Shooting Free Throws and Mastering Patient Safety Skills

With the National Basketball Association playoffs having just ended, I couldn’t help but be reminded about the relationship between great coaches and great educators. The best coaches through the years have been some of the best teachers and provided examples of role models for leaders in many industries. Tracy Granzyk, MS, illustrates this relationship in an excellent post, John Wooden’s Spirit Alive and Well in Telluride, about the benefits of using leadership examples outside of healthcare, such as that of legendary UCLA basketball coach John Wooden, to improve communication during the patient-provider encounter. She writes:

“If they haven’t learned it, you haven’t taught it.” This was a Woodenism oft quoted at the Resident Patient Safety Summer Camp in Telluride by special guest faculty, Paul Levy. Wooden and Levy are both coaches and teachers in their respective fields–one hospital administration and the other NCAA Men’s Basketball. With that quote, they both take responsibility to the fullest extent for successfully transferring knowledge to those they themselves are charged with educating.

It became clear to all the resident physicians attending the Telluride Patient Safety Summer Camp that as caregivers, we do indeed assume the role of educator on a daily basis. How many ways, and how many times, do we need to say the same thing to our patients so that they truly understand issues such as risks, benefits, treatment alternatives and the possibility of doing nothing? As many ways, and as many times, as it takes. For as John Wooden says, “if they haven’t learned it, we have not taught it…” our patients in a way that conveys an understanding of their diagnosis or their upcoming procedure, and how both could affect the quality of their life. The role of educator is subtext to a medical education, and few graduate medical schools prepare future doctors to teach or coach patients.

As Granzyk points out, these two very important educational themes from Telluride – communication and education– highlight the need to improve on the transfer of knowledge to our patients and family members, and identifies where holes in medical education still exist. How much time is dedicated to development of these two skills that are cornerstones of patient-centered care throughout medical education? Not enough. Looking to leadership in industries outside healthcare to fill these gaps is one way to jumpstart the transfer of knowledge in a meaningful way.

Telluride has also proven to be a fertile educational environment where the need for skill development in these areas is a top level agenda item. One excellent communication technique between caregivers that was discussed at length with residents in Telluride this year, was the “write-down, read-back” method for handoff of a patient. This technique calls for the caregiver receiving the patient to listen to the caregiver handing off the patient relate details about that patient’s care, preferably in the SBAR format. As the handoff caregiver shares important issues related to the patient’s care, the receiving caregiver writes down the important notes, and then read the notes back to the caregiver handing off the patient. This technique is powerful because writing down notes leads to better recall of the case details, and it provides a form of traceable documentation.

A second excellent communication method also shared in Telluride last week, was the story of a physician asking his patient, “May I tape this conversation?” As the patient agreed, the entire meeting was then tape-recorded, with the patient thinking this to be a self-serving attempt at medical malpractice prevention. At the end of the encounter, the physician removed the tape from the recorder and handed it to the patient saying, “I know we discussed a lot of information today and you might not have completely taken it all in. Please take this tape home and listen to it. Have your family and friends listen to it too, and then let me know if you have any additional questions.” What a great example of patient-driven care—what a great example of teaching until the knowledge is imparted and can actually be used by the patient.

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