IHI Open School Short
Video Transcript: How Long Does It Take to Use Patient-Centered Communication?

Connie Davis, NP, Co-Director of Centre for Collaboration, Motivation and Innovation

That’s a really good question. Most physicians are focused on how short their visits are. “Ask, Tell, Ask” — asking one question before you give information or advice — takes just a few seconds, and the amount of attention you get back pays off really well for the time invested.

Another good investment is the time to check for understanding. If that doesn’t happen, what it does is actually breed more visits in the future, or misunderstandings that actually could increase care. So it’s a little bit of investment up front. That’s one way to think about it.

Brief action planning, we’ve actually tried to understand how much time it takes. A simple brief action plan can take between two and two and a half minutes. If you need to use more skills, it could take five or seven minutes.

And that is a significant amount of time. But here’s what clinicians do when they’re using it. If you think about a primary care practice, you might have 20 patients scheduled in a day. Maybe for about 10 of those visits, you would think, “Oh, brief action planning might fit here.” Then, if you actually ask people to monitor what responses they get, a couple of those ten people will say, “Nah, not right now,” so you don’t have to do anything different there. A couple will say, “Yeah, I’ve been thinking about this…” and they can quickly make an action plan. A couple of people will say, “I need a little more help here.” That might take a little longer.

And with a couple of people you might open something up and say, “Wow, this is really complex.” But as clinicians we encounter that all of the time and we need to know in our system what to do with these complex situations, and pass it on.

The other cool thing in a practice setting is that you’re used to not working alone. You have a team, and these are all skills that can be taught to peers and members of the community. So anybody on your staff could be a potential support to help with action planning or any of these things. So you can spread it out among the team members. Use the medical assistants; They usually love doing this kind of thing.