Impact of hospitalist communication-skills training on patient-satisfaction scores.

BACKGROUND: Hospital patient-satisfaction scores now affect hospital payment, but little research addresses how hospitals or clinicians might improve performance. OBJECTIVE: To assess the impact of a communication-skills training program on patient satisfaction with doctor communication and overall hospital care. DESIGN: Preintervention vs postintervention comparison of patient-satisfaction scores. We designed a communication-skills training program for hospitalists consisting of three 90-minute sessions, based on a popular framework. SETTING: Nonteaching hospitalist service in an urban academic hospital. MEASUREMENTS: Doctor-communication items from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey surveys, and HCAHPS overall hospital rating. RESULTS: Overall, 61 (97%) of 63 hospitalists completed the first session, 44 (70%) completed the second session, and 25 (40%) completed the third session of the program. Patient-satisfaction data was available for 278 patients during the preintervention period and 186 patients during the postintervention period. Two of the 3 HCAHPS and all 5 of the Press Ganey doctor-communication items were rated higher during the postintervention period, but no result was statistically significant. Similarly, the overall hospital rating was higher during the postintervention period, but the result was not significant. Analyses based on level of hospitalist participation did not show significant differences. CONCLUSIONS: Patient satisfaction did not significantly improve after a communication-skills training program for hospitalists. Because of the small sample size, larger studies are needed to assess whether such a program might truly improve patient satisfaction.

Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT).

BACKGROUND: Hospitalists care for an increasing percentage of hospitalized patients, yet evaluations of patient perceptions of hospitalists' communication skills are lacking. OBJECTIVE: Assess hospitalist communication skills using the Communication Assessment Tool (CAT). METHODS: A cross-sectional study of patients, age 18 or older, admitted to the hospital medicine service at an urban, academic medical center with 873 beds. Thirty-five hospitalists assigned to both direct care and teaching service were assessed. MEASUREMENTS: Hospitalist communication was measured with the CAT. The 14-item survey, written at a fourth grade level, measures responses along a 5-point scale ("poor" to "excellent"). Scores are reported as a percentage of "excellent" responses. RESULTS: We analyzed 700 patient surveys (20 for each of 35 hospitalists). The proportion of excellent ratings for each hospitalist ranged from 38.5% to 73.5%, with an average of 59.1% excellent (SD=9.5). Highest ratings on individual CAT items were for treating the patient with respect, letting the patient talk without interruptions, and talking in terms the patient can understand. Lowest ratings were for involving the patient in decisions as much as he or she wanted, encouraging the patient to ask questions, and greeting the patient in a way that made him or her feel comfortable. Overall scale reliability was high (Cronbach's alpha = 0.97). CONCLUSIONS: The CAT can be used to gauge patient perceptions of hospitalist communication skills. Many hospitalists may benefit from targeted training to improve communication skills, particularly in the areas of encouraging questions and involving patients in decision making.