Listening Beyond Auscultating: A Quality Initiative to Improve Communication Scores in the Hospital Consumer Assessment of Health Care Practitioners and Systems Survey

IntroductionPhysician communication is critical to patient care. However, integration of sound communication practice with clinical workflows has proven difficult. In this quality improvement initiative, medical students used the rapid improvement model to test interventions that could enhance patients' perception of listening by physicians as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey.MethodsLiterature review and process analysis yielded 42 potential interventions, of which 24 were feasible for implementation. Small-scale testing established the 4 most promising interventions; pilot testing was subsequently undertaken on the entire Medicine service. Patient and physician feedback guided further refinement. The final intervention used a structured reminder embedded in the electronic health record to direct physicians to begin interviews by eliciting patient concerns.ResultsPatient concerns elicited after implementation included pain symptoms (28%), disease or treatment course (16%), and discharge planning (10%). In the Hospital Consumer Assessment of Healthcare Providers and Systems survey, physician listening scores rose from a 2014 average of 73.6% to 77% in 2015.DiscussionAmong 24 tested interventions, an open-ended question was most feasible and had the greatest perceived impact by hospitalists and patients. A structured reminder embedded in required electronic medical record documentation facilitated the behavioral change without being overly burdensome to physicians and established a mechanism to enact change in practice.ConclusionMedical students used established improvement methods to promote patient-centered care and align patient and physician agendas, providing a strategy to improve hospitalized patients' perceptions of physician listening

A regional approach to climate adaptation in the Nile Basin

The Nile Basin is one of the most important shared basins in Africa. Managing and developing the water resources within the basin must not only address different water uses but also the trade-off between developments upstream and water use downstream, often between different countries. Furthermore, decision-makers in the region need to evaluate and implement climate adaptation measures. Previous work has shown that the Nile flows can be highly sensitive to climate change and that there is considerable uncertainty in climate projections in the region with no clear consensus as to the direction of change. Modelling current and future changes in river runoff must address a number of challenges; including the large size of the basin, the relative scarcity of data, and the corresponding dramatic variety of climatic conditions and diversity in hydrological characteristics. In this paper, we present a methodology, to support climate adaptation on a regional scale, for assessing climate change impacts and adaptation potential for floods, droughts and water scarcity within the basin

Hydroeconomic Models as Decision Support Tools for Conjunctive Management of Surface and Groundwater

Abstract Conjunctive use (CU) of surface and groundwater storage and supplies is essential for integrated water management. It is also a key strategy for supporting groundwater-dependent ecosystems, and for adapting water systems to future climate and land use changes. CU has become increasingly sophisticated and integrated with other innovative and traditional water management techniques, such as water transfers, water reuse, demand management, and aquifer remediation. CU adds value for society (increasing ..