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Better Medicine Through Improv
What is the number one factor that everyone talks about when it comes to improving patient outcomes? Hands down it’s good patient communication. It’s well known that being in sync with your patient and his or her family early in the relationship is just as important as good clinical skills. But how do you know when that’s happening? How do you take relating with your patient to an art form?
Paul Haidet, MD, Director of Medical Education Research at Penn State College of Medicine, internist, and jazz DJ, made a unique discovery through his passion for jazz music (https://amednews.com/article/20100517/profession/305179943/7/). After years of research, he found that improvisation, a jazz hallmark, is a vital aspect of clinician-patient communication: “Jazz is a musical conversation and for that conversation to be harmonious and interesting, you’ve got to not only play your own solo, but you’ve got to be able to listen to the meaning that the other musicians are playing…That’s when jazz is at its best and, to be honest, that’s when medicine is at its best, too.”
At a meeting of the American College of Physicians, Dr. Haidet and Gary Onady, MD, PhD, an internist and pediatrician, led a session about improving patient communication skills (http://bit.ly/1lihXVL): “They described a physician’s range of skills within his specialty as his instrument. They compared a patient’s chart with song sheets. The riff, they said, is a physician’s rapid recall of knowledge. A physician needs to be ready to improvise when he or she walks into an exam room and encounters unexpected aspects of a patient’s illness.”
Fourth-year medical students at Penn State University get an opportunity to take Dr. Haidet’s class, “Jazz and the Art of Medicine.” Four fundamental skills are taught throughout the course:
- Managing the tension between structure and freedom.
- Finding meaning in another person’s communication.
- Finding your voice as a communicator.
- Using space effectively, i.e. allowing the patient to speak, rather than interrupting during the course of a conversation.
Good patient communication skills are for everyone involved in the patient care continuum. Anyone who participates on any level with the people coming to your hospital for care has to be in tune with effective interpersonal skills. What is your communication style? Can you trade solos with your patient? Maybe an evening with Miles Davis might provide some insight.
Quality in the Halls
Beyond the monthly or quarterly Quality Improvement meetings where we show up to either strut our collective performance achievements or gingerly release the tale of woe that befell our beleaguered improvement projects, are the real champions of quality. These are the people who are your front lines and actually reveal to you the substance of your quality initiatives. Take a look at the blog post by Robert Lloyd, Executive Director of Performance Improvement at the Institute for Healthcare Improvement. It’s been my experience that most people who find a folder misfiled and refile it correctly, notice that storage is being utilized for a purpose other than that for which it was intended and help to find a solution, or review their documentation one more time for a code they participated in to assure complete accuracy, do these things because it’s their nature. They want to leave something better than how they found it, and quality is at the heart of their work ethic.
It has also been my experience that even people like this can become disheartened when quality is merely a four-walled room and a monthly meeting. In Lloyd’s post, he tells about the CEO who, upon learning that there was a shortage in the ER Department, went down and started registering patients and even transporting them in wheelchairs to their next destination. The people who reflect the culture of quality in your hospital are beacons of care and commitment in their own right, most likely. But, with leadership such as the ER-working CEO who demonstrates a walking-the-walk focus on every person doing quality, there will be a rise in dedication to quality that is widespread, enthusiastic, and positively infectious!