Hi-5 Communication Checklist

As a physician at Johns Hopkins, I try to improve my communication skills.

As a Healthcare Systems Leadership Fellow in the Armstrong Institute for Patient Safety and Quality, I worked with my mentor, Dr. Peter Pronovost, to develop a communication checklist.

Hi-5 Communication Checklist

About: This communication checklist was developed based on input from patients, their loved ones, and physicians who study and teach communication skills. This checklist is organized into five domains of behaviors. Within each domain, checklist behaviors, example tools/techniques, and explanations of why these approaches are valuable are listed. Some behaviors are not applicable for all types of encounters with a patient.

Domains	Suggested Behaviors	Tools & Techniques
1. Hi	þ Knock (announce) before entering
2. Familiarize	þ Introduce your first and last name; have team members introduce themselves and their roles þ Ask the patient how he/she would like to be addressed þ Have other people in the room identify themselves and how they are related to the patient; ask the patient if these people should stay in room	Use a Providers Pictures Sheet to identify team members and their roles (post it in the patient’s room for easy reference)
3. Interact	þ Sit down (be at patient’s eye-level) þ Ask open-ended questions þ Acknowledge and affirm patient’s efforts, experiences, and emotions	Ask about personal item in room, hobbies, or upcoming plans Use summary statements Allow for silence as appropriate
4. Voice	þ Set an agenda þ Engage the patient (and loved ones) to discuss the situation and plan	Use plain, simple language Write on white board to share information and explain concepts
5. Exit	þ Ask the patient (and loved ones) to summarize the plan þ Create a way for patient to record thoughts, questions, and concerns	Use Ask-Tell-Ask or Teach Back methods to assess understanding Ask “Anything else?” before leaving the room

The above version of the Hi-5 is the result of editing by leaders in a specific department to customize the checklist according to local needs, culture, and practice. Below is the original prototype of the Hi-5 that departments and clinical units adapt and take ownership of to customize the specific behaviors, tools/techniques, and why explanations to meet their unique needs, culture, and practice preferences.

Domains	Suggested Behaviors	Tools & Techniques
1. Hi (Entering)	þ Knock before entering þ Pause for three seconds before entering and take a deep breath	While pausing, say to self, “Just like me, this patient _______.” (e.g. “is scared” or “is a parent”)
2. Familiarize (Identifying)	þ Introduce yourself; have team members introduce themselves; and, share everyone’s roles þ Ask the patient how he/she would like to be addressed þ Have other people in the room identify themselves and how they are related to the patient	Use a Faces Sheet to help identify team members and their roles (and post it in the patient’s room for easy reference)
3. Interact (Connecting)	þ Connect with the patient as a person þ Invite the patient into the conversation by asking open-ended questions	Be at the patient’s eye-level, if possible Ask about a personal item in the room, such as a picture of a family member or of a pet Ask about upcoming plans for when the patient leaves hospital
4. Voice (Discussing)	þ Set an agenda with the patient þ Engage the patient (and loved ones) to discuss the situation and to determine the plan of care þ Acknowledge and affirm the patient’s efforts, experiences, suffering, and emotions	Use plain, simple language Ask, “What’s your understanding of your situation?” Write on white board to share information, explain medical concepts, and list plans / goals State, “You ask good questions.” State, “It sounds like you’ve been through a lot.”
5. Exit (Concluding)	þ Ask the patient (and loved ones) to summarize the plan þ Establish shared expectations for what will happen between now and the next encounter þ Establish a way for the patient to record thoughts and concerns to share at the next encounter	Use Ask-Tell-Ask or Teach Back methods to assess patient’s (and loved ones’) understanding Ask “Anything else?” before leaving the room Invite the patient to record (on white board / notebook / iPad) questions, thoughts, and concerns

Goal: The overall goal is to establish a consistent and shared mental model for all physicians in a department or an organization to use in care for patients. This checklist “domains of behavior” scaffolding also permits local ownership and customization to adapt to various clinical environments.