SF General coaches patients in 15-20 minute chunks throughout their stay to avoid overwhelming patients and improve retention.
Collaborator (Non-Members)Larissa Thomas, Michelle Schneidermann
In the beginning, when we enrolled patients we would sit with them for two hours because we wanted to teach them everything. Then we realized, after about 15 or 20 minutes, they didn’t hear anything we were saying. Everyone has a limited attention span and it gets even shorter when you’re sick in a hospital bed. Patients also probably tuned out because we were taking advantage of the fact that they were a trapped audience in their hospital bed.
San Francisco General is a non-profit hospital and level 1 trauma center in San Francisco, CA. It has 598 beds and serves a diverse population, the majority of whom are lower income and do not speak English as their first language. Many are also illiterate in English as well as their preferred language. The hospital also serves individuals who may not have health coverage, housing or access to food. They enroll the most difficult to engage patients who have a history of substance abuse and poor health outcomes. Their transitions program began in 2009 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We now meet with patients for, at most, 20 minutes at a time, but we’ll visit them multiple times a day. We check in with them in the morning and then circle back a few hours later—“How was lunch? Did you get a chance to read the booklet I left you? Any key points we can take away from that?” That’s it—fifteen minutes here, twenty minutes there, over the course of their stay. Each visit is dedicated to one learning goal so that we don’t overwhelm patients.
It can be hard to keep track of what you’ve covered with each of the patients, so we developed a logging system. Before and after each visit with a patient I’ll check the log to see which topics I’ve covered already and which I still need to review with them. The four big topics I cover are symptom recognition, navigation of the system, connecting to the pharmacy, and medication information.
The main benefit is that patients retain more. There are two main reasons for that. The first is that when you only talk for a few minutes and focus on one topic, it’s easier for patients to follow what you’re talking about and remember any questions they might have. The second is that we’re reinforcing the material multiple times a day across a few days.
This coaching approach has helped us develop stronger relationship with our patients. The fact that we visit them multiple times shows that we’re committed to their care and they actually start to recognize us among the many people who stop by their bedside. They also appreciate that we don’t just talk at them for hours. With this foundation, patients are more likely to listen and open up to us. It also makes them more receptive to our follow up calls after they’re discharged.
The nurses on the floor also appreciate this new coaching method. We never get in their way by staying with a patient for too long and the patients we see are more likely to take an active part in managing their health.
Coaching isn’t limited to the patient. If there are caregivers in the room, I include them in the conversations as well.
I always take my white coat off before going to see patients and make sure to sit when talking to them. If you’re standing over them in a white coat, they’re just going to think you’re a doctor and stop listening to you.
Patients feel more in control when you ask for permission to speak with them. “Can I sit with you for 15 minutes?” That way they know how long I’ll be there and can tell me if it’s not a good time for them.
It’s important to do your homework before visiting with the patient. I don’t take notes or read from the patient’s chart when I’m with them. That makes it feel too clinical. I’ll check the education log beforehand and then update it after I leave the patient.