Optimizing Hospitalist-Patient Communication: An Observation Study of Medical Encounter Quality.

BACKGROUND: Optimizing patient-hospitalist interactions heightens patient satisfaction, improves patient health outcomes, and improves hospitalist job satisfaction. A study was conducted to recognize hospitalist communication that enhance encounters, identify hospitalist behaviors for improvement interventions, and explore the association of time and gender with communication quality. METHODS: Researchers observed encounters between 36 hospitalists and 206 adult patients. All but 1 of the hospitalists was observed at a 410-bed, general medical and surgical facility in the Midwest. RESULTS: On the adapted Kalamazoo Essential Elements of Communication Checklist (KEECC), hospitalists scored highest on the Builds a Relationship, Shares Information, and Gathers Information dimensions. Participants were seen using multiple, effective verbal and nonverbal techniques to show care and concern, as well as create relational rapport, often while successfully sharing and obtaining clinical information. Hospitalists scored lowest on the Understands the Patient Perspective and Reaches Agreement dimensions. Hospitalists were observed infrequently and inconsistently empathizing with patients and rarely attempting to gain shared understanding and agreement from patients. Significant difference was found in sharing information (t [194] = 2.47; p = 0.01), with male hospitalists (mean [M] = 4.14; standard deviation [SD] = 1.01) more highly rated than female hospitalists (M = 3.78; SD = 0.90). Hospitalist and patient gender match revealed significant difference in sharing information (F [3,192] = 2.60; p = 0.05). Male hospitalists were rated higher interacting with female patients than female hospitalists interacting with male patients. CONCLUSION: Results identify specific hospitalist communication techniques that may ultimately contribute to better-quality medical encounters. Communication interventions are recommended.

Observing and Identifying Hospitalist Best Communication Practices in Patient Interactions.

This study identifies actual hospitalist best communication practices that optimize patient interactions in a busy hospital context. We observed and rated 36 hospitalists and 206 patient encounters using the Kalamazoo Essential Elements of Communication Checklist-Adapted (KEECC-A). We collected descriptive statistics of checklist scores and thematically analyzed fieldnotes to identify communication patterns. Results show hospitalists score highest and most frequently use three of seven KEECC-A dimensions: builds a relationship, shares information, and gathers information. We first identify exemplar behaviors and then provide statistical comparisons by professional and hospital tenure, gender, and day of rounding observed for these three dimensions. Male hospitalists scored higher than females for shares information and significant differences were found for gender between cross-sex patient-hospitalist interactions. Hospitalists early in their professional and hospital tenure received significantly lower ratings than mid-to-late career hospitalists in the three KEECC dimensions. Hospitalists observed on the first day of rounding received significantly higher ratings than those observed on a middle or last day. We offer interpretations to explain study findings and suggest interventions to help hospitalists with less-than-desirable communication skills.