HealthPOWER! Prevention News (Winter 2012)—Feature Article 

Patient Education: TEACH for Success—Making an Impact at the Local Level

It was the comment that made all the hard work worth it for Connie Malik, the Veterans Health Education Coordinator (VHEC) and lead facilitator for the Patient Education: TEACH for Success (TEACH) program at the James A. Haley Veteran's Hospital in Florida.

In March 2011, Malik was talking with the Chief of Medical Service, Dr. Jose (Joe) Lezama, when he told her that the TEACH course had been transformative training for his hospitalist staff. "It made my day to hear that he and other physicians who had taken the course were seeing tangible rewards," says Malik. "And it was exciting to get that endorsement from a clinician who has really embraced and practiced the principles of TEACH."

Impact

Veterans also are experiencing the rewards of TEACH at the Tampa facility, which accounts for about 1 million visits per year and serves more than 116,000 patients in a four-county area in VISN (Veterans Integrated Service Network) 8. The Haley facility is the busiest of four VHA polytrauma centers, and like all facilities, has to deal with some patient complaints. Lezama believes that the reduction he has seen recently in complaint-related calls and letters is due in part to the impact of TEACH. "Since our hospitalist physicians began taking the TEACH program 2 to 3 years ago, these complaints have decreased by at least 80 percent on the general medicine wards," he reports. "Of course, the reasons for this are multi-factorial, but I do fully feel, having taken the TEACH program myself, that it has played a big part in this marked decrease."

Lezama's observations on the impact of TEACH are particularly noteworthy because the Haley facility has a prestigious "Magnet Hospital" designation for excellence in patient care. With TEACH's focus on the clinician-patient relationship, it's easy to see why the course is benefitting both Veterans and clinical staff.

TEACH Means…

TEACH is based on a patient-centered philosophy that is the foundation for the five critical skills that clinicians need to effectively educate their patients:

•  Tune in to the Patient
• Explore the Patient's Concerns, Preferences and Needs
• Assist the Patient with Behavior Changes
• Communicate Effectively
• Honor the Patient as a Partner

TEACH helps clinicians develop effective relationships with patients by using shared decision making, mutually agreed-upon goals, and evidence-based health education and behavior change interventions. It emphasizes practical, specific patient education techniques that can be implemented in a brief encounter with a patient. TEACH also shows clinicians how to use health coaching to enhance patient self-management, and it emphasizes an interdisci plinary, holistic approach to patient care and education.

Divided into five units, the TEACH training program includes an initial self-assessment to help clinicians focus their attention on developing new skills and reinforcing existing skills. Classroom sessions use simulated patients and case scenarios to allow clinicians to practice the strategies and techniques presented in each unit.

Tailor-Made for VHA

"TEACH aligns with the Veteran-centric, results-driven, and forward-looking focus of VA's Transformational Initiatives for the 21st century," says Barbara Snyder, Health Education Coordinator at the VHA National Center for Health Promotion and Disease Prevention (NCP). "It’s a major reason why the TEACH program was recognized as a tailor-made course for training Patient-Aligned Care Teams (PACTs) in patient-centered communication skills." Because patient education is an essential component of health care delivery across the whole continuum of care, the training stresses applications in a variety of clinical settings. By the end of the TEACH program, participants understand the value and relationship of patient education to improved health outcomes. They also are challenged to use the techniques from the course in their day-to-day encounters with patients.

Training the Trainers

The TEACH program was created by the Office of Veterans Health Education and Information (VHEI) at NCP and it relies on a "train-the-trainer" design. "Facilities select individuals to serve as course facilitators who attend national or regional training, then return to their facilities to present the course to clinical staff," says Snyder. "TEACH was designed for VA—all the patient scenarios and case examples are Veterans, and all the instructional materials are provided at no cost to VA facilities."

In each VHA facility, the VHEC manages the course and acts as lead facilitator. In most facilities, the Health Behavior Coordinator (HBC) and Health Promotion/Disease Prevention (HPDP) Program Manager (and sometimes additional clinical staff members) are also trained to facilitate the course. TEACH is offered on an ongoing basis to clinical staff from all disciplines, which ensures that all PACT teams and staff have the opportunity to get trained. "Post-course, TEACH facilitators are expected to follow-up with participants to help reinforce and enhance the patient-centered communication, health education, and health coaching skills developed in the TEACH training," says Becky Hartt Minor, VHEI Health Educator at NCP and lead for the national TEACH program.

Jump-Start

At Haley, Malik relates that TEACH got a jump-start about 4 years ago, primarily through the efforts of Dr. Angela Denietolis, now the hospital's Associate Chief of Staff for Ambulatory Care. Denietolis saw TEACH's potential value to patients and was an early advocate of the training. She proactively pushed for all of the facility's hospitalists to attend the program. Along with her, Drs. Ana Miranda (now at a different facility), Yvonne Dunn, Lezama, and Motivational Interviewing Network of Trainers (MINT)-certified HBC Elizabeth Jenkins were the other TEACH proponents who helped make the training de rigeur for Haley's staff. As of December 2011, three-quarters of Haley's hospitalists have attended TEACH training and one has been trained as a TEACH facilitator. 

Blueprint

With guidance from the VHEI Office, and key local and VISN network support, Malik has used a blueprint for developing TEACH that is simple: get buy-in for the program at multiple levels. She networked with hospital leadership, generated "word-of-mouth marketing," and solicited positive quotes to promote the program. Distributing posters also proved to be effective in generating participation. "The PACT and MI staff training requirements stimulated the 'uptake' of TEACH," says Malik, "but we also got a diverse group with direct patient-care responsibilities involved and that really helped."

Malik explains that they conduct the program in a leased, off-site space, and in a dedicated room, which "creates an environment that helps participants focus and promotes team-building," she says. The course also uses interactive role-playing to make the training more fun and memorable. The course has become popular, and in Fiscal Year 2011, Malik facilitated ten TEACH classes for a variety of staff, which brings the TEACH attendance rate for PACT members to 55 percent. With the help of a team of TEACH facilitators (Janet Schneider, Diana Weinel, Dave Folds, Jaclyn Lewis-Croswell, Beth DeBella, Jolie Haun, and Nicole Miller), she plans to do nine more of the one-day courses in 2012.

Other Benefits

There have been additional TEACH-driven benefits according to Malik. Team-building is happening organically among clinical staff because of the interdivisional coordination needed to support the TEACH program. "People who normally wouldn’t be working together now are," says Malik, "and that really promotes interdisciplinary development." She believes that the program can help reduce staff burnout because TEACH-trained clinicians now realize that they don’t have to immediately solve all of their patients' problems. Malik also thinks that awareness of health literacy has increased because "TEACH encourages clinicians to really focus on patients' understanding and perspectives."

Role Models

Hartt Minor and Snyder believe that what the Haley team has done with TEACH is amazing. "They’ve executed an impressive system for marketing, supporting, developing, and integrating TEACH, and both Veterans and staff are experiencing the practical and clinical value of the program first-hand," Hartt Minor says. "The team at Haley has really led the way with TEACH, and they're role models for other VA facilities looking to maximize the value of this powerful program."

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