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Using Patient Teach-Back to Improve Patient Education
Patient teach-back allows providers to assess patient understanding and cement information in patients' memories.
Patient education and health literacy strategies are incomplete without patient teach-back, a practice many providers use to make sure their patients understand health information.
As the healthcare industry confronts a growing population of folks with chronic illnesses, plus reimbursement changes shifting toward value-based care, clinicians are looking for ways to keep their patients healthier and out of high-cost settings like the hospital or emergency department. As a part of that, most providers prioritize patient engagement and education.
But patient engagement can be an uphill battle. An engaged patient must be an informed patient, and the data shows they aren’t always informed.
In 2023, University of Michigan School of Medicine researchers wrote in The Joint Commission Journal on Quality and Patient Safety that only between 50 and 60 percent of patients remember key information from inpatient stays, including their diagnosis and even changes in medication regimens. Forgetting health information, including self-management plans, can have adverse consequences like ED visits and hospital readmissions.
The inability to remember healthcare advice is also driving up industry spending. According to the Center for Health Care Strategies (CHCS), low health literacy and insufficient patient education can cost up to $236 billion every year.
And that’s not to mention the patient experience impacts of poor recall and understanding. Poor understanding of information can put patients on the defensive, reduce satisfaction, and erode trust between patients and their care providers.
The University of Michigan experts indicated that better patient portal access will be a key step in helping patients recall information from a healthcare encounter, but retention also needs to be complemented by patient education. Patient education hinges on personal health literacy—a person’s ability to understand and use health information—and to get there, providers need to make sure patients actually understand the information shared with them.
That’s where patient teach-back, a systematized check on patient understanding, comes in. Below, PatientEngagementHIT will review the how-to’s for patient teach-back and discuss the effects it can have on patient experience and clinical outcomes.
WHAT IS THE PATIENT TEACH-BACK STRATEGY?
Patient teach-back is a patient-provider communication strategy during which providers ask patients to repeat information back to them. This allows providers to assess how well they explained healthcare information to the patient.
According to the Agency for Healthcare Research and Quality (AHRQ), healthcare professionals should use the teach-back method to improve patient understanding of and adherence to care instructions. The strategy may also decrease clinic calls and improve patient satisfaction and outcomes.
Nurses are primarily in charge of patient education and therefore use patient teach-back more than other clinicians. However, doctors, social workers, care coordinators, and other healthcare personnel may also use patient teach-back.
Clinicians can use teach-back when communicating one-on-one with patients and with patients’ family members or caregivers, too.
HOW DO PROVIDERS CARRY OUT PATIENT TEACH-BACK?
Patient teach-back is a key part of patient-provider interactions that should be used toward the end of an appointment or after introducing a new healthcare concept or treatment plan.
Generally, patient teach-back can be broken down into a handful of steps, according to AHRQ:
- Summarize patient information in clear, plain language (say “high blood pressure” instead of “hypertension” or “walk” instead of “ambulate”). Using medical jargon will not be helpful for layperson patients.
- Ask the patient to repeat the information back in their own words.
- Assess patient understanding. Was their response accurate? Are there areas the patient still doesn’t seem to understand?
- Ask the patient where you can explain better, and then clarify misunderstood information.
When eliciting a patient’s response, providers should make clear that teach-back is not a test, according to the Institute for Healthcare Improvement (IHI). There is not necessarily a wrong answer, but rather information the provider needs to clarify. It may also be helpful to set the expectation early on that teach-back will happen at the end of the appointment, giving patients the chance to proactively ask questions.
AHRQ recommends providers explain that the responsibility for the patient to understand is on the provider, not the patient.
Providers should also avoid using simple “yes” or “no” questions, IHI and AHRQ both say. Open-ended questions will reveal more information to the provider and allow the provider to assess whether the patient truly understands a healthcare concept. A “yes” or “no” question will allow a patient who may not understand a concept to leave the clinic without receiving a full and satisfactory explanation.
Instead of asking, “do you have any questions?” clinicians can try saying:
- “I want to be sure I explained everything clearly. Can you explain it back to me so I can be sure I did?”
- “What will you tell your husband about the changes we made to your medicines today?”
- “We’ve gone over a lot of information. In your own words, please review with me what we talked about.”
Providers should also consider their body language during this process. Being engaged, perhaps sitting at the same level as the patient instead of standing over them, will make the patient feel comfortable reiterating information. Using a caring and empathetic tone of voice instead of shaming or lecturing the patient is also important to a positive patient interaction.
Where applicable, providers should also engage a family member or caregiver who has joined the patient for the appointment, AHRQ advises, because family engagement helps patients adhere to their care plans.
Not all patients consent to their family members being present for healthcare appointments. In these instances, providers can encourage patients to share their experiences with a loved one at home.
As providers consider patient education and patient teach-back, they must be mindful of language preferences. Like other patient-provider communication strategies, patient teach-back will be less effective if there is not language concordance. Healthcare organizations should stay apprised of federal mandates for language access and assistance by offering patient access to interpreter services.
In some cases, patient engagement technologies could ease interpreter access; digital tools can be more easily translated into patients’ preferred language.
Utilizing Patient Education Aids
Providers can also employ patient education aids to assist in patient teach-back. Printouts can reinforce education during and after the clinic visit.
Additionally, patient education technology can help streamline the patient teach-back process. Patient education technology includes videos or digital modules that teach patients about certain healthcare issues. Some organizations have started using patient education technology to streamline provider workflows and ensure continuity of education throughout the entire hospital or clinic stay.
After using the patient education technology, providers can circle back with patients to check patient understanding. Using the same open-ended questions, providers can elicit patient feedback on the patient education technology, ensuring patient understanding.
HOW CAN ORGANIZATIONS INTRODUCE TEACH-BACK TO CLINICIANS?
Patient teach-back is a key patient-provider communication strategy. If an organization implements a patient teach-back program throughout the clinic or hospital, it may be a significant workflow change. After all, providers already struggle to make enough time for patient relationship-building between their clinical and documenting duties.
Implementing patient teach-back as a patient education strategy will require strong provider buy-in. To achieve a high level of engagement from staff, organization leaders will need to communicate with their providers.
AHRQ recommends organizations begin by electing a provider champion for the teach-back strategy campaign. This champion can serve as a liaison between providers and leadership, help educate colleagues, and address other problems clinicians have with workflow change. These advocates may also be able to negotiate room in provider schedules to allow for the workflow shift where necessary, AHRQ says.
Next, organizations should train all members on the teach-back method as outlined above. This will require leaders to determine how and when teach-back will be implemented. It may be difficult to squeeze the new communication strategy into all patient interactions immediately. Instead, AHRQ suggests a more incremental approach.
For example, providers might try implementing patient teach-back with the last patient of the day until clinicians become comfortable with the strategy. This way, if teach-back causes the appointment to last longer than normal, it will not impact the entire day’s schedule. This should help providers gauge the pacing of their appointments going forward.
Organizations should also inform patients and family caregivers about teach-back and why they use it. AHRQ recommends organizations use handouts and office signage to help patients understand this new communication method. This can help make clear why and how the strategy is implemented and that it is not a test for patients.
Once teach-back has been implemented organization-wide, leaders should evaluate and refine their strategies. Organization leaders can survey providers about the effectiveness of the strategy or areas where they need more support. This will help all providers become more comfortable with the communication method and ensure it is seamlessly integrated into patient communications.
According to IHI, organization leaders should:
- Build motivation by highlighting the proven efficacy of teach-back
- Show an understanding of already time-strapped clinician working conditions
- Be sure to confront the problem, not the person when encountering issues
- Promote skills development
- Build provider confidence in skills
Organization leaders should acknowledge that workflow changes are often difficult and take time. By demonstrating this understanding to providers and implementing teach-back with patience and empathy, they can more effectively support providers.
HOW EFFECTIVE IS PATIENT TEACH-BACK?
Data continues to show that patient teach-back is an effective way to make sure patients understand the medical information communicated to them.
In 2020, researchers found that teach-back can reduce the comprehension deficit for emergency department patients from 49 percent to 11.9 percent. That means far fewer patients had poor understanding of the medical information explained during the ED encounter.
What’s more, the study, which was published in the International Journal of Emergency Medicine, put to rest any lingering concerns about the workflow impacts teach-back can have. Generally, patient teach-back doesn’t add much to the provider workflow. Teach-back conversations took 1:39 minutes, compared to an average of 3:11 minutes for the usual discharge interview.
A separate 2020 literature review in Federal Practitioner found that patient teach-back can improve patient satisfaction with care, reduce the risk of post-discharge readmission, and improve quality of life scores. However, the researchers did acknowledge that there is inconsistent data indicating that teach-back can improve patient education or understanding scores.
Still, organizations advocate for the communication strategy because it can improve patient understanding of a condition and empower patients in self-management. According to research cited by AHRQ, patients prefer the teach-back method to supplement provider communication and better understand their own health.
As the healthcare industry continues to tackle the issue of chronic disease management and patient empowerment, they must ensure patients understand health information. Supplementing patient education efforts with patient teach-back allows providers to determine patient understanding and enhance education in key areas.
