A couple of months ago, I completed a master trainer course offered by the Agency for Healthcare Research and Quality on TeamSTEPPS, a set of evidence-based strategies and tools to enhance team performance and patient safety. Information sharing and communication are key principles of the program. Since the training, I have thought about opportunities to leverage emerging technologies, including interactive websites, social media, Web-based video conferencing, mobile and more into health care.
TeamSTEPPS promotes techniques that create highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes for patients and eliminate barriers to safety. These techniques include Briefs, Huddles and Debriefs, Check-backs or Teach-backs, Feedback, Advocacy and Assertion and SBAR (Situation, Background, Assessment, Recommendation). While the system originally was focused on the professional care team, the techniques also can be applied to communications and engagement of patients and family caregivers; especially during transitions in care.
Elements of these communication techniques also can be incorporated into the design of technology applications. One example is Boston University School of Medicine's use of a virtual discharge advocate to deliver education and guide patients through their individualized after-care plan. The avatar, Louise, teaches patients in simple language and checks to ensure that patients understand the various components, such as their prescribed medications, follow-up appointments and diagnoses.
Other Efforts To Boost Patient Safety, Communications
Team STEPPS isn't the only program focused on patient safety and communications.
Communication is central to CMS and the Joint Commission's national campaign urging patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team. The campaign, called SpeakUP, promotes educating one's self, asking trusted family member or friends to be advocates and to actively participate as part of the health care team.
Ask Me 3, a program of the national Patient Safety Foundation, promotes communication between health care providers and patients for improved outcomes. It encourages patients to find and understand the answers to three questions:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do this?
Additionally, health care leaders have a responsibility for guiding an organization's safety culture and listening to voices of patients and families.
According to the American College of Healthcare Executive's policy statement, they should then apply the input gathered into design and improvement of care processes and adopt information systems that support the patient safety strategy. They also are expected to seek out and apply best practices.
Opportunities for Emerging Technologies
New and innovative technologies can be used to educate and share stories that increase patient engagement, elevate safety knowledge and lead to improved safety and health outcomes.
Patients and family caregivers can use these Web-based tools to enhance their encounters with physicians for coaching when well and to support more fluid transitions in care, such as post discharge. The tools also can help them:
- Become more aware of their role in reducing medical errors, readmissions and unwanted consequences;
- Understand why it is important to keep follow-up appointments;
- Learn to take their (or give) medications as directed and comply with treatment plans;
- Recognize warning signs and symptoms they should be monitoring after leaving a health care facility;
- Understand what they can do to reduce their risk for a fall, food/drug interactions or the deterioration of their health status;
- Know who to call when new symptoms arise or their condition worsens;
- Take control over their care -- learning and practicing self-management skills for their chronic disease; and
- Build skills to negotiate the health care system and advocate for one's self or the patient.
Health care organizations are straining with major delivery system shifts and limited resources. Increasingly, they are re-defining the patient experience with interactions that influence patient behavior and perceptions across the continuum of care. The strategies adopted also could leverage technologies to stretch resources, overcome poor provider communications and facilitate:
- Management of roles and relationships so personalized information can be delivered to patients and caregivers at appropriate points in time, rather than how and when it is more convenient for staff or the organization;
- Improved clinical and business processes by tracking patient understanding, auditing and documentation, trending and creating a record of self-management activities and interventions;
- Communications and education when patients, or their caregivers/advocates, are not physically located in the hospital or clinic;
- More efficient and timely data collection and enhanced communications between patient, doctor and hospital staff;
- Presentation of disparate systems on an enterprise platform that offers ease of navigation, single sign-on and more seamless and consistent interactions along the continuum of care;
- Outreach to patients on familiar and preferred channels making it easier for them to engage; and
- Outreach and checking in with recently discharged or home care patients during emergencies or disaster events.
Applying self-care and management applications that incorporate closed loop technology can increase patient compliance and improve diagnosis and educational processes. Offering these and other tools on an enterprise portal provides a platform for addressing patient needs, where they are in their experience, and for contiguous interaction on the staff side. The customer relationship and personalization features leverage and capture patient data, continually enhancing experiences throughout their interactions from shopper through post treatment.
Electronic health records often don't have health education materials that are understandable and actionable for patients with basic or below basic health literacy. But, leveraging audio, video, graphics and simulated environments can help minimize use of medical terms and long text so that information can be presented in a format that can be understood and used by patients. This is especially important for the estimated 77 million people in the U.S. with a poor understanding of basic medical vocabulary and health care concepts -- often those at greatest risk for readmissions.
Evidence-based communication practices for safety include making the patient part of the team, advocating for the patient, engaging the patient and closing the loop with communications. Emerging technologies offer opportunities for new and innovative strategies that will transform the way health care institutions and professionals communicate with their patients and with the rest of the care team.