Delivery of healthcare is a complex process that involves a lot of human interaction between patients/families and healthcare workers and among healthcare workers as well. It has been proven that the majority of the errors that happen in healthcare are related to communication. Studies show that poor communication is the major cause of patient dissatisfaction, litigation, and financial loss. It is also proven that patient outcomes are better with good communication. Since good communication is not addressed in any healthcare curriculum, organizations have to try hard to improve the communication skills of their staff as communication plays a major role in the quality.
What is effective communication?
By definition, communication is a transactional process to create meaning. There are 3 components of communication. Those are sender-receiver and message. In atypical doctor-patient interview, the doctor assumes the role of the sender as well as recover. The meaning which needs to be communicated is not in the message as the doctor may have a different meaning and the patient may have a different one. So the purpose of effective communication so to share a common meaning
An organization has to train to communicate effectively. Some areas like consenting, patient-doctor interviews and nursing assessment need to be stressed upon making the communication effective.
Indicative list for effective communication
The following is an indicative list which needs to make communication effective
• Greeting, establishing the rapport
• Listening properly
• Having a favorable body language which includes the way we dress up, sitting [posture eye contact etc.
• Showing empathy (Putting ourselves inpatient/family position)
• Not using unnecessary medical jargon
• Not being judgmental
• Clearing the doubts and confirming whether they have any query
• Greeting, thanking
Though apparently it appears that good communication demands more time, the literature has proven that on an average it takes s only a minute more to communicate well once the skill is mastered.
Communication is one of the cornerstones of patient safety. Some areas where communication leads to patient safety incidents are handing over, communication emergency situations, and lack of assertiveness among nurses. There are various methods for doing the handing over. One of the easier examples is using ISBAR tool.
l: identification (of the staff, patient)
S: situation (current problem)
B: Background (past problems, comorbidities, treatment is given so far etc)
A: Assessment (Vitals, pain, drains etc)
R: Recommendation (investigations to be done, medication to be given, consults to be taken, pending things, planning for discharge or move out etc).
The same tool can be used by doctors also for handing over during shifts, telephone conversations about a patient or for communications among different specialities.
Another tool which helps in achieving patient safety is a tool called “assertiveness saves lives”. This steps are
1. Get person’s attention (Doctor, I am …. Calling from ward…., I have a serious problem now)
2. Express concern (I am really concerned about Mr. ….)
3. State problem (His pulse is 130, BP is 90.60,, and he is looking pale….)
4. Propose action (Doc, I would like you to come and see the a patient immediately)
5. Reach decision (Doctor, so… you are busy in theatre, can I inform the consultant, as I think a doctor is needed urgently to make a decision)
Special situations where enhanced communication would be required
Tough the principles of communication remain the same whatever the situation, some special protocols need to be decided beforehand and the concerned staff need to be trained on those. Some examples of those situations are
• Breaking bad news
• Disclosing death
• Handling an aggressive patient/family
• Communication in case o emergency./disasters
• Disclosure of an adverse event
• Managing an angry employee
• Handling patient staff argument
c. The protocols for enhanced communication during the laid down situations should include the following points through can be customized according to situation. Below is an example of bad news
• Who is responsible person to handle it (the concerned treating consultant should be the one to disclose and not the junior doctors)
• What preparation should he have before (the doctor should have enough time, have a room where serious conversation can happen, know about the patient and relevant investigations, have sufficient knowledge about further plan, have an experienced nurse along to help the patient to deal with the emotions)
• Where to do the breaking bad news (Not on corridors, nut in a comfortable confidential room)
• How to break the bad news (Assessing patient knowledge about illness, knowing the background information, gently but unambiguously breaking the bad news without medical jargon)
• Plan (Further plans, curative, palliation, support etc.)
This is just a very sketchy example of breaking bad news protocol. Similarly organization should have protocols for different scenarios.
There are many barriers to effective communication. Many are internal barriers like fatigue, lack of interest and motivation, type of patients etc. which need to be identified and handled by each healthcare professional. But one of the major communication barriers in this vast country is language. So the organization should identify staff who can act as interpreters in case of need for a particular language, to help in the patient interaction and counseling. lt is also necessary to identify patients with speech and hearing disability so that they can be appropriately counseled.
Unacceptable behavior is the behavior of a staff which is worse than the minimum expectation a patient or management would have about the staff. These types of behaviors will make the patient unhappy and the hospital to lose its patient base. So it is the responsibility of the management to identify such unacceptable behaviors. The management also should ensure a disciplinary action is taken against staff displaying unacceptable behavior. List of unacceptable behavior is exhaustive, but at least the common indicative list as below should be made public to the staff.
• Alcohol and smoking at workplace
• Abusing a patient
• inappropriate behavior with women
• Employees fighting in the corridors
• Disrespect to any religion
• Any behavior violating the patient right
• Talking bad about professional colleagues of same or different specialty o Talking bad about alternate approved system of medicine
• Corruption etc.
System to monitor and review the implementation of effective communication.
a. The organization has a documented complaint redressal procedure. This includes verbal/ telephonic, method of compiling, analysis, Time frame, documentation etc. We also assure that complaints are kept anonymous.
a. Outpatient and visitors complaints are collected through a Complaint register placed at the OPD Reception Counter/ Nursing Counter.
b. If in case of oral/ telephonic complaints, the patient/ visitor/ relative shall be guided to the administrator/ operations department/ MSW. The complainant can be asked to write the complaint or it can be written by the receiver on behalf of the complainant.
c. Out- patient & In-patient feedback is taken through OPD / IP Feedback Form and analyzed.
d. Patients are made aware off email id for sending suggestion, feedback and complaints at a given email id or simply drop-in the written complaint/suggestion into the complaint boxes.
e. The complaints thus received are checked by the administrator/ operations department and informed to the appropriate department. The correction is taken immediately. The corrective action and preventive action is planned to avoid the recurrence of the same problem.
f. Collection and Analysis of Out-Patient and Inpatient Feedback and complaints are done by an independent in – house Quality Improvement Team. The hard copy of Feedback Form & Electronic data from tablet are maintained for 6 months.
g. The complaints thus collected are handed over to the Administrator/ Operations Department on a daily (verbally), weekly & monthly basis through formal report.
h. These complaints are critically analyzed and appropriate action taken by the concerned department heads.
i. The root cause analysis and action taken is documented.
j. A reply is sent to the complainant and informed about the action taken.
k. The action taken report is prepared and presented weekly in the QI meetings.
f. Staff are trained in healthcare communication periodically.
Training includes handling challenging situations as well as in good practices in health care communication.
The training needs for communication skills are identified by analyzing patient complaints, incident reports, appraisals and employee feedback.
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