Social learning theory (Rotter, 1954) and attribution theory (Heider, 1958) have distinctive origins and idiosyncratic "ranges of convenience." On the one hand, social learning theory makes use of concepts from reinforcement theory to furnish an explanation of clinical phenomena. In contrast, attribution theory utilizes concepts that evolved from "everyday life" to provide an analysis of social perception. It is therefore surprising that these conceptions are commensurable with respect to a given phenomenon: expectancy shifts following attainment or nonattainment of a goal. Furthermore, the two theories make disparate predictions about expectancy change. Hence, it is possible to perform a series of "crucial" experiments and compare the validities of the theories with respect to this phenomenon. Social Learning TheorySocial learning theory is quite explicit concerning the determinants of expectancy shifts and, in turn, behavioral potential (or strength of motivation). Rotter (1966) states: "If a person perceives a reinforcement as contingent upon his OVVTI behavior, then the occurrence of either a positive or a negative reinforcement will strengthen or weaken potential for that behavior to recur in the same or similar situation. If he sees the reinforcement as being outside his OV^TI control or not contingent, that is, depending upon chance, fate, powerful others, or unpredictable,

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Background:With increased emphasis on improving the patient experience, clinicians are being asked to improve their patient-centered communication behaviors to improve patient satisfaction (PS) scores.Local Problem:The relationship between clinician communication behaviors and PS is poorly studied in the emergency department (ED) setting. The purpose of this study was to identify whether specific communication behaviors correlate with higher PS scores in the ED setting.Methods:During a quality improvement project, we performed 191 bedside observations of ED clinicians during their initial interaction with patients and recorded the frequency of 8 positive communication behaviors as defined by the PatientSET tool.Interventions:The frequency of use of the PatientSET communication behaviors was compared between known high performers in Press Ganey PS scores versus low performers.Results:Being a high Press Ganey performer was associated with a significantly higher frequency of performance in 6 of the 8 PatientSET communication behaviors.Conclusions:Positive communication behaviors such as those in the PatientSET tool occurred more frequently in ED clinicians with higher PS scores.

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