What works? Improvement is dependent on consistently using the fundamentals of communication with all patients and guests. The AIDET SMiLe framework captures fundamentals which are highly effective when used in every patient interaction. Organizationally, UCSF Medical Center staff, physicians and nurses are all being trained in communication through an initiative called Living Pride.
Acknowledge Introduce Duration Explanation Thank Sit Down Manage Up Listen
Acknowledge the patient and family: use the patient’s name (preferred name or formal name if preferred is unknown). Acknowledge family by introducing them and their relationship to the patient. Examples: “Hi Mrs. Smith, My name is ….. Is there a name you prefer to go by?” “I see you have some family/ friends here. (Turning to family) How are you related?” Introduce yourself (by first and last name) and your role on the healthcare team. Write your name on white board. Use a business card or face card to reinforce your name and role. Patients meet many providers in a teaching hospital. In the literature, only 10% of patients could correctly name one physician involved in their inpatient care. This leads to confusion about who is responsible for what part of care, how people are communicating with each other, and whether anyone is responsible.
to the hierarchical dynamic. Get down to the patient’s level if possible. Sitting down is known to increase the patient’s perception of time spent with a physician.. Listen. Start by asking open ended questions. Elicit the patient’s concerns first, before moving on to your own. Avoid interrupting for the first couple minutes. Examples: “I’d like to review your medical history with you today, but first, is there anything you or your family would like to make sure we talk about today?” “We’re going to spend some time talking about what we’ve found so far, but first I want to make sure I understand what your main concerns are.” Duration. Address how long things will take. Patients spend a lot of time waiting in the hospital, and often they are unsure about what happens next. Explain the work that is happening behind the scenes and approximately when they can expect to see you again, have an answer, or be discharged. Example: “You are scheduled to go to the operating room to have your gall bladder removed later this afternoon. The surgery should take a couple hours and you’ll come back to this room this evening. Most people can go home the day following surgery, and we expect you will be able to go home tomorrow. I will speak with your family when the surgery is completed.”
Explain. Simplify medical language and avoid acronyms. Consider using analogies or drawings to help explain medical conditions. For patients with a non-English primary language, ask what the patient’s preferred language is and if they would prefer to have an interpreter. At MoffitLong, interpreter phones are now available at Example: “My name is John Smith, I’m one of the every patient’s bedside for this purpose. Recap residents on the surgical team. I work with Dr. the assessment and plan into a lay-person two Jones who is the supervising doctor on the team. line summary at the end of your visit so that the We are the primary team taking care of you while patient is left with a clear understanding of what is you’re in the hospital, though you may also see happening. some other specialists. I’m putting our names Example: “I want to recap what we talked about to here on the white board.” be sure I’ve been clear about what the plan is. You Sit down. Standing over the patient can contribute were admitted with bleeding from your stomach that we think was caused by an ulcer. In you, we 2