April 2, 2015. Phoenix, AZ. “Tell me what you heard”. It’s a clear way to make sure the message was received. But, in practice, it isn’t as simple as it seems. If you’re a parent like I am, you’ve probably said that phrase a million times and know that what’s recited back is rarely what was said in the first place.
The same is often true in healthcare. Studies have shown that depending on conditions, 40-80% of information discussed in a doctor’s appointment can be forgotten immediately. Of the information that is recalled, about half is remembered incorrectly.
“An even more disturbing finding is that patients often forget their medical diagnoses even when the conditions are serious. In one study patients could not recall 68% of the diagnoses told to them in a medical visit. When there were multiple diagnoses, patients could not recall the most important diagnosis 54% of the time. Some of the diagnoses in this study were serious, even life-threatening conditions such as diabetes, hypertension, and liver disease. In another study, patients and physicians agreed on problems that required followup for only 45% of the problems identified by the physician as requiring followup. When there was disagreement between the physician and patient regarding the need for followup, the likelihood of appropriate management was significantly lower.” Robert H. Margolis, PhD
Teach-Back. A group of diabetes nurse educators at Phoenix Children’s Hospital came up with a creative way to overcome this education hurdle leveraging the concept of “tell me what you heard” or teach-back. They created what they call a Journey Board, specifically with parents of children with diabetes in mind.
The Journey Board maps out each mini-chapter of learning as a step in a process. For example, the first three stepping stones are “I can tell you why my child is in the hospital”, “I can tell you what bothers or worries me most about my child’s condition,” and “I can tell you what medical tests my child is getting and what they are for”. The challenge for the parents is to teach back to the nurses as a milestone at each of those points on the journey.
Today, there are over 20 Journey Boards for different disease states and scenarios and two of those are being made into apps. Within the app, there’s also a tab with resources specific to that topic if more learning is required prior to teach back. And, there’s a notes section for the parents to use.
Born of a simple goal of improving parents’ knowledge about their child’s diabetes, the tool works for a number of reasons:
Bite-sized information. Each topic is clearly broken down into manageable groupings that are easier to retain.
Achievement-driven. The stepping stones identify actionable tasks in a gamified, achievement-driven format.
Reinforcements at-hand. The app provides resources that are available from a phone or tablet for reference-ready information.