The new year is the time for taking stock and evaluating the systems that we have in place. One such system that may need a refresh is that of the practice member experience. The trust between patient and health practitioner, often referred to as the therapeutic alliance, can have a significant impact on how a patient perceives the quality of their care and the clinical outcomes. Establishing trust with practice members through the experiences they have when attending your practice may be such a given in today’s approach to healthcare, but when did you last evaluate your patient experience?
We know that the therapeutic alliance is important. Recent chiropractic papers have talked about the role of trust in the therapeutic alliance, as well as trauma informed care playing a role in creating safe spaces for patients. This is before we get to the simple power of a person feeling safe and connected on the vagal tone of a person under care.
When we discussed this topic in the past we wrote:
“While chiropractic care has an excellent and even exemplary safety record, it is trust that allows a person to relax on the adjusting table and let the chiropractor do what they do best. It is also trust that allows individuals under care to trust their chiropractor with the non-musculoskeletal details of the stresses and strains that impact on and emerge out of their nervous systems.” -The Therapeutic Alliance: How Important is Trust?
This remains true.
Two articles recently published in Chiropractic & Manual Therapies tackled this topic, investigating how different factors affect perceived treatment effects, and how patient-centred care can be enhanced. We’ve broken them down for you, so refreshing the practice member experience in your practice can be as simple as possible.
Study details
The first study, based in Canada, sought to identify the key moments in the new patient experience that could be improved by providing chiropractors with focussed resources, what might get in the way of enacting these best practices and recommendations for seeing these practices implemented. [1] The study utilised best practices for the patient experience seed statements and took a human-centred design approach in the methodology, prioritising the desires and challenges of end-users (which in this case are our practice members)
The chiropractors who participated in the study were asked to rank key moments in patient care that they perceived to require the most support to enhance the overall patient experience. Participants were also interviewed, exploring their perceived barriers and enablers to implement the best practices statements they were provided.
Participating chiropractors identified “treatment” first, followed by “report of findings”, with “informed consent”, “physical examination”, and “before the appointment” ranking equal third, as the most critical moments in the patient experience journey that could benefit from targeted support.
Barriers to implementing the best practices included access to credible resources and enhanced training and support to develop or maintain diagnostic and management skills for complex musculoskeletal conditions across a diverse range of practice members. The participants identified that time constraints, economic pressures, and the availability of resources in rural areas were all challenges.
Interestingly, underutilisation of the biopsychosocial model (which looks at the way biology, psychology, place and economics impacts decisions) was highlighted as a particular barrier for people who had developed habits and practices under different health paradigms. Mentorship, practice tools and resources, multimodal collaboration, and access to culturally appropriate care resources were all identified as enablers for chiropractic uptake.
Many of these barriers, including limited consultation time, are well known and frequently experienced when developing a therapeutic alliance between chiropractor and practice member. This study highlights the importance of recognising what these barriers are and approaching the relationship in a conscious and intentional way. This includes developing educational tools and interventions that are designed with the users, chiropractors, in mind.
The second study, also a qualitative study, interviewed participants in sets of three, with one patient receiving spinal manipulative therapy, one intern performing the treatment, and one clinician overseeing the treatment. [2] Developing a strong therapeutic alliance between patient and intern was a prominent finding of this study, along with the use of adjunctive therapies in concert with spinal manipulative therapy. It showed the importance of immediate subjective and/or objective improvements as an indication of a successful treatment. Utilising other adjunctive therapies, such as at-home care recommendations, was found to contribute to an improved perception of care as patients are involved as active participants in their care plans. Interns also mentioned functional changes and visual or palpable changes as important from their perspective.
While these studies aren’t necessarily groundbreaking or completely reimagining how chiropractic care could be carried out, there is merit in reinforcing the importance of a strong therapeutic alliance between practice members and chiropractors. If we can create trust and safety in the relationship between chiropractor and patient, it’s good for all of us. At the end of the day, it all comes back to that.
References
- To, D., Southerst, D., Atkinson-Graham, M., Yu, H., Connell, G., Draper, C., & Cancelliere, C. (2024). Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment. Chiropractic & Manual Therapies, 32(1).
- Boylan, P. (2024). Factors that contribute to the perceived treatment effect of spinal manipulative therapy in a chiropractic teaching clinic: a qualitative study. Chiropractic & Manual Therapies, 32(1).
