Becker's Clinical Quality & Infection Control

22 PATIENT & CAREGIVER EXPERIENCE 'A total disruptor to how we do business': Cleveland Clinic's new patient experience metric By Erica Carbajal S ince their initial rollout in 2019, plan of care visits — which bring nurses and providers to the patient's bedside together — have become characteristic of the way care is delivered and managed across Cleveland Clinic. ey've become so beneficial that the system has done away with chasing other experience scores, such as patients' likelihood to recommend. "It's been a total disruptor to how we do business at the Clinic in the best imaginable way," Judith Welsh, MD, enterprise associate chief experience officer and academic emergency physician at Cleveland Clinic, told Becker's. "You can't walk on a Cleveland Clinic campus anywhere in the organization … and find people who don't know what plan of care visits are. … It's our culture and it's our way." e structure of these visits aims to ensure everyone has a clear understanding of the care plan and what milestones would need to be met before discharge. ey're different from traditional multidisciplinary rounds in that they don't solely focus on the physicians' goals and updates. e visits start with providers first asking patients what's most important to them and what their biggest concerns are. Providers then ask the nurse for their updates and concerns, and physicians hold their agenda until the end, Dr. Welsh said. "[Physicians] then share responses to concerns and issues and updates to 'what are we waiting for,' 'what conflicts are we having,' 'what medications are we changing,'" she explained. e last step is a "teach back," where the provider confirms appropriate understanding of the plan of care by asking patients how they will describe their care plan with their family. ey've since become Cleveland Clinic's main patient experience metric, with the system embedding two custom questions in their HCAHPS survey to track how frequently the visits occur and how helpful patients find them. An internal regression analysis showed that when these patients perceive these visits happen at least half of the days of their stay, most other important metrics — teamwork, nursing communication, physician communication and likelihood to recommend — also improved. "We very intentionally stopped chasing scores over the last year or so," Dr. Welsh said. "Our CEO has added [plan of care visits] to his scorecard, so we're not chasing likelihood to recommend, or doctor communication or nurse communication at that CEO level. Plan of care visits are [CEO] Tom Mihaljevic's patient experience metric." e plan of care visit is used for inpatient hospital visits every day across Cleveland Clinic, though the structure can be used in any type of visit, Dr. Welsh said, adding that as an emergency physician, she does these visits with her patients and staff as well. Plan of care visits have been especially beneficial amid workforce shortages and staff burnout, which both complicate effective communication and collaboration, Dr. Welsh said. e visits save nurses and providers time by preventing misunderstanding and unnecessary pages throughout the day. "It's not just something we do for the patients," she said. "We find that on the units where plan of care visits are done really well, everybody's super engaged and they love them because they see the benefit in [the visits] for themselves." n Patients' trust in physicians may affect pain level, study finds By Erica Carbajal P atients may experience more pain and pain-related brain activity when they perceive their physicians as less trustworthy, according to a study published Aug. 24 in Cerebral Cortex. Researchers from the University of Miami conducted medical simulations where participants underwent a series of painful procedures with different virtual physicians who appeared more or less trustworthy. Researchers measured participants' brain activity during the medical simulations using functional MRI. The virtual physicians were images of people in white physician coats with faces created using an algorithm to make them appear more or less trustworthy. Researchers found patients reported the simulated diagnostic procedures — which involved heat simulations on participants' arms — were more painful and unpleasant when performed by physicians they perceived as less trustworthy. They also found more activity in a number of pain-related brain regions when the simulated procedure was led by physicians perceived as less trustworthy compared to more trustworthy. "The takeaway from this study is not necessarily that we need to train doctors to make different facial expressions. Rather, our results demonstrate that even small changes to the doctor-patient relationship may be enough to decrease patients' pain," said study author Steven Anderson, PhD, who received his doctorate in psychology from the University of Miami in May. n

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