areas of positive and
negative patient-clinician communications.
Results
offered to providers in the specific firms, as well as general administration.
Helpful
web sites
Catterall,
M. and Maclaran, P. (1997) Focus Group Data and Qualitative Analysis Programs:
Coding the Moving Picture as Well as the Snapshots. Sociological Research
Online, vol. 2, no. 1, http://www.socresonline.org.uk/socresonline/2/1/6.html
Provides
some background information on focus groups and presents discussion that focus
groups elicit more than mere responses to questions.
Gibbs,
Anita. (1997). Focus groups. Social Research Update, Issue 19. Online at:
http://www.soc.surrey.ac.uk/sru/SRU19.html
Excellent
on-line article describing benefits and problems associated with focus groups.
Greenbaum,
Thomas L. List of articles authored by Greenbaum, many of which are relevant to
focus groups. Online at: http://www.groupsplus.com/articles.htm
Relevant
books
Bader,
Gloria E., & Rossi, Catherine A. (1998). Focus groups: A Step-by-Step
guide. The Bader Group. ISBN: 096647080X.
Krueger,
Richard. (1994). Focus groups: A
practical guide for research. Sage.
ISBN: 0803955677
Morgan,
David. (1997). Focus groups as qualitative research (2nd ed.).
Qualitative Research Methods Series. Sage. ISBN: 0761903437
Templeton,
Jane Farley. (1994). The Focus Group : A Strategic Guide to Organizing,
Conducting and Analyzing the Focus Group Interview. Probus. ISBN:
1557385300.
URL of current page: http://www.utmem.edu/~crussell/navaamposter.htm
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