Adrienne Boissy on how physicians are learning to improve doctor-patient relationships at the Cleveland Clinic

Communication is a key to a successful business, but it is paramount in health care. The need for transparent dialogue between doctors and nurses is a given, but now greater attention is being paid to the interactions between caregivers and patients, and how those relationships affect health outcomes. Adrienne Boissy, a neurologist and the chief experience officer at the Cleveland Clinic, has co-written a book entitled, Communication the Cleveland Clinic Way. How To Drive A Relationship-Centered Strategy For Superior Patient Experience. She wrote the book with Tim Gilligan, former co-director of the Cleveland Clinic Center for Excellence in Health Care Communication. Boissy shared some the lessons she has learned on the [email protected] show, part of Wharton Business Radio on SiriusXM channel 111. (Listen to the podcast at the top of this page.)

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An edited transcript of the conversation follows.

[email protected]: The patient experience is one of the most important focuses that hospitals have these days, right?

Adrienne Boissy: You’re absolutely right. We’ve been thinking a lot about patient experience for probably the past decade. I don’t know how familiar you are with Toby Cosgrove’s story in that, but that was really the spark that lit the fire for us around patient experience.

[email protected]: In your title and the work that you do there, it is a point of emphasis for you because the experience is not just how the patient is treated when they’re being looked at by a doctor or a nurse, but it’s the whole experience of coming to the hospital and the neighborhood around the hospital.

Boissy: We know that patients are making choices about where they’re going to go and who they’re going to see based on the experience that they have at that hospital or organization. Those are the things people go home and talk about at the Thanksgiving Day table, and that’s what they’ll remember.

[email protected]: Is the training for doctors, nurses and the staff at a facility like the Cleveland Clinic being tweaked so that this patient experience is a growing part of their whole understanding of what it is to be a doctor or a nurse these days?

Boissy: There’s lots of humanism and communication skills training going on in medical schools and nursing schools, probably even more so. And I think that’s great. It’s important to understand that before you’re a staff physician or a nurse out on the floor, when you’re in school or a student, you have minimal responsibility.

“The challenge is that all of us have a role in modeling the skills we want to see in the world.”

You don’t have a lot of on-the-ground, real-world experience, and your empathy levels are at an all-time high. Yet the challenge comes when you’re really the one with full responsibility to sit down with a patient you’ve never met before and tell them they have ALS, or to tell someone who thinks they have one disease that they have another. Those types of conversations carry the emotional burden, I think, for the clinicians who have those.

[email protected]: How much of teaching does the Cleveland Clinic have to do on top of what the doctors and nurses learn in school?

Boissy: It’s really important for a couple of different reasons. The first of which is just what I said, that it’s very different being a student and studying it versus being immersed in it up to your chest. The second thing is, transparency is a driving force across health care systems today. Not only is patient experience valued, but we’re transparent about how organizations and individual doctors, clinicians are performing. That’s both internally as well as externally. A patient can go on Google and look up Cleveland Clinic physicians or clinicians and see what other patients are saying, and we know that guides choices.

We learned that once you make it transparent at that level, you also really have to be able to follow that up with training. Meaning, what’s the point of being transparent if you don’t have programs that actually support your people to get better? That’s the definition of futility. It’s very risky, in my mind. You have to be able to do both: be willing to be transparent and drive that as an organization, which I think we did, and to be able to back that up with resources to help your people.

[email protected]: The model that Cleveland Clinic uses in terms of the communication process is called REDE. Can you explain what that is and how it has been implemented?

Boissy: I’ll tell you a quick story. When I was asked about eight or nine years ago to develop a communications skills training program for the Cleveland Clinic, I thought that would be great. — trying to deliver training or teaching around a product or a service that most people think they’re already good at and don’t think they need. Yet the complexity of the conversations and the fragility of those conversations really became very interesting to me. Could we deliver training that would honor that?

As a practicing neurologist, I never really thought much about how I communicated, even though I had gotten training in school earlier and thought I was really good. One of my colleagues came up to me and said, “You know, I think we should couch these communications skills in the context of a relationship.” I looked at her and I thought, what are you talking about? My job as a doctor isn’t to build relationships with my patients. I’m stamping out disease. I prescribing medicine.

“Empathy is a relentless pursuit. You can’t … just expect that empathy is thriving around every corner.”

It was an a-ha moment because I reflected back earlier on my career when I had tried to tell some patients some really difficult information. It was the first time I was meeting them, and it didn’t land on them really well. In my youth, I didn’t understand it. I thought, what’s wrong with you? I’m telling you the truth, this is really important. I’m telling you things nobody else said. But giving that information in the absence of a relationship, people won’t hear you.

To me, that was an a-ha moment. Although it may not sound earth-shattering to you, for many clinicians it might be because not all of them necessarily view their job as building relationships with their patients. Yet that is the one thing that is incredibly therapeutic for both.

[email protected]: You talk in the book about how there are certain situations or certain diseases that doctors have a very hard time discussing. I think we assume that doctors who have expertise in a field or a disease don’t have any concerns in terms of having the conversation. You talk about the fact that they do.

Boissy: This work leaves sort of an emotional residue on caregivers, without a doubt. The training we offered was an eight-hour training. It’s a lot of creative methods of improv and group facilitation, physicians to physicians.

What was so interesting was that the first rendition actually didn’t allow them to bring their toughest cases. We added that later. The reason

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