Patient safety, patient experience, workforce health, and cost-effectiveness are critical outcomes with an important common root. They’re all impacted by our ability to communicate effectively and respectfully. Additional terms to describe these skills include people, interaction, interprofessional, relationship, and social skills. They can even be used to describe behaviors inherent in many properties of complex adaptive systems, such as the butterfly effect, flexibility, and adaptability. The more we understand these contributing factors, the more we can apply solutions that lead to meaningful long-term change.
Sometimes the link from a communication failure to an adverse outcome seems obvious. For example, a nurse or other health care team member who fails to speak up when they see something wrong about to happen, such as a wrong site, wrong patient, or wrong procedure. Yet often, there is an elusive trail of ineffective or disrespectful human interactions contributing to poor outcomes. One way to make this point is to consider how a hypothetical situation might unfold with ineffective vs. effective communication skills.
The case of the soiled dressing
Scenario A: A post-op patient is horrified to see a nurse pick up soiled wound gauze from the floor without gloves and complains to the surgeon, “It was disgusting.” The surgeon tells the patient, “This is unacceptable. I will find out who is to blame for this incompetence,” and proceeds to yell at the nurse manager, “Your nursing staff is incompetent and unprofessional, and I want the person responsible off of this unit.” The nurse manager finds the nurse and yells at her, “How will we ever stop these complaints when you do something as stupid as that?” The nurse mumbles to the patient before giving her an IM injection, “I got in a lot of trouble yesterday for not using gloves.” The patient hoped she would get a different nurse for the rest of her stay. The patient completed a survey with critical feedback about the incident a month later. News reached the CEO, and she held a meeting with the CNO to investigate who was to blame. The nurse was given a warning, and the incidents of running out of gloves in patient rooms persisted.
Scenario B: A post-op patient is horrified to see a nurse pick up soiled wound gauze from the floor without gloves and says to the surgeon, “It was disgusting.” The surgeon responds, “I can understand how that would be disgusting. I’ll talk to the nurse manager and see what’s happening.” He catches up with the nurse and takes her aside, saying, “Hey, Sally, got a minute? Mrs. Smith said she noticed a nurse not wearing gloves while disposing of an old wound dressing. Was that you?” And Sally said, “Oh, I know; I went to grab gloves in the bathroom, but it was empty, another patient’s IV pump alarm was going off, and visitors were coming in. Thanks for calling me on it. I’ll apologize to Mrs. Smith and let the nurse manager know about the glove issue.” The surgeon follows with, “Great, let’s talk with the nurse manager together and see what’s going on with stocking the rooms.” After both of these conversations took place, Mrs. Smith felt confident of the care she was receiving, and the nurse manager found several rooms were out of gloves. She contacted central supply to discuss solutions. Neither the CEO nor CNO knew about the incident but did send out a congratulatory message to all staff for improved patient experience numbers three months later.
Soft skills are essential, although hard to teach and learn. Challenging in part because communication involves underlying emotional intelligence, which is hard to develop and practice, especially in high-stakes, high-stress work or toxic cultures.
Nevertheless, seeing how they are linked to outcomes will give leaders a powerful incentive for utilizing strategies, like medical improv, that are effective for building the interprofessional skills that health care students and staff need to provide safe, cost-effective care and optimal patient experience, as well as experience long-term, rewarding careers.
Beth Boynton is a nurse and improvisation practitioner.