HI-FIVE (Health Informatics For Innovation, Value & Enrichment) Training is a 12-hour online course designed by Columbia University in 2016, with sponsorship from the Office of the National Coordinator for Health Information Technology (ONC). The training is role-based and uses case scenarios. Also, it has additional, optional modules on other topics of interest or relevance. Although we suggest to complete the course within a month's timeframe, the course is self-paced and so you can start and finish the course at anytime during a month's time period. No additional hardware or software are required for this course. Our nation’s healthcare system is changing at a rapid pace. Transformative health care delivery programs depend heavily on health information technology to improve and coordinate care, maintain patient registries, support patient engagement, develop and sustain data infrastructure necessary for multi-payer value-based payment, and enable analytical capacities to inform decision making and streamline reporting. The accelerated pace of change from new and expanding technology will continue to be a challenge for preparing a skilled workforce so taking this training will help you to stay current in the dynamic landscape of health care. This course is one of three related courses in the HI-FIVE training program, which has topics on population health, care coordination and interoperability, value-based care, healthcare data analytics, and patient-centered care. Each of the three courses is designed from a different perspective based on various healthcare roles. This first course is from a clinical perspective, geared towards physicians, nurse practitioners, physician assistants, nurses, clinical executives and managers, medical assistants, and other clinical support roles. However, we encourage anyone working in healthcare, health IT, public health, and population health to participate in any of the three trainings. If you would like to obtain continuing medical education (CME) or continuing nursing education (CNE) credits, you will need to have eligible credentials, complete the entire course, and complete the evaluation survey at the end. The HI-FIVE team verifies after each month that these requirements have been met and then a separate certificate (fee may apply) is distributed to you from our accreditation office. Please allow time for processing. If you have any further questions about continuing education, please see our website at www.hi-fivetraining.org. Accreditation Statement The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. AMA Credit Designation Statement The College of Physcians and Surgeons designates this enduring material for 12.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The planning committee members are: Rita Kukafka, DrPH, MA, FACMI; Bruce Forman, MD; Gil Kuperman, MD, PhD; Virginia Lorenzi, MS, CPHIMS, FHL7, and Victoria Tiase, MSN, BN. None of the members of the committee, who planned this CME Activity, have any relevant financial relationships to disclose. The release date is 2/1/17 and the expiration date is 1/31/18. This activity is eligible for 12 continuing nursing education (CNE) credits. Columbia University School of Nursing, Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Trust and Respectful Interactions
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En provenance du cours de Columbia University
HI-FIVE: Health Informatics For Innovation, Value & Enrichment (Clinical Perspective)
103 notes
Columbia University
103 notes
À partir de la leçon
Mr. Osner Santana Meets Dr. Jefferson (Part 2)
Rencontrer les enseignants
Rita KukafkaAssociate Professor
Biomedical Informatics
Welcome to Patient-Centered Care, Patient-Provider Communication.
This is Lecture b, the objectives for this unit,
patient-provider communication are one, explain the importance, elements,
and processes of patient-physician communication.
Two, discuss the concept of trust in the context of healthcare interactions,
and three, describe various informatics tools and
the practical considerations to support patient-provider communication.
In this lecture, we will discuss trust and respectful interactions in healthcare
between provider and patient, and between healthcare team members.
Trust is defined by the Institute of Medicine as quote, confidence in and
reliance upon others, whether individuals, professionals, or organizations,
to act in accord with accepted social, ethical, and legal norms, end quote.
A clear understanding of trust and
values of trust is important to both healthcare and lifelong learning.
The building of a trusting provider patient relationship
is based on communication.
The patient must see the provider as someone that he or
she can be open with about their concerns and not feel judged.
If a provider seems uncaring or disinterested,
the patient may feel not comforted, and may feel depressed from that.
Sometimes this condition can make the patient situation more stressful.
Trust is a part of everyday life and of relationships, but
there are characteristics of trust that are specific to a healthcare context.
Those are vulnerability, altruism and competence.
Healthcare organizations may demonstrate their trustworthiness
by putting into place integrated systems with a clinical, educational, and
administrative infrastructure that can enable healthcare professionals
to practice in accordance with professional competencies.
To achieve the desired patient outcomes in routine care delivery setting.
Trust must be present in each encounter with patients and
families, among interdisciplinary healthcare professionals, and
across all levels of the healthcare organization,
to achieve optimal patient outcomes and create a healthy work environment.
Trust and
betrayal are two dichotomous forces that affect the quality of relationships at
the interpersonal, intrapersonal, team and organizational levels.
These two forces coexist in human interactions and are considered
fundamental to developing and maintaining relationships, achieving outcomes and
goals, and ensuring the integrity of individuals, processes and structures.
Vulnerability creates the necessity for interpersonal trust.
Illness carries an element of risk.
There is an uncertainty of outcomes and
also an information imbalance between provider and patient.
All of these factors play into vulnerability.
And trust is an essential factor in the patient-provider relationship
at this vulnerable and helpless point in their life.
Although the focus of the patient-provider relationship is on the patient in their
vulnerable state, everyone in a healthcare setting experiences risk, uncertainty and
information imbalance which should provide the foundation for empathy and caring.
Here's the component of transactional trust of the Reina trust and
betrayal model.
According to Rushton, Reina, and Reina, there are behaviors that build trust and
offer guidance, in creating a trustworthy environment of care.
Since the trust is transactional,
in that it exists in relationships between at least two parties,
it involves a mutual exchange, and it is created incrementally over time.
Quote, these components include competence trust, trust of capability,
communication trust, trust of disclosure, and contractual trust, trust of character.
For each type of trust, the model specifies behaviors that are essential for
building that trust and
suggests ways to interact with patients and families, end quote.
Transactional trust comprises of competence trust, contractual trust and
communication trust.
Competence trust is one of capability.
Contractual trust is one of character and communication trust is one of disclosure.
According to Mok and Chiu,
there are four themes in the development of a trusting and connected relationship.
Quote, one, understanding the patients needs, two,
displaying caring actions and caring attitudes, three,
providing holistic care and four, acting as the patients advocate, end quote.
When a provider responds to a patients needs in a trustworthy way,
a relationship of trust is developed and
in all conditions the provider strives to be fair and consistent with each patient.
This intentional attitude of responsiveness inspires trust,
amplifies professionalism, and enhances the credibility of the provider.
However, a trusting relationship by its very nature
leaves both parties vulnerable to abuse of the trust.
In addition, the patient can become less empowered to do the nature of the trusting
relationship, and providers need to encourage both exploration of empowerment
as well as nurturing trust.
The importance of clear straightforward communication is vital to trust, and
as much as patients can relate their symptoms without fear or caveat.
So too, must providers lose jargon and
explain why they know and understand about those symptoms in plain language.
Being able to risk saying, I don't know or showing uncertainty about
the outcomes of treatment are part of balanced interpersonal interactions.
In this respect, not only must patients trust their providers, but
also providers must trust their patients.
This shift could be attributed to top-down policy initiatives, negative media
coverage of medical scandals, and wider social and cultural change.
When clinical care professionals become aware of the myriad ways
that trust can be built, they are able to alter their communication,
decision-making, and behaviors in trustworthy ways.
This awareness can lead to the development of intentional strategies
that can be integrated into each patient care encounter
by becoming more aware of the impact of trust on the relationship.
The more that a patient is responsible for
their own complex care, such as managing wounds or
insulin doses, the more the healthcare professionals must trust the patient.
The more the provider is managing and
in control of patient care, the less the provider has to trust the patient.
Conversely, the more the provider adheres to clinical recommendations,
the more the patient trusts the provider.
And the less aligned the provider is with professional standards,
the less the patient trusts the provider.
Acknowledging people skills and
abilities became an essential component of trusting relationships.
Medical care professionals demonstrate competence trust
when they work closely with patients and families to clarify their intentions and
access their preferences.
Trust includes the act of engaging a patient and family in exploring and
understanding the implications of certain decisions on the whole person and
the family.
Competence trust supports patients and families in their
own decision making process and involves others who can support and
facilitate patients or families own internal resources.
Inquiring about how they can be helped and supported, the strengths that serve them
as they navigate through difficult times, and practices that support their
well being, acknowledges the inner capabilities of patients and families.
The framework on this slide shows the variation in types of trust based
on the context of the relationship of the provider to the patient.
Trust can be developed and
nurtured by providing the right conditions that promote and support trust.
These conditions include behaviors on the part of the person seeking to grow trust
that are addressed towards both the trustee and the trustor.
The behaviors that build conditional trust include managing expectations,
establishing boundaries, delegating appropriately,
encouraging mutually serving intentions, and keeping agreements and consistency.
One key behavior to foster conditional trust is to work with patients, families
and colleagues to clarify the meaning and conditions of the relationship.
Establishing therapeutic and professional boundaries, and identifying shared
intentions about the relationship helps avoid unintentional betrayals,
and creates a shared understanding of expectations and
of responsibility that are essential to building trust.
Clear boundaries, the limits of the professional relationship, that allow for
a safe therapeutic connection, between the professional and
the patient, are essential for trustworthy relationships.
The beginning of a therapeutic relationship is the best time to establish
respectful boundaries with patients and families.
Later, circumstances marked by increasing vulnerability may
make maintaining a balance of engagement and separateness more difficult,
especially if either party has a diminished capacity for trust.
Boundary violations, either constricted or diffuse, can undermine trustworthiness.
Contractual trust, another dimension of transactional trust
is based on the confidence that promises that are made will be kept.
Promises make concern the expectations patients or their families have about
outcomes, treatment processes, or potential complications to the boundaries,
and ten of their relationships with healthcare professionals.
Clinical care professionals, patients and families may employ constrictive or
controlling behaviors to create a sense of safety from the uncertain and
unpredictable events that are inherent to all patients.
Constrictive or controlling behaviors are manifested in multiple ways.
Such as rigidity in the individual's actions and thought or
criticism of others not sharing the same values.
It can also be manifested as distancing behaviors ranging from emotional withdraw,
physical isolation, and superficial interactions to raging hostility or
distraction in a flurry of activity.
Informed trust is important,
especially within the context of shared decision making.
Informed trust includes both the patient's effect and
cognition, as well as the provider status and performance for the basis of trust.
With this type of trust, the patient has an active role in the relationship.
Information weighs heavily in the trust between the patient and
the provider, including courage or collaboration between patient and
provider when it comes to decision making.
Peer trust is between providers, and is based on cognition and status.
Patterns of over involvement may be the clinicians attempt to relieve feelings of
loneliness by establishing connections.
Inappropriate disclosures and interactions,
including breaches of confidentiality may also be a manifestation.
Whatever form they take, boundary violations can undermine relationships and
break trust in every sphere, personal, professional, and community.
Earned trust is another type of trust between clinicians.
It is also based on cognition, but instead of status, it is dependent on performance.
In other words, actions and outcomes are highly valued.
This encourages collaboration and teen based practice between providers so
that one could experience the performance of other providers.
Trust is key in the performance of a teen when delivering care.
There are other units that go further into detail, regarding teamwork,
relationships and communication.
Status trust is between a provider and administration and relates to authority.
There is a symbiotic relationship between the two roles,
because they rely on the other to make decisions and perform work.
Contractual trust also involves matching the needs of patients and families
to participate in care with appropriate opportunities, resources and support.
Clinicians must be mindful to consider ways to engage patients and
families in meaningful participation in treatment and care giving.
Understanding how patients and families wish to participate and
their own assessment of their capabilities to do so is the foundation for
delegating appropriately.
Performance trust is a bidirectional relationship between clinicians and
administrations.
Because again, they depend on each other to perform.
Administration makes decisions about resources and services, and
clinicians affect the performance goals, targets and outcomes.
In broad terms, trust is a relational notion or
psychological state that influences individuals willingness
to act of the basis of the words, motives, intentions, actions, and
decisions of others under conditions of uncertainty, risk, or vulnerability.
Workplace trust in healthcare settings is a phenomenon that involves
fair treatment and respectful interactions between individuals.
Workplace trust in healthcare settings entails the provider's trust in colleagues
linked to teamwork and shared experiences, trust in supervisors related to
personal behaviors and which do have an impact on trust in the organization.
And trust in the employing organization influenced by leadership and
human resource management practices.
Such trust relationships enable cooperation among healthcare workers and
their colleagues, supervisors, managers and patients, and
may act as a source of intrinsic motivation.
At the surface, trust may be a simple concept,
specially since we encounter it in our everyday lives and relationships.
However, there are various kinds of trust between different people and positions.
There is a transactional trust which implies that trust is between two parties.
And there is a mutual exchange of trust, competence, contractual,
communication, and conditional are types of transactional trust.
We also discussed embodied trust, which is between a clinician and
a patient, and is more reflective of a paternalistic type of relationship.
The shift from a paternalistic relationship to a mutual relationship
between patient and provider reflects informed trust, and
more of a partnership and collaboration.
Then there are types of trust between clinicians, peer trust is one type and
is traditional in the sense that it is dependent on status.
Earned trust is another type of trust between clinicians and
instead of status it is due to performance.
Additionally, you can have trust between clinicians and administrators.
One type is called status trust and is dependent on authority.
The other type is trust due to performance.
As you can tell, trust is a simple but yet also, a complex concept.
Trust is very important, especially in the context of healthcare.
This concludes lecture b of patient-provider communication.
To summarize, there are behaviors that facilitate trust and
respectful interactions, such as listening carefully,
treating patients respectfully, being honest and consistent,
following through on commitments and having an accepting attitude.
Patients must be able to trust their doctors with their lives and well-being.
Trust is a central element in the provider patient relationship.
And the trust that patients have in their provider to act in their best interest
contributes to the effectiveness and quality of medical care.
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