Although there are more than thirty-seven million people in the United States living with some form of disability, many health care professionals lack significant awareness of and training in caring for patients with disabilities. Furthermore, many patients with disabilities describe experiencing a lack of proper care and respect in health care settings. Lehigh Valley Health Network hopes to expand education throughout the network on this very important topic, through the creation of a twenty-minute educational video, which is currently being produced.
Invisible is what patients with disabilities have described feeling when dealing with health care providers at the Lehigh Valley Health Network and beyond. Patients have described negative experiences such as practice staff members assuming they were unable to advocate for their own care, addressing aides or family members while looking right past them. Individuals with disabilities clearly deserve the same amount of dignity and respect due to every individual, yet many clinicians are unaware of how to treat them, or simply too nervous around them to employ the proper etiquette.
In recent years, there has been a significant amount of study conerning the health care of people with disabilities. In a 2008 report by the ARC of Massachusetts, focus group data revealed that health care professionals lack sufficient training and exposure in caring for patients with disabilities. Morrison et al. noted from the consumer side that clinicians needed more training and awareness about how to work with patients with disabilities. These are very significant findings in light of the Centers for Disease Control and Prevention (CDC) estimates that more than 37 million people living in the United States have some form of a disability.
In 2006, LVHN Department of Family Medicine in collaboration with the Pennsylvania Academy of Family Physician Foundation (PAFP/F) and in partnership with patients with disabilities, their families and community agencies, commenced the Medical Home Project. The vision of this multidisciplinary project team is to integrate patient centered care into all medical practices in the Lehigh Valley Region. All persons involved in health care for individuals with disabilities will be educated on ways to provide care that is accessible, continuous, comprehensive, patient centered, coordinated, compassionate, and culturally competent.
One strategy the Medical Home Project team has employed to meet its vision is a three-hour educational session called Patients with Disabilities as Teachers (P-DAT). This session places a patient from an LVHN primary care practice in the role of educator to give medical students a first-hand lesson on how to interact with patients with disabilities. Students view a video called “The Ten Commandments of Communicating with People with Disabilities,” a film created in nineteen ninety-four, that provides examples of interactions in a business setting.
While looking for more current productions, the team determined that most existing films teaching disability etiquette do not cover specific instances that are seen in healthcare. The previous work has shown that additional training in disability etiquette can increase knowledge and sensitivity in communicating with patients with disabilities [4, 5]. There has been other work to increase awareness among medical students about patients with disabilities [6-8], but curricula are not consistent across medical schools and residency programs. The work of Tervo et al. showed that work experience influenced attitudes of healthcare professionals who worked with patients with disabilities .
Working with advisors from the Medical Home Project and the Media Producer of the LVHN Division of Education (DOE), Mark Flamisch and the Medical Home Project team have created a screenplay for a new video to be used throughout the Network. The video is currently being produced onsite, utilizing the DOE’s Simulation Labs. Editing and Post-production will also be done by Mark Flamisch in the DOE. When completed, the video will be used in place of the film currently in use for the P-DAT training, which is outdated and does not focus on a medical setting. Employees across the LVH network will view the video as a part of their training.
Video production crew:
Senior eLearning Designer
Instructional Media Producer
Director of Photography
Camera & Sound
Camera & Sound
Purpose and Objectives
The purpose of this project is to enhance the educational experiences that LVHN is already providing and to expand learning opportunities to all colleagues. The expected outcomes are:
Create a 20-minute video featuring health-related interactions and utilizing the disability etiquette standards set forth by United Cerebral Palsy. By showcasing examples of real-life healthcare scenarios involving these etiquettes, healthcare employees will demonstrate proper protocols when caring for people with disabilities.
Integrate the new production into ten in-person P-DAT (Patients with Disabilities as Teachers) training lessons for medical students, residents, and practice teams through the Network.
Produce a version of P-DAT training that can be utilized by employees through LVHN’s “The Learning Curve” (TLC).
Hypothesis and Measurement
The team involved in the making of this video hypothesize that through educating employees across the network, they will gain the awareness and practical knowledge needed to interact respectfully with patients with disabilities, improving the relationships between these patients and the network, as well as their overall experience with health care anywhere in the network. Because the video will show the proper interactions in several different situations, it will include clinicians in outpatient or inpatient settings, and other health care employees who interact with patients, such as receptionists.
The team will be working with the DOE on how to proceed with creating the education module featuring scenes from the video within TLC. As a part of the course, there will be a short questionnaire on disability etiquette within TLC.
An evaluation form is to be completed by each participant at the end of every P-DAT educational session. This form will ask participants to rate the different activities on a Likert scale of one through five (i.e., one equalling really disliked; and five equaling really liked) and will include open-ended questions for feedback on the program. Based on the surveys collected over the past two years, the outdated and business-setting focused video has on average scored lower than the other aspects of the program. It is the hope that after implementation of the new video within the P-DAT training, those scores will increase, as the awareness and knowledge on this important topic increases.
This video project is currently in the production stage. The video will be some twenty minutes long when completed and edited, and will cover a variety of types of disabilities. The individuals with disabilities involved will be: an individual with a vision impairment, an individual with a hearing impairment, an individual with a prosthetic, an individual with autism, an individual of short stature, and an individual with a wheelchair.
After editing, the video structure will include short vignettes of the interactions between the individuals with disabilities and the health care staff and clinicians, each demonstrating a different reason for seeking medical care, such as a new patient visit or a pre-operation discussion. Through watching these interactions, viewers will gain not only important knowledge on the subject, but also practical ways to implement the proper protocols. The scenes will be supported by text on-screen as well as vocal narration, which together will serve to clearly outline and review the proper etiquette and protocols demonstrated in the scenes.
Every person involved in the production and post-production of this video is working to create an end product that will enhance the awareness and education of health care employees in the Lehigh Valley Health Network on this important topic.
Measurement of the impact of this video will be determined using the evaluation forms to be completed by each participant. Hopefully, this video will enhance the knowledge of health care professionals on proper and respectful etiquette in caring for patients with disabilities. In the future, the video will have the potential of inspiring other networks and institutions to further their education of disability etiquette. In upholding the dignity of each person, the experiences of both patients with disabilities and clinicians will improve.
(1) Nichols, A.D., et al. (2008) Left Out in the Cold: Health Care Experiences of Adults with Intellectual and Developmental Disabilities in Massachusetts.
(2) Morrison, E.H., V. George, and L. Mosqueda, Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups. Fam Med, 2008. 40(9): p. 645-51.
(3) Centers for Disease Control and Prevention. Disabilities and Health, Data and Statistics. December 16, 2011 [cited 2013 September 12]; Available from: http://www.cdc.gov/ncbddd/disabilityandhealth/data.html.
(4) Jain, S., et al., Patients with disabilities as teachers. Fam Med, 2013. 45(1): p. 37-9.
(5) Royce-Hickey, R., et al., Patients With Disabilities as Teachers (P-DAT) Training in Medical Education, in Society of Teachers of Family Medicine 2013 Annual Spring Conference. 2013: Baltimre, MD.
(6) Graham, C.L., et al., Teaching medical students about disability in family medicine. Fam Med, 2009. 41(8): p. 542-4.
(7) Moroz, A., et al., Immediate and follow-up effects of a brief disability curriculum on disability knowledge and attitudes of PM&R residents: a comparison group trial.
A curriculum to teach medical students to care for people with disabilities: development and initial implementation. Med Teach, 2010. 32(8): p. e360-4.
(8) Woodard, L.J., et al., An innovative clerkship module focused on patients with disabilities. Acad Med, 2012. 87(4): p. 537-42.
(9)Tervo, R.C.P.G.P., Health professional student attitudes towards people with disability. Clinical Rehabilitation, 2004. 18(8): p. 908-915.
(10) Program Development Associates, The Ten Commandments of Communicating with People with Disabilities. 1994, Irene M. Ward &Associates: Columbus, OH.
(11) United Cerebral Palsy. Disability Etiquette. [electronic] 2013 [cited 2013 September 12]; Available from: http://www.ucp.org/resources/disability-etiquette.
Published In/Presented At
Fasanello, E., (2014, July, 25) Ensuring and Enhancing Respect for Patients with Disabilities: The Making of an Educational Video. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters