The concept of hybrid is to combine the best of two worlds. A gasoline engine and an electric engine in hybrid cars. In-person and virtual learning in hybrid learning. Or peanut butter and jelly, ice cream with chocolate sauce or pizza with pineapples (okay, I understand the last one is debatable ;-).
In a successful hybrid model, the sum is more valuable than the individual parts.
And that is the premise and value of hybrid care: offering the best of in-person care and virtual care, i.e., telehealth, telemedicine.
The Value of In Person Care
The Covid-19 health crisis definitely demonstrated to many that telehealth is a viable care delivery option. Reportedly over 92% of US clinicians engaged in one or another form of telemedicine (“practicing medicine at a distance’) in 2020.
Yet healthcare is traditionally highly conservative which is understandable, given that it takes a physician almost 15 years in education and training to reach full autonomy. That makes adapting to change difficult.
And a lot of healthcare is about that trusted personal relationship between the patient and their physician which is much easier to create in a direct personal context. That makes accepting virtual care all the harder.
But with the ongoing (and continuing) spread of Covid-19’s more virulent strains and a vaccination deployment that has not yet reached “herd immunity”, conducting in-person care “business as usual”, unmasked, with hand shakes and sitting close to each other seems unfathomable for months to come.
Thus minimizing exposure for staff (even if vaccinated) and limiting the spread of Covid among patients is still a very viable risk mitigation strategy that requires physician practices to blend in-person and virtual care delivery.
In fact there are ways to establish similarly strong and trusting relationships with patients virtually, even if you’ve never ever met in person.
A personal case in point: There’s at least a handful of business contacts that I’ve worked with for months, sometimes even years, that I did not meet in person (or, in some cases have never met) until months into the relationship. And in all cases meeting in person was almost a “non-event” — aside from the “oh you are taller than I thought”.
One of the things it takes for that to happen in a clinical environment, is some focused training on what I and many others in the industry are referring to as “webside manners”.
Webside Manners: How to behave “at a distance”
As research into malpractice lawsuits has shown over and over again, most patients are not unhappy with their treatment or the outcome; rather they are more than often unhappy with the behavior of the physician, with the “personal treatment” rather than the clinical one.
Another personal example: during the birth of our second daughter in Rochester, MN, the mistake of a young physician caused a serious injury to my wife. Yet due to the excellent bedside manners of the clinician who fixed the problem (though not the physician who caused it) we decided not to sue the prestigious institution.
These days most physicians have been repeatedly trained in improving their “bedside manners” — listening to the patient, asking “is there anything else I can answer for you today”, or being prepared for the doorknob moment (when the patient remembers something important they wanted to ask or share).
But very few have been trained in the appropriate “webside” manners, i.e., how to act and interact in the virtual, web environment.
When we train physicians on webside manners, there are a number of things we cover during the 20 minute training. Here are just three of them:
- Focus on true “eye contact” in the first 30 seconds of the visit and throughout the conversation when you are trying to share something important. This requires, as awkward as it feels, looking right into the lens of your webcam.
- Do not gloss over the unique situation — thank them for “inviting you to their house”, acknowledge the pet in the background or the people walking by (unless they are only scarcely clothed; then it’s best to not say anything…).
- Explain what you are doing when you are not looking into the camera. Acknowledge that you are looking at a second monitor to look up some test results or type in some notes.
I have seen first hand a tremendous increases in trust and satisfaction for both, physicians and patients after just a 20-minute training session that boosted the physician’s self-confidence in how to appropriately act and interact in this new, virtual environment.
But there are other things, too, that an organization can do to improve the quality of care delivery in a virtual setting, including appropriate expectation setting and clear communication with patients.
Virtual Care is Awesome — and a Clinical Tool
As a patient and healthcare consumer I have to say that virtual care is awesome. For most routine stuff (or even my daughter’s delayed allergic reaction to a wasp sting 7 days after the bite) a telehealth visit offers unbeatable convenience and great outcomes.
One thing that is often overlooked is that the visit component is but one of many elements of diagnosis and treatment. Most conditions that physicians can diagnose confidently with just an in-person visits can be just as confidently diagnosed with a virtual visit, especially if certain exam tools are available (e.g., otoscopes in a school setting for diagnosing ear infections).
But most diagnoses happen in the context of more data points than just a visit: the measurement of vital signs, a blood test, an X-ray, or an EKG. Yes, these are easier handled in an in-person clinic environment, but the visit itself can still be virtual.
Some readers of my weekly column will recognize last week’s theme: That Telehealth is a Clinical Tool, meaning that it should be used judiciously by the physician. If it cannot provide sufficient insight to make a confident diagnosis (or to confirm treatment), the alternative is an in-person visit.
But to dismiss virtual visits as a care delivery tool means to not recognize the desires and needs of the modern healthcare consumer.
Making Hybrid Care Work
The secret to successfully blending in-person care delivery services and virtual care delivery services lies in the conscious design of a number for critical workflows.