Strategies for Improving the Patient Experience

Alicia Duvall, RN, CMOM-HEM/ONC
Regional Manager
MultiCare Regional Cancer Center
Tacoma, WA

Who determines how successful we are at providing high-quality cancer care? It is our patients and their caregivers, as well as our communities. Most healthcare organizations have specific teams and tools designated to focus on improving the patient experience. They know that patient satisfaction is vital, and invest in teaching this to their leaders and holding them accountable to achieve the best possible satisfaction scores. As we continue to work toward value-based payer models, it is imperative that we emphasize the importance of service excellence.

With the emergence of the COVID-19 pandemic, it has been necessary to initiate mitigation measures to ensure the safety of patients and staff, and these measures have often taken precedence over other daily leadership tasks, including efforts to improve the overall patient experience. However, as we begin to resume normal operations, patient satisfaction scores will be awaiting our attention. The challenge facing healthcare leaders today is how to effectively coach their teams, so they do not lose touch in today’s “touchless society.”

One way to achieve this goal is to implement tools that can help us improve communication with patients and their families. A tool specifically designed for this purpose is AIDET, which stands for Acknowledge, Introduce, Duration, Explanation, and Thank You. Created by the Studer Group, AIDET is aimed at enhancing communication with patients, thereby decreasing anxiety, increasing compliance, and improving clinical outcomes. It has also been shown to improve patients’ satisfaction and perceptions of care.1 By using this tool to coach ongoing service excellence, leaders can aim to make the patient experience go above and beyond expectations. In this article, I will discuss the 5 AIDET behaviors, as well as some of the adjustments that providers may need to make as they implement these action items during the pandemic.

Acknowledge

AIDET suggests that providers greet patients by name, make eye contact, smile, and acknowledge family or friends in the room.2 A smile may be the most important aspect of establishing trust with patients because it conveys the message, “I’m glad you are here.” It is a sign of compassion, empathy, and friendliness, and can benefit providers and patients by building a relationship of trust.

How can leaders ensure that acknowledgment remains a viable component of their team’s AIDET when their smiles are hidden behind masks or other face coverings during the pandemic? One way is to use more forms of nonverbal communication and body language, such as hand gestures and eye contact to enhance communication. For example, in addition to smiling, providers can elevate their eyebrows as a sign of welcome. When listening to patients, they can lean into them (without physically moving toward them) by tilting their heads and nodding as a sign of attentiveness.

As a result of current social distancing recommendations, many cancer centers have chosen to limit the number of people allowed in their clinics. As a result, patients may not be able to have a support person with them during their appointment. This may have a negative impact on patients who are missing that connection to their loved ones. For those who typically have support people with them but now must comply with limited visitor policies, providers can offer to phone caregivers and loved ones to provide details regarding the visit. They should also ensure that patients leave appointments with an after-visit summary or other necessary documentation that they can share with their family and caregivers.

Introduce

AIDET advises that providers introduce themselves to patients by stating their name, skill set, professional certification, and experience.2 This should be done during in-person and virtual visits. This is an action item that can help to assure patients that providers are successful in their roles. Although cancer care amid the COVID-19 pandemic is uncharted territory for everyone, reminding patients of your cancer center’s safety protocols, such as screening measures and testing prior to treatment, can help to decrease anxiety and fear.

Duration

AIDET recommends that providers give patients an accurate time frame for tests and the physician’s arrival, and that they clearly identify next steps. When this is not possible, they should provide patients with a time when they can expect to be updated on progress.2 Updating patients on longer-than-usual wait times is a key factor in decreasing anxiety. If healthcare professionals do not fulfill this expectation, patients may begin to paint their own picture as to why the physician is taking longer than usual to see them, such as, “My labs are not good”; “My chemotherapy is not working”; or “My cancer is back.” Much of this worry can be avoided by simply providing patients with updates when there are delays.

As a result of the pandemic, workflows may be affected by limited staff, because some team members are required to perform other duties, such as COVID-19 testing, screening, triage, and virtual visit troubleshooting. Many healthcare organizations are faced with budget cuts and staffing restrictions because of the pandemic. We are forced to do more with less. This added complexity to already tight staffing models can lead to delays.

When coaching the team regarding this issue, an age-old dilemma of whether to be transparent with patients about staffing shortages may surface. Does this gain the trust of your patient or diminish it? One strategy for discussing delays with patients is to remain focused on safety. Healthcare providers can tell patients, “I apologize your visit is taking longer today. Your safety is important to us and we adhere to safety requirements even if it leads to delays in care.” This can be followed with educating the patient on safety protocols that may be resulting in those delays.

Explanation

AIDET suggests that providers explain step-by-step what patients should expect next, answer any questions they may have, and let patients know how to contact them, such as a nurse call button.2 Unfortunately, wearing a mask can muffle speech for both healthcare providers and patients. Many patients have hearing deficits and historically have relied on lip reading to assist in comprehension. It is important for providers to articulate slowly and clearly with adequate volume to ensure that patients can hear their message. Do not finish the patient’s report of symptoms or assume what they are trying to say because you cannot hear them clearly, as this could lead to an incorrect diagnosis. To ensure your team members are using adequate volume when they speak, encourage them to ask each other, “Can you hear me?” It is important that patients can hear the explanation of diagnosis and/or treatment, but at the same time, it is also important to protect their privacy.

Thank You

AIDET recommends that providers thank patients and their families for choosing their center and for their communication and cooperation.2 This suggestion may be challenging for your team. I typically hear, “This doesn’t feel natural when I see the patient so frequently.” However, now more than ever, it is imperative to thank patients for coming into the clinic. Things that you may consider thanking your patients for include the following:

  • Wearing a face covering and keeping it on for the entire visit
  • Undergoing screening and temperature checks at the front door
  • Keeping the waiting area socially distanced by not arriving early for their visit
  • Leaving caregivers in the car during the appointment
  • The willingness to participate in a virtual visit with their physician.

As we strive to return to normal operations post–COVID-19, we cannot assume that our teams are ready to resume typical strategies aimed at improving patient satisfaction. As leaders, it is imperative that we emphasize this skill as we work to re-establish trust in the communities we serve. Resting on our laurels with strategies once used for patient satisfaction may be inadequate. More than likely, patients are nervous about returning to in-person visits. It is our responsibility to help them feel more at ease and turning to simple tools such as AIDET can be instrumental in reaching that goal.

References

  1. Register SJ, Blanchard E, Belle A, et al. Using AIDET education simulations to improve patient scores. Clinical Simulation in Nursing. 2020;38:P14-P17.
  2. Rubin R. AIDET® in the medical practice: more important than ever. November 17, 2014. www.studergroup.com/resources/articles-and-industry-updates/insights/november-2014/aidet-in-the-medical-practice-more-important-than. Accessed September 5, 2020.
Article provided through a partnership with
Practice Management Institute
and
Michigan Society of Hematology & Oncology

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