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Mayo Clinic’s Empathic Communication Training

David Ence, MHSASheila Stevens, MSW

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Objectives

• Discuss the process of building and implementing a data-driven, empathy-based training program, improving clinical outcomes and patient/employee satisfaction

• Identify specific empathic communication strategies that can be applied in challenging patient scenarios to enhance the patient experience

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Meet Mr. Jones

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Mayo Clinic Culture

“It is easy to philosophize; the philosopher is said to be the one who bears with equanimity the sufferings of others”

• Dr. William J. Mayo

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0 5 10 15 20 25 30

Communication

Access

Shared Decision Making (SDM)

Clinical Quality and provider knowledge and skills

Physical environment

Patient Education

Electronic Medical Record (EMR)

Pain control

Discharge process

Preventive services

Number of Studies

What Patients Say

Mohammed, et al.

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What Providers Do – Missed Opportunities

Expressed Emotion

• Explicit – Stated

• Implicit –(Psychosocial Cues) Death, Illness, Life Issue

Provider Response

• Ignore/Change Topic

• Dismiss/Minimize

• Elicit

• Problem-solve

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The Difference

“The irony is that clinicians tend to take for granted that care is going to be compassionate, whereas patients take for granted that care is going to be excellent.”

• Thomas Lee, M.D.

An Epidemic of Empathy in Healthcare

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Discuss/Define Empathy

• Empathy vs. Sympathy vs. Courtesy

• Ability to communicate that you have taken one’s perspective and feelings without judgment

• “At least…” “yeah, but…”

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Discuss/Define Empathy

• Empathy vs. Sympathy vs. Courtesy

• Ability to communicate that you have taken one’s perspective and feelings without judgment

• “At least…” “yeah, but…”

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Empathic Communication for Providers:

Mrs. Bardis - 56-yr old, married sales rep

Heel pain has left her unable to walk without limping. She presents today at a consult with a podiatrist after her PCP has referred her with a diagnosis of Plantar Fasciitis.

“The pain has been horrible for months with no signs of improvement. I’m unable to perform at work and enjoy life. I’m really scared that I’ll be debilitated for life.”

A) Assess for diagnosis

B) Offer explanation of why this occurred

C) Explain treatment options

D) Other

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Empathic Communication

• Tend to the emotional elements of what you hear

• Mindful Presence of relationship/partnership

• Acknowledge patient’s perspective before giving yours

• Reflective Listening

• Paraphrase words/emotions

• Statement form, not question

“…I’m unable to enjoy life

…I’m really scared that I’ll be debilitated for life”

“Mrs. Bardis, this pain is really impacting your quality of life.”

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Building Relationships through Empathic Reflective Listening

• Shows sensitivity to the to the fear, tenderness, rage, confusion or whatever the patient is experiencing

• Deescalates high emotions

• Creates deeper connections

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Challenging Communication

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Tangential Behaviors

Mrs. Fletcher calls at 1:00 p.m. to cancel her 2:00 eye exam appointment. She explains that she went out to run some errands prior to her appointment, and she is at the grocery store on the other side of town, and her car won’t start.

Mrs. Fletcher is tangential in nature and is relaying details that are irrelevant in this situation. It’s difficult for the scheduler to break into this conversation.

The scheduler would like to offer Mrs. Fletcher a new appointment, but isn’t sure she should interrupt.

Should the scheduler interrupt? If so, when? How?

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Empathic Redirection

• Be self aware of your thoughts/feelings

• Engage your empathy

• Orient with sound/name (optional –gentle touch)

• Ask permission to jump in

• Reflect/Validate/Summarize what you’ve heard

• Redirect to mutual goal

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Empathic Strategies for Service Recovery

Mayo Clinic’s definition of Service Recovery:

An empathic approachto quickly respond and

fairly resolve patient concerns,in a way that

makes them feel satisfied

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EmpathizeListen Apologize Do something

LEAD

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“I waited more than 20 minutes past my

appointment time for you, and this is not

the first time this has happened to me when

I’ve had an appointment with you.”

• Start with a word other than, “I…”or “we…”

• Statement form, not question

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“I don’t want to see a resident.

I want to see a ‘real’ doctor.”

• Start with a word other than, “I…” or “We…”

• Statement form, not question

• No advice/problem solving or rationale

• No apology

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Program Process and Timeline

Initial Leadership Consult

Training with Unit Staff

Follow-Up with Unit

Hand off to Unit Champions

Within 3 months of consult

Within 4 weeks of final training session

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Initial Consult with Leadership

• Not enough time

• Not my jobImportance

• Uncomfortable

• Lack the necessary skillsConfidence

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Training Sessions with Staff

Key Principles:

• Partnering language “We” or “Let’s”

• Mindfulness

• Reflective Listening

• Empathic Redirection

• More for challenging situations

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2016 Program Overview

• Small group sessions – 20-30 per session

• “Unit Champion” model for sustainment

• Duration: 60 min per session

• Content is “contextualized” for the unit or discipline being

trained.

• 400+ Staff trained in 3 clinical units

Specialty Areas Discipline Trained

Dermatology Physicians, Nurses, Front Desk Staff

Neurology Physicians, Nurses, Front Desk Staff

Orthopedic Surgery Nurses Only

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Initial Data and Outcomes

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60

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Overall Nurse/Assistant Care Providers Personal Issues Overall Assessment

Top Box Scores - Neurology

Q3 2015

Q3 2016

Target

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Staff Feedback

• “Such simple, intuitive material, yet crucial and much more difficult to master than would be expected!”

0%

20%

40%

60%

80%

100%

Excellent Very Good Good Fair Poor N/A

Attendee Post-Training Feedback

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Lessons Learned & Next Steps

• Dedicate time away from patient care to attend

• Length of the courses

Challenges

• Varying levels of motivation

• (Great way to model the Empathic behaviors!)

Barriers

• Follow-up

• Sustainment & New employees

• Metric driven identification

Improvements

• Refine content

• Expand training in Rochester and diffuse to other sites

Next Steps

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Back to Mr. Jones

1. Be courteous: Say, “Thanks,” and leave graciously to respect his autonomy.

2. Let him know that you’re not only invited, but that you were ordered by his physician.

3. Ask if you can come back at a different time that might work better for him.

4. Leave some materials, and let him know that he can contact you if he changes his mind.

5. Ask a question such as, “What concerns you the most about what will happen if you do agree

to meet with me?”

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Building Relationships

“People don't care how much you know until they know how much you

care.” (Theodore Roosevelt)

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Summary

• Tend to the relationship (show interest in the patient)

• Focus on patient’s perspective prior to giving your perspective

• Reframe “Difficult Patients” to “Challenging Communication”

Several studies show that empathic communication

enhances the quality of the patient experience

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Questions?

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Bibliography• Hsu, I., et al. (2012). Providing support to patients in emotional encounters: A new perspective on missed empathic

opportunities. Patient Education Counseling. 88(3) 436-442. doi:10.1016/j.pec.2012.06.015.

• Miller, W. R., & Rollnick, S. (2013). Motivational interviewing helping people change (3rd ed.). New York: Guildford

Press.

• Mohammed, K., et al. (2014). Creating a patient-centered health care delivery system: A systematic review of health

care quality from the patient perspective. American Journal of Medical Quality. doi: 10.1177/1062860614545124

• Schattner, A. (2009). The silent dimension: expressing humanism in each medical encounter. Arch Intern Med; 169:1095-99

• Wanzer, M., Booth-Butterfield, M. & Gruber, K. (2004) Perceptions of Health Care Providers' Communication: Relationships Between Patient-Centered Communication and Satisfaction, Health Communication,16:3, 363-384, DOI: 10.1207/S15327027HC1603_6

• Education Guides the Young to Good Citizenship. Minnesota Med., 19:468-470 (July), 1936.

• Lee, T. H. (2016). An epidemic of empathy in healthcare: How to deliver compassionate, connected patient care that creates a competitive advantage. New York: McGraw-Hill