Patient perspectives on communication with the medical team: pilot study using the Communication Assessment Tool-Team (CAT-T)

Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Patient Education and Counseling (Impact Factor: 2.2). 08/2008; 73(2):220-3. DOI: 10.1016/j.pec.2008.07.003
Source: PubMed


Effective communication is an essential aspect of high-quality patient care and a core competency for physicians. To date, assessment of communication skills in team-based settings has not been well established. We sought to tailor a psychometrically validated instrument, the Communication Assessment Tool, for use in Team settings (CAT-T), and test the feasibility of collecting patient perspectives of communication with medical teams in the emergency department (ED).
A prospective, cross-sectional study in an academic, tertiary, urban, Level 1 trauma center using the CAT-T, a 15-item instrument. Items were answered via a 5-point scale, with 5 = excellent. All adult ED patients (> or = 18 y/o) were eligible if the following exclusion criteria did not apply: primary psychiatric issues, critically ill, physiologically unstable, non-English speaking, or under arrest.
81 patients were enrolled (mean age: 44, S.D. = 17; 44% male). Highest ratings were for treating the patient with respect (69% excellent), paying attention to the patient (69% excellent), and showing care and concern (69% excellent). Lowest ratings were for greeting the patient appropriately (54%), encouraging the patient to ask questions (54%), showing interest in the patient's ideas about his or her health (53% excellent), and involving the patient in decisions as much as he or she wanted (53% excellent).
Although this pilot study has several methodological limitations, it demonstrates a signal that patient assessment of communication with the medical team is feasible and offers important feedback. Results indicate the need to improve communication in the ED.
In the ED, focusing on the medical team rather then individual caregivers may more accurately reflect patients' experience.

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    • "This topic is of interest because improving clinical teamwork has been named as a priority area for improving the safety and quality of health care [8] [9] [10]. Also, while teams have been assessed by trained observers or team member self-report [11] [12] [13], research suggests patients may be aware of and able to assess teamwork-related behaviors [14] [15] [16] [17]. Whereas patients have most often been asked only about provider–patient communication, we propose that patients' perception of teamwork may be useful to improvement efforts and may relate to their satisfaction with care experiences [14] [16] [17]. "
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    ABSTRACT: Objective: To explore patient observations of teamwork-related behaviors such as inter-team communication through a newly designed survey. Methods: In this cross-sectional study, 101 patients (N = 86) and caregivers (N = 15) recruited from the emergency department (ED) of an urban, academic medical center (>85,000 visits/year) completed the 16-item Patients' Insights and Views Observing Teams (PIVOT) Survey. We evaluated validity evidence through descriptive statistics and analysis including a Many-facet Rasch model to determine associations between questionnaire items and sociodemographic characteristics. Results: Participant responses provided evidence survey items performed well and reflected patients' awareness of team behaviors such as inter-team communication, coordination, and keeping teammates informed. Also, participants responded about the consistency of information from team members and knowing what people's jobs were on the team. Rasch analysis largely supported that the PIVOT items reflected the intended content area and adequacy of ratings scales supporting evidence of response processes. High internal consistency (Cronbach alpha, r = .87) supported evidence of internal structure. As expected, response patterns differed by ED visit acuity level and length of stay. Conclusions: The PIVOT survey offered a means to collect patient and caregiver observations of health care teams. Practice implications: PIVOT survey responses may contribute to evaluation of teamwork behaviors.
    Patient Education and Counseling 06/2014; 96(3). DOI:10.1016/j.pec.2014.06.002 · 2.20 Impact Factor
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    • "Furthermore, Crowe et al. (2002) pointed out that the interpersonal relationships between the patients and health care provider is the most important determinant of customer satisfaction (Gill and White, 2009). Similarly, the quality of the relationship between patients and doctors has a considerable impact on the patient satisfaction measure (Alhashem et al., 2011; Mercer et al., 2008; Moret et al., 2008). In this context, patient satisfaction is defined as the judgment made by patients on their expectations for care services that have been met or not in respect of both technical and interpersonal care (Campbell et al., 2000; Esch et al., 2008). "
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    ABSTRACT: Purpose ‐ The purpose of this study is to investigate hospital service quality and its effect on patient satisfaction and behavioural intention. Design/methodology/approach ‐ A convenience sampling technique was used in this study. A total of 350 questionnaires were distributed and 216 were returned (61.7 per cent response rate). Findings ‐ The results confirm that the five dimensions ‐ admission, medical service, overall service, discharge and social responsibility ‐ are a distinct construct for hospital service quality. Each dimension has a significant relationship with hospital service quality. The findings of this study indicate that the establishment of higher levels of hospital service quality will lead customers to have a high level of satisfaction and behavioural intention. Research limitations/implications ‐ This research examined the concept of hospital service quality, patient satisfaction and behavioural intention from the perspective of patients. However, this study did not explore the perspective of service providers. This is a limitation in as much as it only considers the patients' view, which might be different from the providers' view. Practical implications ‐ The results indicate that managers should use the perceived service quality and customer satisfaction as mechanisms for exit strategy that will increase loyalty among the present customers. Originality/value ‐ This study will enable hospitals to have a better understanding of the effects of service quality, which will lead to patient satisfaction and behavioural intention in order to build long-term relationships with their patients.
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    • "This awareness is particularly important in work situations with high cognitive demands [25], and has previously been related to high performance in trauma teams [26]. In contrast to when staff works independently in the ED, taking patient history together reduces the need to hand over patient information [27] as well as the work duplication caused by patients giving their history numerous times to different staff members [28]. However, although taking patient history together may be beneficial from a patient safety perspective and may be more effective in some aspect, it may also be time consuming if one or several of the team members is not able to be engaged in any appropriate task during the activity. "
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    ABSTRACT: Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. This study illustrates how behavior analysis can be used to understand discrepancies between planned and observed behaviors. By examining the contextual conditions that may influence behaviors, improvements in implementation strategies can be suggested. Thereby, the adherence to a planned intervention can be improved, and/or revisions of the intervention be suggested.
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