Recently, I had the opportunity to present on a webinar entitled “Successful Transition from Surviving to Thriving: Stories from the Healthcare Ideas Community.” It was an incredible opportunity to present alongside a dear friend and gifted colleague, Sarah Gilstrap, MS, CPXP and another amazing leader, Sydney Peters. We each shared a bit about our respective work in creating a desirable provider telehealth experience by adopting innovative approaches for the future of patient experience.
My focus on the webinar was an overview of the “Art of the E-Visit” pilot. Many organizations have a coaching program – they may call it Care Team Coaching, shadow coaching, physician coaching, etc. At DTA we refer to this as Care Team Coaching, a service we provide, train, and support through our Coaching Reporting Tool. If you’re not familiar with this type of coaching it’s a strengths-based positive approach. In essence we shadow a provider or care team member for an hour or two as they interact with patients. Then, we call out the communication strengths that we observed during their interactions, any inconsistences (things they did some, but not all of the time), and any opportunities that they could start incorporating into their practice. I’ve coached literally hundreds of providers and care team members across the country over the past ten years using this approach and modality.
Most every organization has faced some kind of rapid pivot from in-person to virtual visits during COVID-19. While many had telehealth on their 5-Year strategic plan, most had to “prop up” this strategy in just a few weeks or even days. While the Art of the E-Visit pilot was in discussions before COVID-19, it quickly (by necessity) became a reality in April of 2020. For this pilot, I was so pleased to partner with Melissa Magstadt, MS, MBA, CNP, Founder and Lead Provider of QuickCare Clinic in South Dakota. We teamed up to apply this proven strengths-based model of Care Team Coaching from in-person encounters to e-visits. We know that Care Team Coaching works: organizations that have providers who participate in Care Team Coaching have seen as much as 90 percentiles of improvement in their patient experience scores. Others have improved ten times the national rate of improvement in just nine months.
Personally, I was interested to see how the key care practices that we use in Care Team Coaching might emerge differently in e-visits. I was excited to work with Melissa and her team to help identify best practices in this regard and also get some patient feedback, if possible, along the way.
We certainly had some considerations and challenges to overcome in the process:
- Technology – As you may expect, there were some challenges in getting the systems to cooperate as planned. It took some time but we were able to get me, the coach, set up as a “consultant” in the EMR. Then the provider just added me, like they would a cardiologist or other team member, to the visit. We also faced some of the technical blips that many of us have experienced with video communication (e.g. the provider could see but not hear the patient and had to move to a phone call, etc.)
- Change management – We always face a bit of provider angst when we are using Care Team Coaching as a modality. However, Melissa did a great job of prepping her team to participate in this pilot and that helped to minimize that fear for the providers of having someone watching them. This included reminding them that it was a strengths-based approach and by modeling leadership by participating in the coaching herself, too.
- Feedback and innovation – As with our in-person Care Team Coaching, I was able to share real time feedback and debrief with each provider at the end of their series of visits observed that day.
- Patient voices – We wanted to get patient feedback about the encounter with each provider. Since this clinic did not have an established feedback survey in place, each patient was asked if they would stay on the line to answer a few questions in person.
- Celebrate the good – One of my favorite parts about Care Team Coaching is that it helps providers (even in non-COVID land) feel better about themselves and the great work they do. This was even more important during this really difficult time. The use of this strengths-based approach to tell providers something positive that they often didn’t even realize, was impactful.
There were many lessons learned in this process, some of which will be explored further in future blogs and podcasts, but here are a few highlights:
- The key care practices observed in Care Team Coaching are important and can be even more so in the virtual world. For example, we often try to get providers to thank patients at the end of the visit in response to when the patient thanks In the virtual visits, we identified that it was also a best practice to start off by thanking the patient at the top of the visit with a “thanks for letting me come into your home” or “thanks for your patience with the technology.”
- We did have challenges in obtaining patient feedback as it didn’t work to stay on the line with the patient after the provider left the call. I look forward to exploring this further in future iterations.
- This pilot was in urgent care and we are excited to expand this to primary care with scheduled visits, and other settings as well. Please reach out if you or your organization are interested in exploring this concept further.
From an outcomes perspective, the feedback from providers was positive. They appreciated the opportunity to get timely, at-the-elbow/onscreen feedback to assist them in the midst of deploying a new technology. Coaching was an important support during a crucial time. They were excited to learn how to communicate effectively in virtual visits early on versus having to unlearn a bad habit later. Melissa said, “I’m grateful for this experience and opportunity to offer Care Team Coaching to providers. Incorporate this sooner, rather than later, into your organization. This is an important support to help providers communicate better with patients, regardless of the setting – both now and into the future.”
