Job # 073842 Windover 08-13-13In 2010, Drs. Joseph Hahn and James Merlino asked Dr. Adrienne Boissy to develop a communication curriculum for Cleveland Clinic Health System. Pulling on variable expertise and interest, a Communication Task Force was assembled. The group was made up of Dr. Boissy, Dr. Tim Gilligan, Dr. David Taylor, Dr. Vicente Velez, Dr. Saul Nurko, Dr. Amy Windover. The group surveyed what data existed around communication skills and programs, both nationally and internally. We also reviewed what other healthcare systems were working on as well as the Cleveland Clinic Lerner College of Medicine curriculum.

In 2011, a small group of clinicians were trained in communication skills, adult learning theory, and group facilitation. A one-day foundational course was designed and rolled out in fall 2011.  Intentionally, the course welcomed from various specialties in a private, small group setting. The course, now called R.E.D.E. to Communicate℠: Foundations of Healthcare Communication (FHC), was significantly revised with feedback from our physicians and incorporating the R.E.D.E.SM Model. The course is a peer-led CME accredited course with most of the time spent practicing specific skills. In addition, we created an opportunity to work through challenging communication scenarios that the clinicians have encountered.

The feedback was overwhelmingly positive and powerful. In light of that, the program expanded. An advanced communication skills curriculum evolved, including courses using video feedback and the simulation center. We also recognized the need to develop our own model of communication that is explicitly relationship centered with benefits to both parties, is more broadly applicable, and encourages reflective competence.

We have recruited and trained 42 physician facilitators from over 25 different specialties, many of whom are surgeons. We have recruited and trained 16 advanced clinical care provider facilitators from many different focus areas which includes physician assistants, nurse practitioners, nurse managers, social workers, and others with significant patient care contact..

In 2013, our executive leadership team completed the communication skills training. Our CEO, Dr. Delos Cosgrove, requested that all staff physicians and housestaff complete the R.E.D.E. to Communicate℠ course by March 2014, a commitment of  more than 3000 physicians. We rolled out the program across the entire health system and required all employed physicians and trainees to attend beginning in October 2013.

To date we have had over 5000 staff physicians and clinical trainees and over 1000 advanced clinical care providers complete the R.E.D.E. to Communicate℠: Foundations of Healthcare Communication course. Additional advanced courses have been developed within the R.E.D.E. to Communicate℠ course series for Communicating to Patients with Chronic Pain, Delivering Bad News, Motivational Interviewing, Family Meetings, Discussing Code Status and Communication during Inpatient Rounding and more advanced courses are still being developed.  The R.E.D.E. to Communicate℠: Foundations of Healthcare Communication course is mandatory for all on-boarding staff and clinical trainees at Cleveland Clinic.

The R.E.D.E.SM Model

We chose to focus on communication skills for our providers not only because it is easily within their power to influence and change, but because we know loyalty, confidence, trust, and compliance depend on it. Over the last several years, the Cleveland Clinic and CEHC have emerged as a leader in patient experience and improving clinician communication. The R.E.D.E.SM Model is the cornerstone of the program and is the conceptual framework for effective communication in healthcare relationships.

The R.E.D.E.SM Model stands for Relationship: Establishment, Development, and Engagement. Whether seeing a patient before surgery for 5 minutes or walking with them during a chronic illness, we are responsible for the relationships we forge. The model also recognizes that there is no cookbook for meaningful communication skills, yet having a framework to apply to any conversation can be transformative.