A Brief Communication Curriculum Improves Resident and Nurse Communication Skills and Patient Satisfaction

Abstract

BACKGROUND: Despite the ever-expanding role that the patient experience plays in healthcare, effective strategies proven to increase patient satisfaction ratings remain scarce. At the University of Pittsburgh Medical Center, we identified patient-doctor and patient-nurse communication as an area for intervention to improve suboptimal patient satisfaction among medicine inpatients. We posited that the likely reasons for underperformance in this area were a lack of adequate training in bedside communication skills. DESIGN: We developed and evaluated a curriculum for medicine residents and nurses focused on clear communication at the bedside. A total of 76 internal medicine residents and 85 medical service nurses participated in 2016. The curriculum utilized didactics, video demonstrations, and role play, and was evaluated using pre-and post-surveys of participants' health literacy knowledge, attitudes, and confidence. Communication skills were evaluated using pre-and post-direct observation at the bedside with a communication skills checklist. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were compared 3 months before and after the curriculum to assess changes in patient satisfaction. KEY RESULTS: Knowledge and attitudes improved significantly for both residents and nurses. Residents' and nurses' observed clinical communication skills improved significantly in most domains, and there was moderate increase in communication-specific HCAHPS scores. CONCLUSION: A small investment of curricular time devoted to clear communication skills improved residents' and medical nurses' knowledge, attitudes, skills, and communication-specific HCAHPS scores. This curriculum, focused on improving bedside communication skills, could be implemented in a variety of settings to improve patient satisfaction and patient experience. Among many barriers to communication, one particular barrier is health literacy. Only 12% of adults have proficient health literacy 7 and it is known that patients with limited health literacy have trouble understanding written medical information, communicating with healthcare providers, and implementing self-care instructions. 1,8 Additionally, both communication skills and an understanding of poor health literacy are required milestones for resident education 9 and communication skills are tested on the national nursing exam. 10 Though recent studies have shown that system-wide communication skills training for faculty physicians can combat poor health literacy and improve patient satisfaction scores, 11,12 these outcomes have not been studied in the resident and nurse populations. As part of a division-wide effort to improve the patient experience, we noted that the general medicine service HCAHPS scores for both our doctors' and nurses' communication had room for improvement, particularly on the item, BDuring this hospital stay, how often did doctors (nurses) explain things in a way you could understand?^Based on

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