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July 22, 2016

How Cleveland Clinic tackles its physician communication challenges

Daily Briefing

Editor's note: This popular story from the Daily Briefing's archives was republished on Aug. 14, 2019.

A one-day program focusing on revealing doctors' "blind spots" has helped improve physician communication at Cleveland Clinic, Chief Experience Officer Adrienne Boissy tells NEJM Catalyst's Thomas Lee.

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It can be difficult to "engage physicians to improve when they already think they're pretty good to begin with," Lee writes. But the Clinic has broken through: According to Boissy, every participant in the program, which is now in its seventh year, has improved their communication skills—regardless of their specialty, tenure, or initial patient satisfaction scores.

The program started out as voluntary, but has been so successful that it has become an "expected requirement of all physicians across the enterprise" Boissy says.

To craft its core program and additional training opportunities, Boissy says the Clinic "did our homework" to find evidence-based best practices, which yielded several key lessons about how to improve physician communication.

1. Focus on direct examples

It's crucial for doctors to realize they have room to improve their communication. "If you don't have an interest in learning or you don't think you have any blind spots," Boissy says, "you absolutely won't engage in the learning process."

But piquing doctors' interest in that process can be a challenge and "in a course, talking about HCAHPS scores or patient satisfaction scores is not the greatest inspiring force," according to Boissy.

So rather than focusing on numbers, the Clinic focuses on people: It shows doctors how patients perceive their communication with them.

"One of the ways to move people out of unconscious incompetence is through transparency, to reflect back to them their blind spots," Boissy says.

2. Gather the right leaders

Another key to getting buy-in from clinicians is recruiting the right leaders, Boissy says. For instance, the chair of neurosurgery originally turned down her request to be involved in the core training program and instead directed her to a younger, less-tenured employee. But Boissy thought the chair's expertise was vital to the program, so she responded, "I appreciate your suggestion, and I'd still like you to do it."

Once the chair decided to assist with the communication program, more people became interested and involved. "That word of mouth has a very powerful effect on the rest of your organization," Boissy explains. "You can't underestimate the power of one person who is that node, that sphere of influence."

3. Reach out to the disengaged

The core program through initial invitations "spread and trickled throughout, to the point where we were able to train a thousand people."

But when the program became an expected requirement for all doctors and was included in continuing physician education, Boissy says that about 5 to 10 percent of participants were not convinced that it was necessary.

Can doctors learn to communicate with patients?

To help get to the root of the problem, class leaders speak to disengaged doctors privately, asking them to reflect on how their negative attitude could be affecting the rest of the group. "Even if we don't think it's important," Boissy says, "there are lots of other people at the table who probably could derive something."

The leaders also ask physicians to become more involved, for the sake of those who may not be as experienced as they are.

"When people said, 'I don't need to come, I've been teaching communication skills in the medical school for five years," Boissy says, she replies, "'That's great. We need your talent in the room just as much as someone who hasn't been doing that'" (Lee/Boissy, NEJM Catalyst, 7/20).

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