Do you remember the scene in Cool Hand Luke, where a “failure to communicate” brings pain and suffering to Paul Newman? It’s similar in a hospital, where miscommunications can have significant clinical repercussions. Beyond that, poor healthcare communication can result in poor non-clinical outcomes leading to low patient or staff satisfaction and higher costs.
In fact, studies indicate that adverse clinical events and outcomes are far more likely to result from communication errors than from inadequate clinical skill. Fortunately, organizations that have poor communications can achieve improvements relatively easily and quickly, generally with little capital investment.
What kinds of communications occur in a hospital?
Every day, tens of thousands of pieces of critical information are communicated among the people associated with a healthcare facility. Consider some of the key types of interactions:
Between patient and care provider. Patients share descriptions of symptoms with medical staff in order to receive appropriate care. Because patients are generally not medical experts, their communications can be incomplete or misunderstood.
For example, a patient may visit a doctor because she wants a prescription for pain medication. Frequent headaches are the only symptom she reports. However, when a skilled health care professional asks the right questions, other seemingly unrelated symptoms such as fatigue, weight loss, and stomach or leg pain may come to light, indicating Addison’s disease, a potentially fatal illness with a quite different treatment plan. Good communication can save a life.
On the other hand, a physician’s instructions to a patient may be ineffective for numerous reasons, such as the use of technical terms or jargon not understood by the patient, language or cultural differences, the timing of communication relative to the patient’s mental readiness, or the patient’s lack of understanding of the seriousness of issues. Without follow-through on the effectiveness of the communications, a life could be lost.
Among members of the care team. A 2012 study from the Institute of Medicine reported “the average surgery patient is seen by 27 different healthcare providers while in the hospital.” In addition to the sheer numbers, multiple functions are represented: doctors, nurses, specialists, therapists (physical and mental), phlebotomists, nutritionists, pharmacists, social workers, and on and on.
Imagine a worst-case situation of all these people working with a patient independently, without communication. The patient could be poked and prodded, quite literally to death. Diagnosis, treatment, and discharge would be very inefficient processes. Conversely, when the team works together with effective communications, the patient gets the best treatment, the hospital’s efficiency is optimized, and the overall health care team morale is high. One method to achieve this success is to use a daily multidisciplinary rounds process to bring staff together to agree on the joint path forward and monitor progress from one day to the next.
Across teams working on different shifts. Just as in any round-the-clock operation, excellence in the healthcare process requires continuity from shift to shift. This in turn relies on shift change communications, a specific area of concern.
How do you improve interdepartmental healthcare communications?
As with other improvement efforts, you will create a focused cross-functional team to do an assessment to find out where the issues lie, apply problem solving to understand root cause of issues, prioritize where to start, and create and execute an improvement plan. Most likely the efforts will include some of these actions:
Provide training in positive communications – Communication is not effective when it is a one-way street as is often depicted in films, where an autocrat barks out rapid-paced orders and a simpering assistant struggles to keep up. Instead positive communications is more like the military practice of “speak back.” The speaker states the information slowly and the receiver recites it back, even writing it down and reading it back to show that he or she understands what was said and has all the correct details. This is especially valuable when communicating between people with different native languages or technical skills, such as a doctor to a patient’s home caregiver. This type of confirmed communications is vital when conveying data, such as dosage level or specific drug. Think of how easy it is to hear “60” when someone actually says “16” or CELEBREX instead of CEREBYX. Of course, written communications must be readable and preferably consistently organized in electronic health records.
Coach interpersonal communication skills – The old concept of good bedside manner is still valuable. A welcoming and personable style is not only useful in drawing out patient information, but also effective in working with medical colleagues to avoid intimidation or other dysfunctional actions. This is especially important when working in a hospital across departments that may operate as quasi-independent silos of highly skilled and often highly opinionated individuals. Pioneering studies by Albert Mehrabian indicate that tone of voice and facial expression can often be more important than specific words used in communications.
Adopt “standard work” in communications – Communications, like other processes, can be improved by standardizing processes. This can come into play in many ways in the healthcare environment.
- Using a communication framework such as SBAR (situation, background, assessment, recommendation) actually helps participants process communications efficiently. Think of your brain going through a logical step-wise process rather than flitting about with random bits of information that have to be organized before being processed.
- Standard work can include a checklist of patient status and treatment plans in a brief huddle at the start of each shift. Other shift change items might include availability of rooms or equipment and updates on ongoing issues.
- The escalation process should be documented so that a consistent proven process is followed when patient changes occur. Action can be taken quickly following a known plan rather than after extended deliberation to invent a one-off path forward.
- Even the communication processes to patients or family members relative to prognosis can be standardized and provided as training. Using best communications practices here make patients and family members more comfortable and confident in the health care provided so they are more likely to comply with medical advice.
Do you really need to do any of this?
Yes. During their many years of education, doctors, nurses, and others in the healthcare field receive extensive training in their technical areas of expertise. That is why they can make people healthy, save people’s lives, and perform miracles on a regular basis. But how much training do they have in communications? Generally, it’s extremely little. However, since health care irregularities that do occur are often related to communications, additional training in these and other communication methods is an essential complement to technical education.
The first step in improving communications is learning where your opportunities lie. Contact EON to get started.