This blog, Emotional Intelligence Depends on More than Physician Behavior, was originally written by Paul Keckley and Marina Karp on May 17, 2016.
Emotional intelligence is not a new idea. In corporate America, it’s widely recognized as an essential quality for effective leadership. In health care, the application of EQ, as it’s known, has been limited to face-to-face interactions between caregivers and patients, but it’s much more.
Much has been written about EQ in social sciences and business research. Daniel Goleman defined EQ as “the capacity of individuals to recognize their own and other people's emotions, to discriminate between different feelings and label them appropriately, and to use emotional information to guide thinking and behavior.” Patricia Harmon described it as “the ability to harness your emotions in sensing, understanding and responding adeptly to social cues in your environment.” And psychologists John Mayer and Peter Salovey wrote “emotional intelligence is the ability to accurately perceive your own and others’ emotions; to understand the signals that emotions send about relationships; and to manage your own and others’ emotions.” It’s essentially the capability of an individual to sense the feelings of those in their surroundings and respond appropriately.
EQ in the Field
Health care is lagging other industries in applying EQ across our widening scope of patient care activities. Most of the research to date has centered around physician-patient interactions, showing direct correlations between low EQ on the part of physicians and higher rates of error and lawsuits, lower patient satisfaction and poorer outcomes compared with physicians who have a high EQ. The literature also points to a positive correlation between physician EQ and their own job satisfaction: as physician EQ improves, their job satisfaction improves and professional fatigue decreases. And last year, the MCAT test, which is the gateway to medical training for would-be clinicians, was modified to include a section on“Psychological, Social and Biological Foundations of Behavior” to get at physician EQ.That’s why notable organizations like Cleveland Clinic, Mayo Clinic, UCSF and others put such emphasis on the EQ of their medical staffs.
But EQ in patient care is much more than the interactions between physicians and patients. And in most organizations, these areas of EQ impact are inadequately addressed. As the health system pivots from volume to value-based incentives that depend on team-based methods of care delivery and use of technologies in diagnosis, treatment and care coordination, a systemic approach to EQ in patient care needs thoughtful implementation. It’s a system imperative requiring more than cursory measurement of patient complaints and occasional intervention with difficult physicians.
The EQ Hotspots in Patient Care
Physician recruitment: Where a physician trained (for undergraduate medical education) and did his or her residency is an important starting point. Academic programs that do not take EQ seriously are more the rule than the exception. Academic programs that limit EQ training to physician personality testing fail to address the full impact low EQ has on patient care.
Team-based EQ: The interaction among caregivers who work in team-based models is a hot spot. Physicians are inclined to think teams are useful, as long as they are deemed team captain. But too often, the input of nutritionists, mental health counselors, pharmacists and nurses is muted because the “captain knows best.” And, regrettably, often patient care is compromised because their input is not sought. That’s the result of low EQ.
Health coaching: Every health care organization is dependent on patient adherence to avoid financial penalties and maximize payments from payers like Medicare and others. Avoidable readmissions and emergency department visits, value-based purchasing incentives, shared savings in accountable care organizations and other programs require health systems to focus on optimizing what patients do themselves. The MVP in most health systems may well be health coaches — the high EQ nurses and educators who are trained to listen intently to cues from patients that provide windows to their needs, values and abilities. Programs at Duke University and others train health coaches to interact telephonically and in person so that coaching is optimized. Their central focus is coach EQ.
Cyber care: The reality of the new normal is that much of the interaction between patients and caregivers will be enabled via chat rooms, social networks, and televisits. Knowing how to probe beneath patients' questions, how to build patient confidence, adherence and how to engage patients as individuals beyond industrialized signs and symptoms queries requires systemic EQ.
Building a system approach to EQ in patient care
An organization that does not take EQ in patient care seriously is prone to poor clinical and financial performance. It’s that simple. A culture in which low EQ is tolerated in the full scope of its patient care activity is prone to poor outcomes, low patient satisfaction and avoidable errors.
Taking EQ in patient care seriously means more than a physician-focused disciplinary effort to weed out dysfunctional clinicians. And it requires more than protocols and checklists that target lapses in care coordination or error detection. EQ impacts every encounter with individuals and their families who seek our help. It requires an investment in tools and training to assess and monitor EQ activities, and leadership that acts to address lapses in patient care EQ.
It’s said, “I don’t care how much you know until I know how much you care” — that’s the challenge in applying EQ in patient care.