5 Principles to Build Positive Patient-Provider Relationships

Intentional preparation, intent listening, agreeing on priorities, creating a connection, and understanding emotional cues are the recipe for success in patient-provider relationships and communication, according to new research out of Stanford University.

A strong patient-provider relationship is the bedrock of a positive patient experience. Patients who report their providers connected with them on a deep level, display their clinical expertise, listened to their questions and concerns, and explained concepts in clear layperson terms tend to report better experiences than those who don’t.

And the feeling is mutual. Most providers got into medicine to connect with and help patients, and experts contend that emphasizing patient-provider interactions can combat feelings of clinician burnout.

But getting there is complicated, according to Donna Zulman, MD, and Abraham Verghese, MD, the Stanford study’s lead researchers. Loaded clinical workflows, extensive quality reporting requirements, and staffing shortages place time constraints of clinicians that keep them from building the strong patient ties that make their jobs – and outcomes – meaningful.

“We were looking for practices that would improve the experience of patients and lead to better care for them, but would also improve the experience of clinicians and help them to rediscover the joy of medicine,” Zulman, an assistant professor of medicine and the director of Stanford Presence 5, one of several Presence initiatives, said in a statement.

“As physicians, we are privileged to work with people in their most vulnerable moments,” she added. “And in today’s climate, particularly in primary care, it’s easy to lose sight of that with all of the administrative demands, time pressures and technology distractions.”

In partnership with Presence, a Stanford interdisciplinary research center focusing on human connection, Zulman, Verghese, and team conducted a literature review of 73 studies about interpersonal connection conducted between 1997 and 2017.

The team analyzed those studies to identify relationship-building practices that had a positive impact on clinical quality, cost, and patient or provider experiences.

The team also conducted interviews with patients and providers to glean insights about certain best practices.

From there, the researchers identified 31 strategies to help improve patient-provider relationships, winnowing and combining that list down to five key approaches. Those best practices include:

• Prepare with intention: Clinicians should become familiar with the patient they are about to meet and create a set plan for each clinical encounter.
• Listen intently and completely: Clinicians should display active listening skills such as leaning forward when the patient is speaking and sitting down. Clinicians should avoid interrupting the patient.
• Agree on what matters most: Clinicians should ask the patient about her healthcare goals and values and be sure to integrate those priorities into their care plans.
• Connect with the patient’s story: Clinicians may put their clinical protocol into the context of a patient’s everyday life and personal background. This will help the provider understand the factors that influence the individual patient’s health and wellness.
• Explore emotional cues: Looking out for body language that might convey a certain emotion from the patient will help cue the provider to display empathy. Clinicians should name and validate patient emotions at the point of care.

“The Presence 5 practices resonate because they speak to something that is timeless and central to medicine,” said Verghese, the Linda R. Meier and John F. Lane Provostial Professor and director of the Presence Center. “Patients want us to be more present. And we as physicians want to be more present with our patients, because without that contact, our professional life loses much of its meaning.”

Future research will focus on the effectiveness of these principles, Verghese and Zulman said. Currently, Zulman is rolling out these relationship-building strategies at Stanford primary care clinics, the MayView Community Health Center in Mountain View, and the San Jose VA Clinic at the VA Palo Alto Health Care System, to test how they impact the clinical experience for patients and providers.

Study authors are also looking into building curricula for training clinicians on these relationship-building and communication strategies, as well as examining how they can be implemented in various medical settings or in different care models.

These findings are not a panacea, Zulman acknowledged. Future work to the medical system, as well as practice treating patients under new regulations, will be necessary.

“While we might not be able to change the system overnight, our study suggests there are some concrete, evidence-based strategies that we, as physicians, can use that will help preserve and foster the connections that are most healing for patients and for us as physicians,” Zulman said.

But these findings do represent a good step forward for preserving the patient-provider relationship in an increasingly changing medical landscape. As providers face an onslaught of documentation and other requirements, these communication strategies may help avoid the deterioration of the patient-provider relationship.