Why is there a lack of it in healthcare?
Communication is essential when it comes to your job, relationships and any aspect of your life. Imagine if you didn’t relay important information at work. How would this affect your job? Probably something not pleasant, but not quite as drastic as what can happen when vital information isn’t communicated or missed in healthcare setting…people can be injured or die. Even with these high stakes, it happens more frequently than it should. Why is this the case? How can it be fixed?
You probably know that health relates to a person’s mental/physical condition and communication means to impart information or news. So, when looking at the two combined, it is the imparting of information about a person’s mental/physical condition. The problem with the current way of health communication is that it is ineffective. In order to be effective, it must be understood by all parties involved and works best when the message is clear and concise. This is definitely not the case. Unfortunately, ineffective communication is extremely prevalent in healthcare today and adversely affects the health outcomes of patients. The core reasons are that healthcare providers don’t talk to each other and don’t spend enough time communicating with patients. Regrettably, this lack of communication isn’t limited to healthcare providers who deliver care directly to patients, but applies to other areas that indirectly affect healthcare, such as researchers not talking to each other, policymakers not talking to the people who are affected by the policy changes that are being made and the private sector not talking to the government. All of this leads to errors occurring because information is unrecorded, misdirected, never received, never retrieved or ignored. We know that errors increase when providers are under stress, in high-task situations and not feeling supported. Communication issues contribute greatly to all of these, so the rate of errors is influenced twofold. Sadly, this happening in all settings of healthcare. This concept of poor, little or no communication is one of the chief reasons that the United States healthcare system has significant defects and repeatedly fails in regards to patient safety and care.
Providers are being burdened with growing caseloads, limited resources and complex record keeping systems. All of these have helped to push the face to face interaction between providers to the background at the expense of patient safety. We know the that poor communication is likely to develop when the number of doctors involved in caring for a patient increases. This leads to miscommunication about patient’s condition, poor documentation and failure to fully read the patient’s medical record. Due to the lack of communication, complications can go unnoticed for extended periods of time and, sometimes, it can be too late to treat them. Disappointingly, this happens much more often than it should. The lack of communication between doctors isn’t the only problem, it frequently occurs between doctors and nurses. The old belief of the doctor always being right has long be ingrained in healthcare, which means some nurses won’t question a doctor’s order even if it doesn’t seem appropriate. The movement to dispel this notion is ongoing. Unfortunately, this hierarchy of power still exists in many healthcare settings. Also, many doctors rely on written orders to convey instructions to nurses rather than communicating them directly. This can cause a big communication breakdown as a result of the doctor’s handwriting being illegible, the wrong instructions were written down or the instructions were written on the wrong patient’s chart. This is why direct communication with confirmation of what the order is and for which patient is key. Another issue with written communication is that nurses are often busy and don’t always know when a doctor has been in see a patient and write orders, so the time between when an order is written by the doctor to when the nurse sees can be longer than anticipated, which can negatively impact the timely of orders being completed. One of the most common areas that communication failure can happen between nurses is in their patient handoff. Since they have to remember a significant amount of information about each patient and each nurse has several patients, this means that things can get missed. Several factors that contribute to this are workload pressures, problems with the hospital’s electronic health records (EHR) system, workplace culture and distractions. Another problem is familiarity between coworkers. This can lead to communication failure because people assume the other party will understand them, therefore, they might not express themselves as clearly as they would if they were interacting with a less familiar coworker.
There is a strong correlation between a provider’s communication skills and a patient’s capacity to follow through with recommendations, self-manage chronic conditions and adopt preventive health behaviors. This is why it is essential to have a good provider-patient relationship. One of the key tools to establishing this is the patient interview. Almost all diagnostic decisions come from this interview and when patients are interrupted or feel that they aren’t being listened to, they might not share all of the essential information, which can ultimately cause them harm if the wrong diagnosis is reached. Some communication issues can include inadequate informed consent, unsympathetic response to a patient’s complaint, inadequate education provided, incomplete follow-up instructions, no/wrong information given, and language barriers. These issues with communication lead to patients not following a provider’s advice because they find the instructions too difficult to follow, don’t understand what they are supposed to do or were afraid to tell the provider that they are concerned about the cost of the recommendations, disagree with the recommendations or feel the recommendation is against their personal beliefs. Language and cultural barriers can make communication even more challenging. It is key to remember that understanding a culture is not the same as having proficiency in language and a shared culture does not necessarily mean a shared language. Another factor is how poor literacy skills impact a patient’s ability to receive and comprehend health information. The most common way we provide instructions is through some form of verbal conversation followed by written material. If someone is unable to write notes during the verbal portion or able to read the written instructions, it can result in poor health outcomes for the patient. The root cause of most malpractice suits is the breakdown in communication between providers and patients.
No question that technology has improved how information can be relayed, but it can be a hinderance. Hospitals and the electronic health records (EHR) systems they use don’t communicate patient information with other hospitals or EHRs because they are in competition with each other. Since providers don’t really communicate with one another and they don’t have access to the data from another facility’s EHR, this often leads to the necessity of repeating tests. If a patient’s insurance company won’t approve a repeat test, then the current provider doesn’t have access to the previous results and this can lead to serious health consequences. Part of this could be solved if patients had direct access to their own health records because they could give a copy of their records to their current provider. Unfortunately, patients don’t have this access and the process for them to obtain their records can be lengthy and challenging. Another issue with technology is that it is only as good as the humans entering in the data. This means that the coding entered by providers can be done so inaccurately because humans make mistakes, which can have a huge impact on a patient’s health outcomes. An additional technological component is the media. The media loves to cover whatever is trending, especially when it is related to healthcare topics because that is something that people are always concerned about. What they fail to realize is that the information in healthcare is technical and requires definitions, terms and acronyms to be explained. If this information isn’t explained in ways that the general public can understand, it makes it easy for the public to misinterpret what is trying to be communicated.
The key thing we should be focusing on to improve communication in healthcare is to engage in direct verbal communication between all providers whenever possible. In order to help change the culture of hierarchy, it is essential to provide training that includes role playing and safety drills that allow for staff members to learn the best techniques in communicating with each other and patients. Department managers need to be actively involved in observing the behavior that is being carried out and help to correct any gaps in a positive manner that will encourage all staff members to adopt a better communication approach. It is important for providers to feel respected, valued, understood and listened to while working in an environment that promotes equity, clear understanding of everyone’s role, why each role is vital and fair compensation. When these needs are met, they’ll feel more comfortable discussing and voicing their thoughts on patient care, which will improve patient safety. Another way to promote patient safety is to implement a method that communicates patient information during handoffs in a consistent and clear way, such as I-PASS (Illness severity, Patient summary, Action list, Situation awareness/contingency planning and Synthesis by receiver). When providers are listening to patients, they should use open-ended inquiry, reflective listening and empathy. This allows the response the provider gives to meet the needs, values and preferences of the patient. Also, patients often struggle to remember what they are told because health information is confusing and difficult to understand due to all of the technical terms. This is why it is vital providers use a teach-back method to help improve patient comprehension and retention of information.
In order to increase patient safety, care and satisfaction, communication in healthcare has to perfected. Healthcare can only be as good as the communication practices used by providers. So, providers need to be educated, encouraged and empowered to develop their communication skills with each other and patients. Healthcare communication can get better, we just need to do everything possible to make it a reality!