2015 JQS Award Finalist

Relationship-centered Communication: A Path to Better Care, Meaningful Experiences

During doctor’s appointments, a physician’s first objective often is to assess their patients’ concerns and determine a course of action. What are their symptoms? What may be causing those symptoms? What tests should be ordered, if any? What’s the most effective treatment?


The Patient-Doctor Equation

Foundation of Healthcare Communication Book Dr. Tracy Hull with patient (employee) with model taken in exam room A-30 on 09-17-13 for  Amy Windover PhD  ***SIGNED RELEASES IN JOB ENVELOPE***But those questions are only part of the patient-doctor equation. Doctors might consider asking themselves a few other questions: How do I make patients feel important? How can I build a relationship and trust with this person? What words would help me to learn more about what’s important to them?


These effective communication strategies not only help to deliver safe, high-quality medical care that matter the most to our patients, but also develops meaningful relationships that impact both parties.


Research has shown that effective patient-clinician communication:

  • Improves patient satisfaction
  • Reduces medical errors and malpractice suits
  • Improves health outcomes
  • Improves treatment adherence/compliance
  • Decreases patient emotional stress
  • Improves physician satisfaction


Putting the Focus on Relationships

Considering the competing challenges of limited time for patient interaction, variable expectations, and increasing medical complexity, it may seem difficult for clinicians to commit to increased communication. However, communication is the most common medical procedure most of us will ever perform. Rather than patient-centered language, we focused on relationship-centered language to honor the value of both the clinicians and patients.


When clinicians, or caregivers as we call them, are offered the resources to develop relationship-centered communication skills, they can improve their listening skills, empathy, teaching, time management and conflict resolution. They become more comfortable in even the most challenging communication situations, enhancing the experience of not only the patient, but also their loved ones.


A Foundation for Effective Communication

At Cleveland Clinic, we have developed the R.E.D.E. (Relationship: Establishment, Development and Engagement) Model. Like any skill, effective communication can be learned through practice and peer feedback. Our “R.E.D.E to Communicate: Foundations of Healthcare Communication” course is the foundational course of our program. It teaches commonly effective tools and our model of communication, while also allowing participants a safe environment to practice.


The course is a peer-led, CME-accredited course with most of the time spent practicing specific skills and working through challenging communication scenarios that the clinicians have encountered.

Positive, Powerful, Expansive

The feedback has been overwhelmingly positive and powerful. As a result, the course has evolved into a comprehensive Center for Excellence in Healthcare Communication, which includes advances courses, a Train the Trainer program for incoming facilitators, peer communication skills coaching, and research. This curriculum includes courses in “Delivering Bad News,” “Managing Difficult Communication Scenarios,” “Health Behavior Change,” and “Discussions of Code Status.”


We have recruited and trained 42 physician facilitators from over 25 different specialties, including surgeons. We have recruited and trained 16 advanced clinical care provider facilitators from many different focus areas, which includes physician assistants, nurse practitioners, nurse managers, social workers, and others with significant patient care contact.


A Systemwide Commitment

In 2013, our executive leadership team completed the communication skills training. Our CEO, Toby Cosgrove, M.D., requested that all staff physicians and house staff complete the course by April 2014. To date, we have had over 2,000 staff physicians, more than 800 clinical trainees, and over 500 advanced clinical care providers completed the course. The course is now part of our on-boarding training for staff and trainees.


A Boost to Self-Efficacy

What’s unique about this program is the research and data to back it up. For 2,000 attending physicians, we demonstrated statistically significant improvements in self-efficacy, burnout on the Maslach Burnout Inventory, empathy on Jefferson Scale of Empathy, and patient satisfaction. The course was also developed by practicing clinicians for practicing clinicians to help them face the real challenges in day-to-day practice. Lastly, we used multiple innovative methods to engage clinicians from the very moment they enter the room.


The Right Approach for Patients

Simply put, ensuring effective clinician-patient communication is the right thing to do for our patients, and critical to the delivery of safe, high-quality medical care. In a healthcare environment full of initiatives and priorities, creatively designed communication skills training for experienced clinicians allows them to build more effective relationships with their patients and also each other…an opportunity to create the very meaning we are all looking for.


Editor’s note: John Q. Sherman Award judges were impressed by Cleveland Clinic’s initiative to empower clinicians across their vast organization with the communication skills essential to effectively engaging patients and ultimately creating better care. You can read further details in their award nomination here.



Adrienne Boissy, MD, MA, Chief Experience Officer, Cleveland Clinic Adrienne Boissy, MD, MA, is the Chief Experience Officer of Cleveland Clinic. She is a staff physician at the Cleveland Clinic Mellen Center for Multiple Sclerosis and has a secondary appointment in Bioethics. Before moving into the Chief Experience Officer role, she served as the Medical Director of the Center of Excellence in Healthcare Communication. Her team has created a comprehensive program to strengthen physician and provider communication skills throughout Cleveland Clinic and has trained more than 4,000 staff physicians and house staff to date.

Adrienne Boissy, MD, MA, Chief Experience Officer, Cleveland Clinic has 1 post(s) at EngagingPatients.org

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  • Marah says:

    Is there anyway to duplicate this training? I am a patient engagement coordinator for a non-profit clinic that serves 8,000 patients in medically undeserved Northeast Pennsylvania. We are a teaching practice with many learners that this can greatly benefit. We help train family physicians, pharmacists, nurses and medical assistants. On every level, this would be a wonderful teaching tool!
    Thank you in advance.

  • You are so right: Positive relationships are the bedrock of leadership and service excellence. As one who speaks to health care audiences on leadership/communication issues, you might guess that I am always looking for examples to illustrate key concepts – and those examples are everywhere – both good and bad. For example, a friend of mine was being treated for a serious condition, and it turned out that what the physician prescribed contained an element that did irreparable damage to his circulatory system. An attorney strongly recommended that he sue the doctor. My friend, who had a good relationship with his doctor, said, “No way. That guy’s intention was to heal me, not to harm me. He’s a heck of a nice guy. There’s no way I’d ever sue him.”

    Aside from keeping your current customers (patients), gaining referrals, and buidling a good reputation for yourself and your organization, positive relationships pay another big dividend. Good relationships keep you out of malpractice legal battles. Research confirms that it’s rarely mistakes that will put a physician in legal hot water, but rather how the patient feels he or she is treated by the doctor.

    Good article and a wise decision to get your physicians actively involved in teaching classes on communication. Maybe that is why the Cleveland Clinic has such a fine reputation!

  • So very important. We at ICHA http://www.icha.in have been doing a level I Pt. Safety workshop on similar lines with a feedback of a ‘wow’ experience.

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