The Role of Active Listening in Value-Based Care

I once worked for a healthcare company where we had a nurse practitioner who was almost famous inside the practice for her ability to manage more patients over the course of the day than most other clinicians. What’s even more impressive is that she managed to maintain exceptional relationships with her patients – to the point where they’d enthusiastically praise the amount of time she devoted to their care.

Someone on the team asked her how she did it, and she let them in on a little secret: she spent less time with her patients than others in the practice, she admitted. “But the difference is, when they’re here with me I sit right next to them, facing them completely, looking them in the eye, and with no computer or notepad in my hand. When they’re speaking, I let them go until they’re done. And then I reflect back to them what I heard.”

It’s such a critical life lesson, but we in medicine look past it almost constantly: the quality of time you spend with a person is more important than the quantity.

And it all begins with listening.

Psychologists and communication specialists put a finer point on this, referring in their literature to theories around “active listening,” which are quite close to those practiced by the wonderful nurse practitioner mentioned above.

Pay attention. Reflect. Clarify. Withhold judgment. Summarize. Share.

So many of us by now are accustomed to the experience of being in a doctor’s office, with the clinician looking at us out of the corner of their eye – while standing across the room – and discussing our symptoms while they type on a computer. They might greet us warmly and by name, and do the same upon leaving, but for the bulk of the encounter, they’re clearly trying to manage several elements at once.

And only one of those elements is a conversation with the patient.

This is not in the least meant as an indictment of our nation’s clinicians – almost all of whom are big-hearted people who went into the profession out of an impulse to genuinely care for those they serve. The problem comes from the business side of the healthcare industry. In too many practices, clinicians must see as many as 30 patients a day and extensively document their encounters so the practice can get paid for every service they provide to a patient.

It is exhausting work, and too often it is impersonal work, which is an almost surreal word to assign to the practice of medicine. But that’s what it has become for too many. And, sadly, it’s also why many are leaving the industry.

At Welcome Health, we’re fortunate to practice a different way. First of all, because we prioritize value-based care, we earn money by keeping patients healthy. If we can save a patient from the hardship of a test or procedure that may not yield any real value – but would in a more typical health system trigger an insurance payment to the practice – we’ll skip it.

Put another way, while our clinicians are caring for you, they’re not distracted by financial considerations.

And while a value-based care approach helps, our care philosophy is the true key to how we listen to patients. We know that outcomes are better when you listen more closely. Patients who may have had a poor experience with a certain medication or treatment regimen may be reluctant to express such issues while a clinician discusses the treatment plan. But clinicians who listen – really listen – during that conversation can sense such hesitation and move toward it, so they can collaborate with the patient on how best to overcome misgivings or past hurdles.

That is how clinicians help their patients adhere to a treatment plan and reach their life goals. Not by brute force, and the power of their authority. But through partnership.

And just as active listening helps improve patient outcomes, I’d argue it’s also key to what I think of as clinician outcomes. By improving the experience of delivering healthcare, we are serving our clinicians better, and providing them with a way to practice medicine the way they always hoped.

We’re proud of how we listen to our patients and everyone on our team, and we’re always seeking ways to get better. If you’re curious about how we do it or have tips you’d like to share about how you do it, we’d love to hear from you.