Fallon Clinic gives feedback for patient interactions


WORCESTER, June 15, 2011 — Although the doctor often muttered a rushed “OK, OK, OK,” at home to his wife, his patients didn’t take kindly to it during office visits. They thought he wasn’t paying enough attention to them, and perhaps trying to hurry the appointment along. He was eventually told of the off-putting mannerism through feedback from a shadow program at the Fallon Clinic.

Now the doctor refrains from using his idiosyncratic expression, of which he wasn’t even aware, and is careful to observe a list of positive doctor-patient interactions formulated by Fallon Clinic. He sits at eye level to his patients, smiles at them and asks permission to use their first names.

If he doesn’t, a Fallon “shadow coach” will write down exactly what happened, and feedback will be forthcoming.

Gary L. Segal, Fallon Clinic’s senior director of training and organizational development, said the program encompasses 187 clinical providers, including doctors, nurse practitioners, medical assistants, optometrists, and support staff such as receptionists, who have been evaluated at 1,600 medical appointments since the program began in 2006.

The shadow coaches are non-clinical Fallon employees who undergo training.

Patients, who get a $10 gift card and a tote bag for their participation, are observed by shadows from check-in to check-out, and all points in between, including the laboratory, EKG and radiology departments.

Fallon Clinic, which is different from the Fallon Community Health Plan, has more than 20 facilities in Central Massachusetts, including in Auburn, Leominster, Millbury, and a big clinic on Plantation Street in Worcester.

Interactions at appointments are documented by the shadows on two three-page checklists — one for doctors and one for support staff, to get a complete picture of how patients are treated. There is little interaction between shadows and patients, a shadow is never alone with a patient, and a patient can ask a shadow to leave at any time.

Mr. Segal said lists of all appointments are looked over daily, and patients are called three days in advance and asked if they could be shadowed. Almost all agree, he said.

“We are looking for certain behaviors, and this program has shown a significant improvement in behavior. The patients love it,” Mr. Segal said.

Ronald R. Nolette, 56, is a patient of Dr. Talal Bou-Harb who agreed to have a shadow with him for a recent appointment to check on a heart problem, and for a physical.

He said the shadow sat with him in the waiting room until he was called, went into the exam room where vital signs were taken by a medical assistant, and remained in the room when Dr. Bou-Harb examined him. The only time the shadow was not at Mr. Nolette’s side was when the doctor needed to take a close look at his body, and a curtain was drawn. The shadow took notes during the visit.

Mr. Nolette, of Brimfield, also agreed to fill out a short evaluation form after the appointment.

“I did not find it intrusive. I think what they’re doing is a very good thing,” he said.

Dr. Robert J. Cavanaugh, who has practiced at Fallon Clinic since 1975, said he doesn’t mind being watched by shadows, since throughout his career, he has been observed by medical students, interns and residents.

The teaching of social skills in medical schools, he said, seems to be lacking, so he sees the need for the shadow program.

“Eye contact, shaking hands and hand washing are important. But so is interacting with patients while looking at lab results and X-rays,” he said. “I like to know how I am doing, and physicians need to learn skills like direct contact. Sometimes, a doctor has spent 45 minutes with a patient, and the patient estimates that it was a 10-minute visit. That means there was a problem with direct contact. Perception is important.”

Melissa DaCosta, manager of customer service operations at Fallon Clinic, said shadowing patients gives her the chance to see services through the eyes of patients.

“It allows me to give substantive feedback to physicians and frontline staff,” she said. “We are able to identify best practices through our conversations and interactions with patients during the shadowing process.”


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