A commentary published in Mayo Clinic Proceedings identifies six concrete, evidence-based approaches to values-driven listening that address the paradox of shortened appointment times while maintaining compassionate care. The authors outline structured listening practices that, according to cited research, can improve patient outcomes, enhance clinician satisfaction, and strengthen organizational efficiency.
Efficiency Pressures and Patient Distrust
The commentary warns that health care systems face what the authors describe as “a false sense of economy” created by efficiency-focused clinical visits.
The authors note, “Attempts to mitigate financial and productivity pressures lead to ever-shorter appointment times, which deepens distrust in health care systems, clinicians, and public health in general.”
Be Present
Physical presence at care sites builds trust and reveals insights that digital communication cannot capture.
Ask Openly
Open-ended questions unlock patient knowledge and lead to collaborative problem-solving that improves care.
Build Trust
OARS technique (Open questions, Affirmations, Reflections, Summaries) creates psychological safety for patients.
Shape Spaces
Simple environmental changes like sitting and creating "talking rooms" dramatically improve patient perceptions.
Empower Staff
Frontline staff input eliminates wasteful processes and saves thousands of hours while boosting morale.
Foster Resilience
Structured peer support through shared meals and reflection reduces burnout and strengthens health care teams.
Six Strategic Approaches
The commentary highlights six evidence-based listening strategies drawn from published studies.
Proximate Listening This approach emphasizes physical presence and availability. The authors cite research showing that “what can be communicated through an electronic health record (EHR) portal pales in comparison to what a clinician can learn in the privacy of an exam room.” A case example from the UK Royal Free Hospital demonstrated measurable improvements in staff engagement using this approach, with “hundreds of changes … made within the program’s first 2 years.”
Curious Listening employs specific questioning techniques. Research cited in the commentary shows that when patients with HIV were asked, “What do you believe are the most important things to change in your care to improve your burden of treatment?” approximately half of suggested changes “could be easily implemented at low cost.”
Trust-Enabling Listening incorporates therapeutic listening techniques. At New York’s Montefiore Medical Center, training programs help clinicians develop “four skills in their interactions with patients and families: open-ended questions, affirmations, reflections, and summaries (OARS).” These skills have proven “especially helpful to clinicians in conversing with patients under intense stress toward reaching a treatment plan.”
Technology Integration and Workflow Solutions
The commentary also addresses practical implementation challenges, including technology integration. At Henry Ford Health in Detroit, “a pilot group of physicians have been given access to a HIPAA-compliant artificial intelligence scribe which documents the encounter in the EHR in real time. This allows more complete attention to be directed toward the conversation, without task interruption.”
Design-Aided Listening
The authors emphasize the role of physical environments in facilitating communication. At Alaska’s Southcentral Foundation, the care system was co-designed with patients to create “talking rooms,” defined as “de-medicalized rooms where conversations can occur in a less clinical, more personal setting.”
The commentary also cites research showing that “patients perceive clinicians who sit as more caring, polite, and informed; as better listeners; and as having spent more time with them.”
Empowering Listening demonstrates measurable organizational benefits by elevating frontline voices. Hawaii Pacific Health’s Getting Rid of Stupid Stuff program (GROSS) generated nearly 200 staff suggestions in its launch year (2017) and another 300 the following year. One implemented suggestion eliminated hourly nursing documentation requirements, “saving 1,700 nursing hours monthly at the system’s four hospitals.”
Clinical Outcomes and Workforce Impact
Resilience-Fostering Listening
Resilience-focused strategies address clinician burnout through structured peer support. The commentary cites two randomized controlled trials showing the effectiveness of commensality—shared mealtimes and conversation—in “enhancing positive feelings about the work and the organization while reducing burnout.”
The commentary finds measurable patient perception changes Research demonstrates that "patients perceive clinicians who sit as more caring, polite, and informed; as better listeners; and as having spent more time with them."
Dual Trust Framework
The authors describe a dual trust model as essential to effective clinician-patient relationships. “In the case of patients, they are likely to trust a clinician’s competence, to assume it, unless their experiences with the clinician prove otherwise. Conversely, perceived kindness-influenced trust must be earned by clinicians in their interactions with patients.”
The commentary references research with cancer patients that revealed six dimensions of kindness, “including ‘deep listening’ as well as other dimensions aided by deep listening, such as empathy and gentle honesty.”
Implementation Framework
The commentary provides specific implementation strategies for each approach, including "no meeting zones" to enable leadership presence at care sites, training programs for therapeutic listening skills, and formalized processes for staff-generated improvement suggestions.
The authors conclude that "values-based listening reflects kindness, and no service requires kindness more than health care service. Aligning values with practical actions ultimately leads to a more effective and efficient health system whose patients, and the staff that serve them, benefit."
The research addresses a critical gap in health care delivery by providing evidence-based methods to maintain compassionate care within efficiency-driven systems, offering health care leaders practical tools to enhance both patient satisfaction and clinician well-being simultaneously.
