There is a saying in the world of education, “You have to care to teach.” Why is it then in healthcare, a profession of and about caring, we do such a poor job of teaching our patients? Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient and provided the “fix.” Is it because we do not take courses in how to teach patients effectively? Or, is it simply because we have not taken the time to fully appreciate the cost of ineffective patient teaching? The costs may be measured in outcomes, quality of life, unplanned readmissions to the hospital and other potentially avoidable utilization of healthcare resources. Now that Medicare will no longer pay for certain unplanned readmissions within 30 days, the cost implications of poor patient education may become staggering to hospitals.
I have worked in the healthcare industry for almost 30 years and am currently in a direct-entry Masters level nursing program at a university hospital. Direct-entry means I am not a nurse, but I already have an undergraduate degree in something that may or may not be healthcare related. As a patient and a student, I am interested in the education provided to patients throughout the hospital stay and at the time of discharge. This is my story and the story of Janet and Sarah, the wife and daughter of John, a patient I cared for. It is a simple story with a simple, yet potentially effective way for minimizing healthcare costs. On the day of his discharge, John asked that his wife and daughter be taught the discharge instructions. As a nursing student, this was my first discharge. I was nervous. I dutiful printed out the discharge instructions and reviewed them prior to meeting with Janet and Sarah. My goal was to be thorough in my explanation of the instructions. I started at the beginning and moved page-by-page through the document as Janet and Sarah nodded in understanding.
“John should eat a heart-healthy diet.” They nodded in agreement.
“He should continue taking the following medications.” I reviewed the list. They nodded in agreement.
“He should start taking the following new medications.” I reviewed the list. They nodded in agreement.
“He should stop taking the following medications.” I reviewed the list. They nodded in agreement.
As I “told” them what John should and should not do, they nodded in agreement. It occurred to me there was no way they understood everything I was covering. I am in healthcare, and I would not have understood had John been my father. I stopped my regurgitation of the information and decided to try a process I had recently read about for improving patient education; the teach-back process.
I asked, “Would you help me make certain I have covered the important points about John’s medications?” They seemed surprised I would ask this. I then asked, “If you had to describe to one another how John is to take his medications when he gets home, what would you say?”
Sarah and Janet looked at each other. Janet shook her head. Sarah slowly started to describe to Janet what she understood. Janet added in what Sarah could not remember. I clarified as they educated one another about how they were going to help care for John when they got home. We then went through other key areas of the discharge instructions in the same manner. When they taught-back what they understood, it helped me strengthen and support their understanding.
In the end, I asked Sarah and Janet how they felt about what we had just done. They both stated “It was great!” They were so enthusiastic it seemed they wanted to do more.
I believe teach-back offers a fantastic way to provide patient education and perhaps ultimately reduce healthcare costs. By improving the patient’s understanding of how to care for him/herself at home, the potential for reducing unplanned readmissions and associated costs could be realized. I learned from this experience not only must you “care to teach”; you haveto care enough to allow the patient/family to teach you.
This essay was submitted via the 2013 Costs of Care Essay Contest.