Over the past nine months, more than 450 Stanford physicians and Advanced Practice Providers (APPs) have completed a new communication workshop, Advancing Communication Excellence at Stanford (ACES); another 250 are scheduled to complete the course by August.
The ACES workshop is designed to augment and strengthen clinicians’ communication skills with patients, families and colleagues. Developed in partnership with the Academy of Communication in Healthcare (ACH), ACES is a one-day course taught by ACH-trained Stanford faculty and staff. The evidence-based curriculum focuses on mastering effective, empathic communication skills, with the twofold goal of improving the patient experience and enhancing professional satisfaction.
“Life changing interactions between patients and physicians begin as choreographed, yet intimate, exchanges between strangers,” said Jonathan Berek, MD, MMS, Director of the Stanford Health Care Communication Program, which promotes ACES. “Research indicates that health care outcomes and physician wellness are influenced by the quality of communication in the patient care environment.” For patients, effective communication has an impact on physiological outcomes, information exchange, decision-making, compliance, symptom relief and satisfaction with care, said Berek, the Laurie Kraus Lacob Professor at Stanford. For physicians, improved communication skills can increase professionalism and personal fulfillment, while decreasing frustration, burnout and malpractice claims, he added.
The eight-hour immersive workshop is offered six times a month and is free to physicians and APPs. Participants earn 7.25 CME hours. Workshops are facilitated by Stanford faculty and staff—one physician coach and one APP leader—who donate their time to guide these sessions. Each underwent six months of training co-led by an ACH master trainer and Stephanie Harman, MD, Director of Palliative Care Services for Stanford Health Care. Harman is also a master trainer for the Academy of Communication in Healthcare.
“We created ACES to develop a shared language for all of our providers. The beauty of this workshop is that it is entirely evidence-based,” said Barbette Weimer-Elder, RN, PhD, ACES Facilitator and Director of Physician Partnership Program. “Everything we teach has research to back it.”
The ACES program teaches a number of skills, highlighting best practices for beginning an encounter, addressing and responding to emotions and closing patient encounters effectively through teachback and clarifying understanding. Within each skill section, there is a short, didactic lecture that explains the evidence supporting the value of this skill. Why is this skill important? Facilitators demonstrate the skill using role play, and divide the class into smaller groups to practice the newly learned skills through role play and observation. Throughout the day, facilitators and fellow participants provide feedback to guide improvement in communication skills.
“The training was specific and highly engaging,” said Carl Gold, MD, a Clinical Assistant Professor, Neurology & Neurological Sciences. As the Rathmann Family Medical Education Fellow, Gold is studying the barriers to effectively communicate with patients and families facing serious illness that neurology residents have identified. “Devoting time strictly to communication training led to important conversations among faculty members about shared challenges and strategies for improvement.”
Workshop participants are discovering that the skills they learn in ACES are making their patient interactions more efficient, rather than slowing them down, said Sarah Foad, Project Manager, Patient Experience. “There’s actually research that says if we let a patient talk uninterrupted, they talk about an average of 90 seconds,” she said. “It ends up saving time to let patients exhaust their thoughts before interrupting.”
Initial results from the first six months of ACES workshops has shown statistically significant improvements in many areas—decreased burnout and interpersonal disengagement, increased professional fulfillment, improved self-reported communication behaviors and increased compassionate self improvement. The ACES administrative team will be studying the impact of ACES on communication behaviors, provider burnout and wellness and patient satisfaction data.
Communication programs similar to ACES have been adopted by health care organizations such as the Cleveland Clinic, the Mayo Clinic, Phoenix, and the University of Maryland, Baltimore. Since its launch at Stanford in September 2017, the program has received positive feedback from its 450 participants, said Foad. “Ninety-four percent of people who have gone through the workshop would recommend it to a colleague.”
As the Associate Chief Medical Officer for Stanford Health Care, Joseph Hopkins, MD, spends most of his time with faculty and staff, rather than patients. He took the ACES course to get firsthand experience of the training to be able to describe it to others, especially colleagues who have difficulty with patient complaints or satisfaction.
“As a very experienced clinician I believed I already knew pretty much all the principles and best methods of communicating with patients,” said Hopkins, Clinical Professor of Medicine. “But I learned a lot that I had not previously used. It will not only improve the patient’s experience, but also the effectiveness of diagnosis and treatment.”
Leslie Tim, MD, is an Internal Medicine Doctor at Associated Internal Medicine in Oakland, part of the UHA network of care. Before ACES training, Tim said she focused solely on data gathering, oftentimes ignoring emotional cues from her patients. “Now I let patients have time to talk so their emotions and concerns come out,” she said. “Recently, some of these visits have been amazing and magical. The training has made a major difference in patient satisfaction and my personal satisfaction of practicing medicine.”
To reserve a spot in an upcoming ACES workshop, email firstname.lastname@example.org.