In-house education: It may have a big payoff

Educating physicians about risk management issues can be difficult and time-consuming, so it’s tempting to let your insurer send in a speaker once in a while and leave it at that. But the risk manager at a Texas hospital says you’ll get better results by developing your own in-house education program for physicians. It’s not as hard as you might think, she says, and the effort will pay off in the end.

Scott & White Memorial Hospital in Temple used to have a typical physician education program, says Lisa Havens-Cortes, JD, MSN, RN, CPHRM, director of risk management. The hospital brought in one or two speakers a year, usually from its insurer, with the sessions presented twice over two days. The results weren’t great, she says. "It was difficult to maximize attendance because we have regional clinics, and we just didn’t think we got much for the money we spent," she says.

The hospital decided to develop its own in-house education program with the hopes of making the sessions more accessible, with multiple sessions at different locations, and more directly applicable to the hospital’s concerns. Those improvements should improve attendance, Havens-Cortes hoped. Flexibility was considered a key component. Instead of speaking in generalities, case studies are tailored to the specialty physicians in attendance to make the discussion relevant. "We have not made our program mandatory, but we wanted to make it as convenient as possible," she says. "We’ve found that if we offer a program several times and market it that way, we get much better attendance."

The program sessions were developed with internal data, such as lessons from defending malpractice cases. Havens-Cortes took the risk manager position at Scott & White after serving as the hospital’s outside counsel for years. The sessions also deal with the most common patient complaints, and requirements of the Joint Commission on Accreditation of Health Care Organizations, along with federal and state laws.

Most of the educational sessions involve a discussion of the current literature on a subject, along with a review of malpractice verdicts and settlements. Havens-Cortes says she realized early on that it was crucial to provide continuing medical education (CME) credits for the sessions as a way to encourage attendance. Doing so requires adhering to certain CME requirements, such as providing a sign-in sheet for each session and post-session evaluations. Some sessions also provide nursing continuing education credit.

In addition to speakers, the educational sessions also include videotapes in which patients tell their stories. For physicians who can’t attend the sessions, the hospital provides an educational packet that includes the same material in printed form, and CME credit is available for reading the packet.

Publicize sessions two weeks ahead

Havens-Cortes discussed the hospital’s in-house education efforts at the recent meeting of the American Society for Healthcare Risk Management in Nashville, TN, along with Carolan Wishall, BA, CPHRM, director of patient relations. Wishall is involved with much of the planning and execution of the education sessions, which are offered at least a half-dozen times per year. Credibility is an important issue for physicians attending in-house education sessions, Wishall says. She recommends using a physician or attorney in presentations, and also in developing the content of the sessions. Outside counsel is an excellent resource, she says.

For each topic you want to address, Havens-Cortes suggests developing an outline that starts with a statement of the problem, regulation, or mandate. Then move on to supporting studies, research, or internal data. Use case studies and depositions to add interest and increase impact. Publicize the sessions with various methods, including any in-house news publications such as newsletters and fliers. E-mail is another good option, as are posters in key locations such as break rooms and lounges. "Give them about two weeks’ notice. That’s not so soon that they’ll forget about it, but it’s not too late for them to plan," she says. "When you’re publicizing it, note the advantage to the physician for attending. Say something like, Do you want to lower your risk of malpractice?’"

Communication issues difficult to teach

Havens-Cortes and Wishall offer this other advice for educating physicians in-house:

Consider using a remote control voting apparatus.

These gadgets allow participants to answer a speaker’s questions anonymously, with the results showing up immediately on a monitor. The speaker can ask about the attendees’ experience with a particular topic or their opinions about how a matter should be handled. "It helps promote great discussions," Havens-Cortes says. "Even when we’re talking about a real no-brainer where you think everyone should know the answer, there is rarely complete agreement."

Be prepared for resistance when you start talking about improving communication.

Most physicians are not interested in learning about better communication, Wishall says. "They think they have it down already. The fact is that most do not," she says. "They don’t understand empathy. They express sympathy instead."

Avoid the touchy-feely approach.

Make the sessions useful and show a practical benefit for attending, such as reducing the physician’s malpractice risk. Doctors will be turned off by any impression that the session is all about personal improvement or becoming a "nicer" doctor. The physicians will quickly tell you they don’t have time to attend.

Don’t throw only negatives at the physicians.

With case studies and patient testimonials, it’s easy to concentrate only on the negative and show doctors what they do wrong. That has a place in the education sessions, but it shouldn’t be the only thing they hear. "People do say positive things and the attendees need to hear that, too," Wishall says. "If they hear the positive things patients say about them, they will begin to recognize what they should say to elicit that response."

Bait your session with food.

"Feed them, feed them, feed them. That’s the best advice I can give to increase attendance," Wishall says. "I don’t know what it is about food that brings them in when the topic won’t."

Don’t expect too much from any one session.

Educating physicians needs to be seen as a long-term, cumulative effort, Havens-Cortes says. You may think that your session is a wonderfully comprehensive, compelling explanation that should immediately change the way physicians practice, but it might not. "It’s not a panacea. Don’t throw this at them and say, Gosh, now they’ll behave,’" she says. "You’d just be setting yourself up to be disappointed and frustrated. But if you can get them to take away some new ideas or information they hadn’t considered, it’s worth doing, no doubt."