Proven Solutions for Old Problems — Part 1 of 3

Tap into physician patient concerns to draw them into education activities

Then use physician champions to increase participation levels among their peers

As part of the interdisciplinary care team, physicians are expected to participate in patient education, according to the Joint Commission on Accreditation of Health Care Organizations in Oakbrook Terrace, IL. But this requirement means little to many physicians, and their lack of contribution to patient education activities is frequently a problem.

"The physicians who participate in patient education truly believe in the value of it. They will do it regardless of whether or not there is a standard that tells them to do it," says Marilyn Barton, RN, BSN, patient education coordinator at Riverside Regional Medical Center in Newport News, VA.

While physicians take part in the Joint Commis sion surveys and participate in mock survey interviews, meeting the standards for patient education is not their main motivation. The trick to getting physicians involved is to tap into their natural concerns for their patients, explains Barton.

To do that, the patient education manager must keep the team focused on the patient, says Leah Kinnaird, EdD, RN, a consultant with Creative Healthcare Management in Minneapolis. "Once you can get everyone to focus on the patient, that makes a terrific difference. You have to keep bringing the issue back to what is in the best interest of the patient," she explains.

Carol Maller, MS, RN, CHES, patient education coordinator at the Veterans Administration Medical Center in Albuquerque, NM, offers this example to illustrate this point. She came to the conclusion that the struggle to get all disciplines to document on one form was not in the best interest of the patient. While the Joint Commis sion looks for documentation as proof of teaching, trying to make physicians document on an interdisciplinary form was not meeting their need to deliver high-quality care, she says.

"I try to look at practice as it exists and then incorporate that into policy," she says. So, although there is a form for documentation of interdisciplinary teaching, the VA physicians incorporate the information into their notes in a more informal style.

Patient interest is not the only common ground physicians and educators have. There are many physicians who embrace patient education, so court them as your allies. Instead of trying to knock down barriers, go where there is an interest in patient education and solicit these physicians as champions for teaching. The patient education committee at the VA Medical Center in Albuquerque consists of Maller’s hand-picked champions for patient education from every discipline represented on the committee.

When conveying policy to hospital personnel, she has these committee members deliver the information at their staff meetings. For example, the dietitian on the committee speaks to the other dietitians and the physician speaks to other physicians. "As much as people are supposed to be on a team, we still have our own identities by our profession. Therefore, it works better for me to work within like groups using my champions," explains Maller.

The fact that physicians are more likely to listen to a colleague than to the patient education manager became clear when Baptist Health Systems of South Florida in Miami linked its Web site directly to drkoop.com, the Web site of C. Everett Koop, MD, former surgeon general of the United States. The association with this famous physician, a champion of education, boosted the value of education in the physicians’ eyes. They eagerly attended a reception with Koop in support of health education when the partnership with drkoop.com was kicked off, says Yvonne Brookes, RN, patient education liaison at the health system.

While a partnership with a famous physician is a good way to draw attention to patient education, you also need physicians who are more readily available. A good way to identify and develop physicians as patient education champions is through community outreach program development, says Brookes. At Baptist Health Systems, physicians collaborate on curriculum development as part of the Community Wellness Health Committee and are used as speakers. "Often, the health and wellness topics relate back to physician’s practices or expertise, and people get to know what services our physicians offer," says Brookes. This process builds good relations, and the physicians become supportive of patient and family education standards within inpatient care, as well.

Current trends in health care can be a boost to physician involvement in patient education. The self-care trend requires the provider to be more involved in what patients are supposed to do, such as monitoring their blood pressure, blood glucose level, or weight, says Maller. Therefore, physicians are much more likely to look to the patient education department for support. To meet this need, Maller has shifted many of the patient education resources to the outpatient areas. For example, the learning center is located near the outpatient clinics, and there are a number of group outpatient classes offered at the VA Medical Center.

"Patients need to be able to manage independently at home. We don’t keep them in the hospital as long as we used to, so the burden is more on them, and that opens the door for me to work with the physicians on patient education because I really have something to offer," says Maller.

In the information age, many patients are much more informed about their diagnoses and treatment alternatives, and they come to their physician visits with many questions. Yet it takes time to answer these questions, something all health care workers are short of these days. The combination of better-informed patients and the ever-present time crunch make it more imperative for physicians to participate in a collaborative process for patient education, says Kinnaird.

Because patients have a lot more information, which generates questions, physicians are supportive of a good patient and family education process in which people are provided with information and useful resources. They will take advantage of the resources by making appropriate referrals, says Brookes.

There are areas where physicians easily fit into the collaboration process for patient education. They can sit on formal committees, and patient education managers can consult with them on the appropriateness of patient education materials. However, patient education managers must be willing to work with physicians.

For example, when asking for their help with material evaluation, you must catch them at the right time — when they are not too busy — and be specific in your request, says Barton. Rather than simply asking for their opinion, ask if they would give the booklet to their patients, she explains. If they take the material for review, be sure to give them a deadline for responding.

When the Joint Commission asks about physician involvement in patient education, examples of their participation on committees and in the development of materials help provide proof, says Brookes.

Also, identify areas of your health care system where physicians must be highly involved in patient education. "It is difficult to show physician involvement in patient education on a regular med-surg unit, but if you use your high-volume services like oncology or cardiac rehab, you will find that physicians are very much involved in the teaching and helping patients change their lifestyles. So pick examples you can point to," says Brookes.

For more information on incorporating physicians into patient education, contact:

Marilyn Barton, RN, BSN, Patient Education Coordinator, Riverside Regional Medical Center, 500 J. Clyde Morris Blvd., Newport News, VA 23601. Telephone: (757) 594-2729. Fax: (757) 594-2257. E-mail: marilyn.barton@ rivhs.com.

Yvonne Brookes, RN, Patient Education Liaison, Baptist Health Systems of South Florida, 6200 S.W. 73rd St., Miami, FL 33143-4989. Telephone: (305) 242-3530. Fax: (305) 242-3578. E-mail: yvonneb@ bhssf.org.

Leah Kinnaird, EdD, RN, Consultant, Creative Healthcare Management, 1701 E. 79th St., Suite 1, Minneapolis, MN 55425. Telephone: (800) 728-7766 or (612) 854-9015. Fax: (612) 854-1866. E-mail: leahjo@aol.com.

Carol Maller, MS, RN, CHES, Patient Education Coordinator, VA Medical Center, 2100 Ridgecrest Drive S.E., Albuquerque, NM 87108. Telephone: (505) 265-1711, ext 4656. Fax: (505) 256-2870. E-mail: MALLER.CAROLYN_E@ALBUQUERQUE.VA.GOV.