What “managing up” can do

Better communication among physicians and between physician and patient can help improve the entire health care experience.

By By E. Coy Irvin, M.D., MBA | Fall 2013 | Remarks

 

As more family physicians and  internists have decided to concentrate on outpatient medicine, positive relationships and effective patient hand-offs have become critical for good patient care.

The technique of “managing up” has been taught by many experts over the past few years as a way of improving the customer service experience. Managing up helps the patient experience by alleviating their concerns about the service and quality of care they will experience in our system. In addition, managing up can improve the relationship between referring physicians and the hospitalists who care for their patients while they are in the hospital.

As we see the separation of inpatient care and outpatient care become more common, patients rightfully are concerned about who will care for them during a severe illness, the very time when they need the most attentive care. Not only will the new doctor be a stranger to them, but so will many of the staff at the hospital. Quite possibly, the attending hospitalist will change during the patient’s hospital stay, shaking the patient’s floundering sense of security even further. This all leads to the clear need for exceptional hand-offs of the patient, their information and the intended plan of care.

Many times we have witnessed patients questioning whether one physician communicates with the other physician when they say, “Do you guys talk to each other?”

This can seriously undermine confidence in our medical care. It also puts our patients and ourselves at risk for unintentional catastrophic accidents and possible legal action.

It is imperative that physicians improve communication and relationships so that when an outpatient physician hands off the patient to an inpatient physician, or when one inpatient physician hands off to another, there is true communication of the needs, status and intended treatment plan of the patient’s medical condition.

Part of the process can be aided by using managing up techniques to educate the patient so that they understand the transfer of care that is about to occur. Remember, this is a two-way street: Not only does communication and managing up need to occur at the time the patient enters the hospital, but it also has to occur during the hospitalization if there is a transfer of care. Finally, it occurs again at discharge of the patient back to the outpatient physician.

So not only does managing up improve the patient’s perception of the hospitalist, it can also improve the perception of the outpatient physician in the eyes of their patient.

Imagine a scenario where the outpatient physician, upon deciding to admit the patient to the hospital, tells the patient, “Mrs. Williams, I am sending you to the hospital. I no longer go to the hospital, so I’m going to place you with the hospitalist service. I’m not sure who the hospitalist is today, and I am not sure you will see the same doctor each day. I’m sorry for this, but I can no longer make rounds on hospitalized patients.”

What would you think if you were Mrs. Williams? You probably wouldn’t have much faith in the hospitalist that would care for you.
Now what if the outpatient physician had said, “Mrs. Williams, I am sending you to the hospital. You will be cared for by my hospitalist service. The hospitalists are an extension of my office practice, and they care for my patients on a daily basis. The hospitalists are experts in inpatient medicine and will know just what to do to help you get better. I trust them to care for my patients as I would trust them to care for my family. We will give them all the information we have on you, and upon discharge, they will share with me the information about your hospital stay.”

Now Mrs. Williams feels reassured that not only will she get good medical care, but also that her information will be passed from one physician to the other. The accepting hospitalist will feel better about taking care of the outpatient physician’s patients, and we will all find taking care of Mrs. Williams to be easier because she trusts the physician’s judgment.

As a physician and consultant who works with both hospitalist programs and medical staff, I see daily the need for better communication across the system. Not only do we need to communicate better physician-to-physician and physician-to-patient, but we also need to improve communication between physicians and hospital staff. Using the techniques of managing up can result in a marked improvement in the final goal for all health care providers, both clinical and non-clinical: Providing the best and the safest care of the patient. Why? Because it improves teamwork, something on which our patients directly rate us. Another positive effect of managing up is that the technique helps to reassure the patient who is nervous and scared about their illness. And our patients will directly benefit from a better coordination of care.

E. Coy Irvin, M.D., MBA, is Chief Medical Officer and Vice President of Medical Affairs for McLeod Regional Medical Center in Florence, S.C.

 

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