How to improve communication in the medical setting

“What we have here is a failure to communicate.”  A famous quote from the movie Cool Hand Luke.    As many know poor communication is common in healthcare.

Consider the following examples.

According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions.  It was the teaching hospital for Brown University and the only Level I trauma center in southeastern New England.  Rhode Island Hospital also had a reputation as “a place riven by internal tensions.”

In one surgery for instance, a neurosurgeon was preparing an emergency surgery for an elderly gentleman with a critical subdural hematoma.  Just before the surgery a surgical nurse noticed that the medical chart and other paper work did not indicate the location of the hematoma.  The nurse cautioned that the surgeon should wait until the needed paper work was seen.  The surgeon yelled at her that he had seen the cranial scan and said he knew where to operate.  He didn’t.  He opened the skull on the wrong side.  Although he corrected his mistake quickly, the patient died soon thereafter.  Such errors are not foreign to most hospitals but the number of errors at this hospital due to poor communication, especially between nurses and physicians who overpowered them with their authority, eventually created a culture of high tension and anxiety.

Poor outcomes for patients and doctors are found in many other medical settings besides surgeries, although these seem to get the most attention in the press.  Consider the following scenario, for instance.  A family physician during a well baby visit was looking for a pediatric stethoscope.  It was not in her office.  She excused herself from the exam room and went searching for it in the office.  It took her 5 minutes to find it.  The incident was very annoying to her and the mother of the child.  She had to hurry through the exam and did not have as much time as she needed to talk to the mother.  There were no serious consequences from this visit but the outcomes were not optimal either.  The mother lost a bit of trust in the doctor that day.

What, then, are some characteristics of good communication?  One is that each staff member has the opportunity in the right setting to express his or her opinion about how a particular process could be improved or how patient safety could be improved.  Being able to express oneself is not enough, though.  Leadership must make sure that good ideas for improvement and safety are implemented in a timely manner.  The person who made the suggestion should be recognized.

Another characteristic of quality communication is that time is set aside for staff meetings to address suggestions brought to the attention of leaders at the site.  For instance, in the ambulatory setting described above, the physician can suggest to the office staff director that something should be done about making sure that physicians need not leave their office during a patient encounter to look for missing supplies or the physician as leader in the office can call the meeting.  Meetings such as these should be scheduled regularly; other issues other than processes and safety can be addressed.  For instance, meetings can be used for training, such as for EMR implementation.

Team meetings are a good place for problem solving using effective communication.  To be effective they must be well organized and run.  Based upon my experience in working with a variety of teams in a variety of settings and based upon discussions with colleagues along with research, I believe that there are several elements that are necessary for effective team meetings.  These are:

  • Strong leadership
  • Preparation
  • An agenda
  • Staying focused
  • Participation by all team members
  • Decision rules
  • A time limit

There are many skills required of a team leader.  Besides controlling disruptions, he must also encourage all to participate.  Someone who may be timid to speak should be encouraged; his or her idea may be one of the most innovative and important.  When I am leading a meeting before I close discussion of a topic I make sure that I personally address any who have been quiet and ask if they have any comments.  If not, I may ask them to summarize the previous discussion so that they will be involved.

As you can tell, communication is very important at medical sites.  There are many benefits to effective and ongoing communication—optimal outcomes for patients, satisfaction among staff that they are delivering quality care in a culture that supports them and improved income.  While I believe that most recognize that effective communication is necessary for these outcomes, achieving it takes a lot of effort.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

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