Effective communication among healthcare workers

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Information about Effective communication among healthcare workers

Published on May 31, 2014

Author: ttylim

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Izatty Lim 0308188 17 Jan 2014 Page 1 Effective Communication among Healthcare Workers to Improve Patient Safety and Quality of Care Name : Izatty Lim Student ID : 0308188 Supervisor : Dr. Mohammed Jaweed (Surgery) Dr. Wong Eng Hwa (Microbiology) Course : Special Study Module Course Coordinator : Dr. Uta Christine Dietrich Date : 14 January 2014

Izatty Lim 0308188 17 Jan 2014 Page 2 Table of Contents Page Introduction ................................................................................................................................................... 4 Effective Communication.............................................................................................................................. 6 Ways to improve communication.................................................................................................................. 8 Communication Failure................................................................................................................................. 9 Summary ................................................................................................................................................. 10 References ............................................................................................................................................... 11

Izatty Lim 0308188 17 Jan 2014 Page 3 Table of Figures Page Figure 1. Adverse drug reaction in US 5 Figure 2. Five Standard of Effective Communication 7

Izatty Lim 0308188 17 Jan 2014 Page 4 Introduction In this modern era, the world had seen a lot of improvement and revolution in the medical world, both in the new technology invented and new discovery that has been made. Despite of the great achievement, the crucial basic skills needed in ensuring good quality of patient care do not receive the attention they deserve. Extensive research have shown that despite of the knowledge own by a physician, if he does not able to develop good communication skills, he may be of no help.1 What we know is important, but deciding on what and how to deliver and share the knowledge is just as essential to achieve quality patient care as a health professional. The quality of communication among the workers in healthcare actually has been a long standing issue. There are numerous medical errors that occur due to communication failures. A report from the Joint Commission in America has stated that communication failure is main factor responsible for over 70% of sentinel events.2 Furthermore, based on an analysis of medication-related liability, operational system failures, which is including poor team communication, is found to be the causes for the most of the medication errors and adverse drug effects issues in a New England malpractice insurance company database. Besides, communication was ranked as the third most common risk management issues in all hospital-based claims by The Doctors Company/OHIC Insurance.3 There are various types of communication in healthcare setting in which could be among healthcare workers themselves or between healthcare workers and the patient. Among the healthcare workers themselves is including communication between one physician and his colleagues, one physician with other specialist, physician and the nurses and also between physician and the lab workers. Communication is divided into two major group- verbal communication and non-verbal communication. A verbal communication is reflected as an act of transfer information, ideas and feeling through the use of mouth. It is the main way of face-to- face interaction. Words, sounds, speaking and language are the key component in verbal communication. As for the non-verbal communication, the main components are kinesics (body movement), proxemics (using space to make contact or to provide privacy), haptics (touch), oculesics (eye contact), chronemics (the use of time pausing, waiting, speeding up), olfactics (smell), adornment (dress, cleanliness, jewelry, tattoos, piercings), posture (body position, stance), locomotion (walking, jumping, swaying, and moving with the help of wheelchair), sound symbols (grunting, ahs, pointed throat clearing), silence (long pauses, withholding information, secrecy) and lastly vocalics (tone, timbre, volume).4 Non-verbal messages are made instinctively or unconsciously and deliver their own strong meaning. The ability to empower both types of communication skill will lead to an increase efficiency of work among the healthcare workers thus may also lead to enhanced patient safety and satisfaction.21 Effective communication is a cornerstone of patient safety – The Joint Commission.5 By referring to various study done by many insurance company, it can be concluded that many accidents and medical errors can be avoided by improving communication quality in healthcare.

Izatty Lim 0308188 17 Jan 2014 Page 5 Figure 1 Adverse drug reaction in US. (Adapted from “Healthcare Communication” by Bruce Hugman) 21

Izatty Lim 0308188 17 Jan 2014 Page 6 Effective Communication In the past, public demands and expectation were low, ineffective communication was not seen as a threat. However, in the 21st century, the revolution in communication has further revolutionized people expectations. Over the years, modes of communication used in healthcare are improving as time goes by. There are various modes of communication that have their own advantages and disadvantages. Communicating through the telephone for example, it has enable a real-time interaction to be conducted whenever needed but, it may also decrease efficiency by disrupting patient flow which is also interrupting a particular session in order to facilitate other. Next, we also have e-mail and electronic medical record. Both of these mode of communication is providing us advantages that it is easily accessible and it is convenient for most of the hospitalist but, both modes are lacking the human tough and system down is a common hindrance.18 22 With all the modes we have, the new or the old fashion one, the importance of effective interaction and communication among the healthcare giver remains the same. Efficiency of communication in healthcare is directly related to quality patient care. 19 22 Effective communication is defined to be a reciprocal, interactive process. It is involving two sides, sender and recipient, in which they need to ensure that the message or information has been received and also understood. In a doctor-patient interaction setting, healthcare professional(HCPs) have to make sure that information are tailored based on the patient’s personality, need and abilities to ensure a good understanding and engagement of the patient are achieved .An effective communication is actually the core of quality patient care. The skills and ability to communicate well will lead to an accurate, comprehensive diagnosis and HCPs will be able to detect emotional distress in patient and response appropriately. This will then lead to the satisfaction of the patient with the care they received and they will tend to agree with and follow the advice given.6 Drugs don’t work in patient that doesn’t take them. – C. Everett Koop, MD7 Besides communication between HCPs and patient, effective interaction among HCPs themselves is also important. Among the healthcare providers, there are two types of communication- intradisciplinary and interdisciplinary. Intradisplinary communications involve members of the same health specialty. As for an example, when one cardiologist speaks to another. While interdisciplinary communication is between different health practitioners such as when a dietitian speaks to an occupational therapist.8 When these communications conducted smoothly, an efficient professional work group can be formed, leading to less chance of repeated unnecessary tests and less possibility of omissions in care.

Izatty Lim 0308188 17 Jan 2014 Page 7 Figure 2 Five Standard of Effective Communication.9 Complete The answer of all the question asked are obtained and satisfactory of communicator involved is achieved Concise Include only relevant statement and unnecessary repetition is avoided. Wordy expressions are shortened. Concrete The words used are precise and accurate facts or stats are given. Clear Short, familiar, conversational words are used to form an effective and easily understood message. Accurate The level of language used is appropriate for the occasion- ambiguous jargon and discriminatory expressions are avoided.

Izatty Lim 0308188 17 Jan 2014 Page 8 Ways to improve communication There are 3 major factors influencing effective communication in healthcare- individual ability and characteristic, team behaviors and systemic factors, and the lack of organizational support of a safety culture. 10 11 For individual level, it is related to the human factors that influence the effectiveness of communication, such as communication skills, personalities and attitudes, memory failures, stress level, distractions and interruptions.10 12 An individual can develop various skills to help improving communication quality in healthcare setting. One of the skills that will be useful is assertiveness, which is referring to the quality of being self-assured and confident without acting aggressive. Sometimes, a healthcare worker may notice the need to challenge a particular decision regarding patient care; however, the situation is complicated and become difficult due to the hierarchical power relationship between senior and junior doctors for example. In this kind of situation, being assertive may help to improve patient safety.13 Another helpful skill would be the ability to perform active listening. Active listening refer to the skill to listen, focus on the information shared and resist interruptions. The skill is portrayed by the eye contact, posture and facial expression of the listener.14 Besides, negotiating skill in a communication is useful as will help an individual to develop self-awareness on the different communication style and skills to confer with HCPs from other disciplines, respect other perspective and manage conflict if the situation arises.15 23 In a healthcare team, members will have advanced technical training and usually have different communication styles thus effective communication is important in order for the team to function optimally and ensure patient safety and quality of care. Therefore, it is necessary to provide more formal training and assessment to improve communication quality among teams. Excellent teamwork which achieved through effective communication will then lead to increase efficiency, less and shorter patient delays, improved staff morale and job satisfaction, and low stress level among staff.16 17 23 At the organization level, effective communication can be supported by opening channels for communication, transparency and trust, assertiveness and strong leadership. Healthcare institution can contribute by providing resources and identifies appropriate communication style and approach strategies so that information is effectively exchanged between people in various kind of situation. Moreover, the organization should create a conducive environment where the team members feel safe to share their own point of view about issues related to patient care regardless of their position in the institution. In addition, the organization may try to implant a work culture that values cooperation, teamwork, openness, collaboration, honesty and respect in order to improve the communication quality in the healthcare institution.23

Izatty Lim 0308188 17 Jan 2014 Page 9 Communication Failure . Breakdown in communication in healthcare setting can lead to various problems, from mild to serious. Based on a study done by Fortis Memorial Research Institute, they have done a survey among anesthesiologists regarding communications skills. They have found that poor communication between team members is regarded as risk factors for mishaps and complaints. Gawande et al. have conducted confidential interviews with surgeons on reported surgical adverse events resulting from errors of care.20 There are 43% of adverse events were a direct result of communication failures between two or more clinicians.20 Furthermore, an analysis done by Lingard et al. shows that over 421 procedurally related communication events in a three month time period, communication failures occurred in 129 cases (30%) of communication events.20 Many factors may contribute to communication failure in healthcare. One of the most common factors leading to communication breakdown is the human factor which refers to the weakness and limitation as a normal human being. It is including negative attitudes and behaviors, low morale, memory failures, stress and fatigue of staff. Due to this negative factors, individual will tend to get easily distracted and interrupted by outside influences during conversation thus making it a failure during communication. Changes of shift between worker also leading to communication failure as the worker may having insomnia and due to the lack of sleeping and rest, the worker may becoming passive and can’t communicate well between each other in the healthcare setting. Gender, social and cultural differences are also one of the factors that affect the communication failure. 23 Due to the system of employer and employee, a hierarchy or power distance relationships is often happen in a professional working area especially in healthcare setting. This could lead to communication breakdown as the junior are reluctant to report or question senior staff whenever they have a different point of view which led to communication failure. Besides, a worker tend to be ego and over-looked other workers as he/she may had a higher training experiences background and is hardly accepting opinion from others which resulting a failure in the communication between healthcare workers. Besides, in a medical field, an individual is more likely to undergo a lot of time pressures and workload whereby without a doubt leading to stress and is hardly to communicate which each worker.23 Limitations to do multitask even when the workers a highly skilled is also the main factor that affected the communication breakdowns. Besides, lacking organization policies and protocol also affected the communications breakdown because the worker is free to do anything without any rules such as acting aggressively towards patients when in a bad mood. Lastly, the lack of defined roles and responsibilities among members of multidisciplinary teams is a huge factor whereby the worker isn’t doing their work respectively. This issue is highly contributing to communication failure in healthcare.23

Izatty Lim 0308188 17 Jan 2014 Page 10 Summary Communication skill is not only a basic skill needed in many professional careers, it is also a skill that is crucial in conducting our daily life routines. We use our communication skill often either consciously or subconsciously every day such as when talking to a friend, teaching the students and chatting in the internet through various social media. Interaction between humans nowadays has made easy with the various kind of advanced technology that we have. We are now able to get connected with people all over the world with just one click and these modes of communication will keep on revolving as the world keep spinning. Despite of all the invented technologies that ease us in communication, the importance of having good communication skill in order to have an effective communication is often overlooked. Effective communication has a very important role in achieving success in a career, especially as a healthcare professional. In a healthcare setting, there are various types of communication happening between all the people in the setting including the doctors, nurses and also the patients. The purposes of these communications are to solve problem, alleviate distress, share information, make decision, persuade, convey feelings, form and maintain relationship, and also for reassurance.6 Effective communication in healthcare will ensure these purposes are successfully achieved. There are many ways to improve communication in healthcare which is divided into three levels- individuals, teams and organizations. There are direct relation between communication efficiency and patient quality care where improved communication will also result in a better patient quality care and also reduce medical errors. Nevertheless, there are also various factors and common mistakes done by healthcare professionals contributing to communication failure in healthcare. As a conclusion, the importance of effective communication should be noted by all healthcare providers. Besides, communication skills among the healthcare worker can be improved from the early stage by proving sufficient education and training at the university level to the students who will soon work in a healthcare setting. Therefore, healthcare communication can be improved thus will also lead to improved patient safety and quality of care.7

Izatty Lim 0308188 17 Jan 2014 Page 11 References 1. Asnani MR. Patient-physician communication [Internet]. PubMed; 2009 [Cited 2014 Jan 10]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20099777 2. The Joint Commission. Annual Report - Improving America's Hospitals [Internet]. The Joint Commission; 2007 [Cited 2014 Jan 10]. Available from: http://www.jointcommission.org/assets/1/6/2007_Annual_Report.pdf 3. ECRI Institute. Healthcare Risk Control [Internet]. ECRI Institute; 2009 [Cited 2014 Jan 10]. Available from: https://www.ecri.org/Forms/Documents/Communication.pdf 4. Jones PD, Adams CH. Therapeutic communication for Health Professionals. 3rd ed.:p5 , New York: McGraw-Hill; 2011. 5. Joint Commission. ‘What Did the Doctor Say?’ Improving health literacy to protect patient safety. Oakbrook Terrace: Joint Commission, 2007. Quoted on p.4. Available from: http://www.jointcommission.org/NR/rdonlyres/D5248B2E-E7E6-4121-8874- 99C7B4888301/0/improving_health_literacy.pdf 6. Lloyd M, Bor R. Communication skill for medicine. 3rd ed., London: Elsevier; 2009. 7. Servellen GV. Communication Skills for the Health Care Professional. 2nd ed., London: Jones and Bartlett Publishers; 2011. 8. Jones PD, Adams CH. Therapeutic communication for Health Professionals. 3rd ed.:p208 , New York: McGraw-Hill; 2011. 9. Murphy HA, Hildebrandt HW, Thomas JP. Effective Business Communications. 7th ed., New York: McGraw-Hill/Irwin; 1997. 10. Leonard M, Graham S, Bonacum D. (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care.Qual Saf Health Care.2004 Oct; v. 13 (Suppl 1): p. i85-90. DOI:10.1136/qshc.2004.010033 11. Fitzgerald L. Human Factors Engineering in Healthcare [Internet]. Australian Federation of Medical Women; 2008 [Updated 7 November 2008., Cited 2014 Jan 12]. Available from: http://afmw.org.au/news/119-human-factors-engineering-in-healthcare 12. Zeltser MV, Nash DB. (2009). Approaching the Evidence Basis for Aviation-Derived Teamwork Training in Medicine [Internet]. Am J Med Qual; 2009 [Cited 2014 Jan 12]. Available from: http://ajm.sagepub.com/content/early/2009/10/02/1062860609345664 13. Curtis K, Tzannes A, Rudge T. How to talk to doctors - a guide for effective communication. International Nursing Review [Internet]. Blackwell Publishing; 2011 Mar [cited 2014 Jan 12]; 58(1): p13-20. DOI: 10.1111/j.1466-7657.2010.00847.x 14. Davis J, Foley A, Crigger N, Brannigan M. Healthcare and Listening: A Relationship for Caring. International Journal Of Listening [Internet]. 2008, Jan 1, [cited 2014 Jan 12]; 22(2): p168-175. DOI:10.1080/10904010802174891

Izatty Lim 0308188 17 Jan 2014 Page 12 15. Ferguson S. TeamSTEPPS: Integrating Teamwork Principles Into Adult Health/Medical- Surgical Practice. MEDSURG Nursing [Internet]. (2008, Apr), [cited 2014 Jan 12]; 17(2): p122-125. Available from: http://ehis.ebscohost.com.ezproxy.taylors.edu.my/eds/detail?vid=2&sid=a06201f1-791d- 435fba4c77ed5cad0c42%40sessionmgr114&hid=110&bdata=JnNpdGU9ZWRzLWxpd mUmc2NvcGU9c2l0ZQ%3d%3d#db=a9h&AN=31804596 16. Kilpatrick K. Understanding acute care nurse practitioner communication and decision- making in healthcare teams. Journal Of Clinical Nursing [Internet]. (2013, Jan), [cited 2014 Jan 12]; 22(1/2): p168-179. DOI: 10.1111/j.1365-2702.2012.04119.x 17. The Australian Commission on Safety and Quality in Health Care (ACSQHC). Measurement for Improvement Toolkit, Part B: Background Information and Resources [Internet]. The Australian Commission on Safety and Quality in Health Care, Commonwealth of Australia, 2006 [Cited 2014 Jan 12. Available from: http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/measurement-for- Improvement-toolkit-a.pdf 18. Hospitalist Leadership Connection. Pros and cons of communication methods with healthcare practitioners [Internet]. HCPro, Inc; 2010 [Cited 2014 Jan 11]. Available from: http://www.hcpro.com/MSL-252518-3336/Pros-and-cons-of-communication-methods- with-healthcare-practitioners.html 19. Jonathan RB. Revolution in the Evolution of Healthcare Communication [Internet]. Advance Healthcare Network; 2003 [Cited 2014 Jan 11]. Available from: http://nurse-practitioners-and-physician-assistants.advanceweb.com/Article/Revolution- in-the-Evolution-of-Health-Care-Communication-4.aspx 20. Kumar M, Har Dash H, Chawla R. Communication skills of anesthesiologists: An Indian perspective. Journal Of Anaesthesiology Clinical Pharmacology [Internet]. (2013, July), [cited 2014 Jan 13]; 29(3): p372-376. DOI: 10.4103/0970-9185.117116 21. Hugman B. Healthcare Communication. London: Pharmaceutical Press; 2009. 22. Taylor H, Leftman R. E-health's influence continues to grow as usage of the Internet by physicians and patients increases [Internet]. Health Care News; 2003 [Cited 2014 Jan 11]. Available from: http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthcareNews2003 Vol3_Iss06.pdf 23. Victorian Quality Council. Promoting effective communication among healthcare professionals to improve patient safety and quality of care [Internet]. Melbourne: Hospital and Health Service Performance Division, Victorian Government Department of Health; 2010 [Cited 2014 Jan 12]. Available from: http://www.health.vic.gov.au/qualitycouncil/downloads/communication_paper_120710.p df

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