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Ask Me 3 Tool

 


Let’s Be Clear: Improving Patient Communication Using the Ask Me 3® Tool

Ask Me 3® is a tool developed by health literacy experts at the Institute for Healthcare Improvement (IHI) that encourages patients to ask three simple questions each time they talk to a care team member:

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?

This video reinforces that effective communication is a two-way street. By adopting the Ask Me 3® method, cancer team members will be better able to anticipate and respond to patients’ concerns by using a clear, empathetic, and effective approach to communication throughout the care continuum.

When watching the video, notice the effective communication between the patient and the members of her care team as she receives her cancer diagnosis and begins treatment.

Ask Me 3® is a registered trademark licensed to the Institute for Healthcare Improvement. Used with permission. This video may be used as is for educational purposes.

Click on the boxes below for more information about the Ask Me 3 tool.
Six Strategies to Improve Patient Communication

Along with the Ask Me 3 approach, try these six simple strategies to improve communication with your patients and increase their comfort in asking these three essential questions: What is my main problem? What do I need to do? Why is it important for me to do this?
  1. Adopt an attitude of helpfulness. Show no judgement or impatience when explaining things to patients. Raise awareness about Ask Me 3 and low health literacy among all staff—not just clinicians.
  2. Check for interpretation or medical proxy needs. Know your patient’s primary language and who helps them with communication issues, and engage the appropriate resources when necessary.
  3. Teach patients and caregivers about Ask Me 3. Encourage them to use this approach each time they talk to anyone on their oncology team.
  4. Watch for signs indicating low health literacy. Some red flags include the submission of incomplete forms or medical histories, the inability to name medications or their purposes, excuses such as, “I forgot my glasses,” and non-verbal cues, such as nodding when clearly confused.
  5. Keep it simple. Use plain language without medical jargon. Cover two or three key concepts and then check for understanding. Read out loud. Speak slowly. Use pictures or analogies. Circle or highlight key points.
  6. Assess understanding. Use “teach back” or “repeat back” methods to assess patient understanding. Rather than asking patients if they understand something, ask them to repeat what you have said to them.
Myths vs. Facts about Patient Engagement

Encouraging care team members to speak plainly to patients and instructing patients to ask questions is sometimes met with resistance. Keep in mind that encouraging patients to learn more about their diagnoses and treatment options—and urging providers to address patients in basic terms—can benefit everyone. Consider these potential assumptions about the Ask Me 3 approach.
  • Myth #1: Only patients with limited education or healthcare knowledge need to know about Ask Me 3.

    Fact: All patients can benefit from universal health literacy precautions. Contrary to common belief, you cannot determine a patient’s health literacy level by their education, appearance, or background. In fact, nearly nine out of 10 U.S. adults have difficulty using everyday health information to meet the demands of navigating our complex health system (National Action Plan to Improve Health Literacy, 2010). 

    Just as providers take “universal precautions” to prevent the spread of disease among patients who may be at risk for pathogens, so should they take universal measures to ensure all patients are able to absorb crucial health information. Make it a rule to use clear communication strategies with all patients, regardless of their education level, age, ethnicity, income, or apparent health literacy skills.
  • Myth #2: Tools such as Ask Me 3 are for patient interactions with their physicians and advanced practice providers (e.g., nurse practitioners and physician assistants).

    Fact: Ask Me 3 can benefit patients and caregivers in interactions with all care team members throughout the healthcare system. All members of the oncology team should support patients and caregivers by encouraging them to ask these three questions of anyone, anywhere, anytime.  
  • Myth #3: Verbal responses to the Ask Me 3 questions are sufficient to gauge a patient’s level of understanding.

    Fact: Being attentive to non-verbal expressions—such as body language, tone, posture, and eye contact—is essential for maintaining clear, effective communication. Recognizing a patient’s non-verbal cues can help you connect with them in a positive way that reinforces your respect and concern. The Ask Me 3 questions establish a “shame-free” environment that encourages patients to ask questions and share their concerns. Being able to interpret your patient’s non-verbal cues can help you recognize any lack of understanding so you can intervene appropriately.

    Often, patients’ and caregivers’ first impressions of a healthcare team member is based in part based on their communication style. Trust is an important part of the team member/patient relationship. Remember that your own non-verbal cues can significantly impact patient or caregiver confidence in their relationship with you.  
Tips for Incorporating Ask Me 3 into Practice

Ask Me 3 is an effective, simple, easy-to-use tool, but it may not be enough on its own to increase patient engagement. Patients and staff need to be educated about the importance of maintaining open communication, asking questions, and refraining from assumptions or judgement. These five tips can help you successfully incorporate Ask Me 3 into your everyday practice.
  1. Obtain Leadership Support. Ask for your leadership’s support and active participation when incorporating Ask Me 3 into clinical workflow and planning for staff training and communication.
  2. Identify Champions. Motivated and enthusiastic champions can serve as resources and role models to help implement behavior change.
  3. Train Staff. Develop an educational plan for introducing staff to Ask Me 3, its use, and its benefits. Incorporate this video and plan for how you will educate staff and encourage patients. Include both your initial education strategy and ongoing continuing education.
  4. Educate Patients. Create a plan to educate patients about Ask Me 3. Consider making brochures available at check-in, playing a video loop in the waiting room, hanging posters, or explaining the concept to patients face-to-face. Check out the Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit.
  5. Measure Impact. Plan how you will track your progress and measure the impact of using Ask Me 3 at your practice. Consider evaluating patient use and outcomes with subjective measures, such as patient satisfaction surveys and care involvement, as well as objective measures, such as financial impact, fewer patient calls, fewer readmissions, and fewer emergency department visits.

 

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