In the shift toward patient-centered care, the healthcare industry is waking up to the reality that many drivers of health won’t be found in a patient’s medical record. Barriers to basic needs such as healthy food, transportation, or safe housing have huge impacts on health outcomes. The inherent link between social drivers and health requires that providers and clinicians communicate intentionally with patients about social drivers of health.
We know the relationship between providers and patients is critical to achieving better health outcomes, but why is this so important for addressing social needs? And how can payers and providers encourage better patient communication in the hospital setting to address SDOH more effectively?
Building a foundation of trust, demonstrating empathy, communicating clearly, and addressing implicit bias are all critical components in strengthening the provider-patient relationship.
Bridge the provider-patient communication gap
When social factors aren’t openly discussed between patients and providers, this can undermine the care plan, setting the patient and provider up for failure or frustration. To create a healthcare plan that is achievable, it’s critical for a provider to understand a patient’s realities and constraints. Stressors at home, an inability to afford childcare, or lack of access to transportation can hinder a patient’s ability to follow their care plan.
In a Modern Healthcare article, Dr. Patrick A. Woodard, the chief digital officer at Methodist Le Bonheur Healthcare, wrote, “If we don’t know how to reach and engage patients outside of the doctor’s office, in a manner that fits both their lived experiences and cultural backgrounds, then we cannot provide the care they need and deserve.”
Dr. Schneider recalled a former patient who could not afford the cost of a new monthly $15 prescription if she also wanted to continue taking the bus to medical appointments and buying birthday presents for her grandchildren. Once Schneider was aware of the financial stressors she faced, he was able to adjust the care plan, reducing the number of prescriptions she was taking and offering lower-cost alternatives to ease the burden.
Lead with trust and connection
Taking a proactive and preventative approach to social care requires a foundation of trust. Patients very often make healthcare, insurance, and lifestyle decisions based on advice from trusted professionals with whom they have a personal relationship. Primary care physicians and family doctors are often at the top of that list.
A Public Agenda survey found that patients who had recently experienced joint replacement surgery, maternity care, or Type 2 diabetes care ranked highly the importance of provider interpersonal qualities, linking high-quality care with the “doctor [making] time for patients’ questions and concerns.”
Nurses are also particularly poised to discuss SDOH, given the meaningful bonds and level of trust they often achieve with their patients, but a study published in the Clinical Journal of Oncology Nursing found that nurses did not often talk with cancer patients about social factors. They found that “of the 124 considerations that nurses made when talking about physical activity with patients, most did not relate to SDOH.”
When nurses include SDOH in discussions with patients, there are real benefits as the study investigators suggested. Such conversations can lead to a better understanding of a patient’s medical and social needs, a more relevant and effective care plan, and improved quality of life for the patient.
Adopt simple, clear communications strategies
A patient who seems unwilling to follow medical recommendations may in actuality not be able to comprehend the medical or prescription instructions. A patient may appear to be withholding medical history, but simply not have the capability to complete medical or insurance forms.
Health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” can impact patient care plans and health outcomes, according to the American Academy of Family Physicians (AAFP).
Payers and providers have a responsibility to communicate with patients in a comprehensive but clear way, and to ensure that patients have the information they need to understand and follow their medical plans.
Providers should assume that patients have limited health literacy, AAFP suggests, and follow specific communication strategies. Here’s what they suggest:
- Use plain language and avoid medical jargon or technical terms
- Sit down to achieve eye-level communication
- Use visual models to illustrate a procedure or condition
- Have patients explain back to you the care instructions you gave them or demonstrate procedures you explained
Not only can these basic communication strategies have a profound impact on the provider-patient relationship, but they increase the likelihood that a care plan will be followed, leading to better health outcomes for the patient.
Demonstrate empathy and understanding
Patient-provider communication should be inherently empathetic, demonstrating support and understanding, as opposed to judgment and dismissal.
For example, you can shift the dialogue from, “Do you have a car? Why aren’t you taking your prenatal vitamins?” to “If you have trouble getting to your prenatal visits, know that there is a free transportation service available to you” or “I know prenatal vitamins can be costly. Do you ever have trouble affording them?”
Part of demonstrating empathy is being understanding of a patient’s limited resources or time constraints. As Dr. Woodard writes in his Modern Healthcare article, “Many patients cannot wait on the phone for half an hour or more or be available during traditional business hours. They work double shifts; they work nights; they are family caregivers.”
Provide implicit bias training for staff members
Everyone has implicit biases, which are unconscious associations or beliefs about particular social groups that affect our reflexive attitudes, judgments, and decisions. In a medical setting, implicit bias reduces the quality of patient care, fractures patient-provider trust, and leads to the further marginalization of vulnerable patients. As teams work toward the goal of health equity, it’s critical that healthcare workers confront their own implicit biases.
While implicit biases are unconscious, choosing to confront these biases is a very conscious and proactive step toward providing better care for patients. To address implicit bias among members of your healthcare team, you should:
- Require implicit bias training for all staff members
- Discuss health disparities with your team and how implicit bias in the medical system plays a role in furthering those gaps.
- Require all staff to take implicit bias tests in order to uncover each individual’s unconscious social associations
As we work toward a goal of health equity, social factors must be considered in the clinical setting. Primary care physicians and clinical staff must generate a dialogue, instill trust, and show empathy, all while being prepared to provide solutions to their patient's problems. Simple, respectful communication is important for bridging patient health literacy gaps. And provider implicit biases must be uncovered and addressed. This means taking a whole-person approach to care and remembering that the patients in the exam room are people first.
Healthify, powered by WellSky is actively addressing SDOH across the care continuum, working with payers, providers, and community-based organizations to build accountable networks that improve care coordination and delivery and close the loop on referrals. Learn more here.