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Peer-to-peer physician coaching shows amazing success and sustainment

Carl Goolsby, Jr., MD, Medical Director of Patient Experience at Wellstar Health System in Georgia, believes that a physician should enter an exam room as if they’re a guest in a patient’s home. He also believes that when physicians are prepared for a patient encounter, their communication skills should be taken as seriously as the medicine they prescribe.

“We recognize that all human experience is relational, and that good relationship results in good experiences,” he says. “We also understand that good communication is key to all good relationships. We know that communication skills and best practices can be taught. We believe that the best ones to teach these skills and practices to in-the-trenches clinicians are other in-the-trenches clinicians.”

The result? Among physicians coached during the COVID-19 pandemic, 96% found the process positive and valuable, providing score improvement and sustainment of 81.1% with an average progress level of seven points.

Peer-to-Peer Program Planning

Under the leadership of Rob Schreiner, MD, FACP, FCCP, past president of Wellstar Medical Group, the organization’s peer-to-peer program began its planning phase, which assessed:

  • Whether the program was for all providers, regardless of the setting
  • Data governance, oversight, and management logistics
  • A choice of coaches based on a set of criteria
  • The creation of a training program for coaches
  • Measures of whom to coach and how to promote the program internally
  • Celebrating the success of steady improvement

From there, Goolsby said they recruited clinicians for the program who were already doing well with patient relationships, as per NRC Health’s Real-time Feedback survey scores—including sub-specialty, surgical, and nonsurgical clinicians.

Next, Goolsby sent an email to select clinicians describing the vision for the program and asking them to participate. When he received positive feedback, he called on all those interested, inviting them to join with training. This included an offsite full day of programming, including hands-on training, role-playing, observation, and feedback. After the session, Wellstar Health System certified each clinician as a coach, complete with certificates and fanfare.

Then the organization identified clinicians for friendly coaching visits, asking coaches’ friends if they would help them practice their coaching skills to keep anxiety levels low and alleviate pressure.

“We wanted the coaches and those being coached to be as comfortable as possible as we got this program off and running,” recalls Goolsby.

Elements of Coaching Program

Introductory phone call. The coach makes this call to their colleague who will be coached, introducing themselves to explain the program and beginning to establish a relationship with their colleague in a non-threatening way. Arrangements are also made for the first visit.

Visit #1: The coach’s practice visit. This visit is essentially a reverse-shadowing session at the coach’s office, which Wellstar Health System finds a critical part of their program. “If I’m going to initiate a coaching experience, I have my colleague come to my practice, and they shadow me,” Goolsby explains. “They go in the room with me when I see patients. The main purpose of us doing this is to establish a relationship, to put our colleagues at ease. We want them to see that the coaching experience can be a positive teaching experience.

“We purposefully demonstrate best practices to our colleagues, and these can be tailored, or a conversation had, based on the data that we have. We teach by explaining what we are trying to do. I’ll tell my colleague, for example, that when I enter a room, I do my best not to touch the computer for five minutes, and I invite them to help me keep track of that time.

“I also demonstrate how I prepare for the visit—where I go in the room knowing that my patient was just in the emergency room last week, or how they were just seen earlier that week by the cardiologist, and I bring that into our conversation, showing my colleague how I attempt to allow my patient to know that I do know their medical history, that I am prepared for them, and how that builds rapport with my patient. We do that for a couple of hours. Perhaps my colleague will hang out with us for three or four visits; we introduce them to the staff, we make them feel at home in our office.”

Visit #2: The provider’s first practice visit. The coach then goes to the coachee’s office to spend time with them, serving as a “fly on the wall” after an introduction and simply observing office interactions. The coaches strive to make this time with their peers feel friendly and laid-back.

“We try to make it fun,” Goolsby says. “We strive to mainly say positive things, because our colleagues are doing such a great job, and we focus on saying numerous positive things about their visits. We attempt to provide feedback that might be constructive or helpful in a way that we know will be well received by our colleagues. We attempt to give them perhaps two things that they could perhaps work on going forward. We don’t want our colleagues to dread this; we want them to feel good about the experience.”

Visit #3: The provider’s second practice visit. This visit is similar to the second visit. Arrangements are made maybe a month later for the coach to return and visit with their colleague again to stay in contact, observe them and how they’re doing, and ask them how they feel things are going.

“I don’t stay as long on the second visit as I do the first visit, because I’ve found that the majority of my colleagues have put into practice the things that we discussed,” Goolsby says. “They’re eager to show how they’ve done, so we find that this is a good time just to reconnect.

“Coaching is really for our colleagues,” he explains. “It’s not just to increase a patient-survey score; we follow up with questions. I feel like this lets my colleagues know that there’s not a focus on any sort of score. These questions, I think, suggest that we care about them holistically, and we follow up on them holistically.”

Follow-up. Goolsby explains that coaches often hold conversations about office flow when visiting colleagues.

“I can provide some assistance with how they’re using Epic, because I’ve been in other offices,” he says. “I can give some best practices in that regard, so we have the visits be about more than just how the interaction with the patient goes, but also how we can make their day better, how they can feel connected and supported by the group as a whole. We want to be prepared and help our colleagues to the best of our ability, and we use NRC Health data to do that. We find it very helpful.”

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