Communication: A Critical Healthcare Competency

By James Merlino, MD

Communication is the cornerstone of healthcare. Effective communication is not only critical to meeting patient needs and providing safe, high-quality, and patient-centered care, it is necessary to how we manage healthcare delivery. To facilitate meaningful improvement, the road to healthcare transformation must be paved with good communication—vertically from the top down and the bottom up, and horizontally across the continuum of care delivery.

This means more than declaring an open-door policy among system leadership and encouraging managers, caregivers, and patients to take advantage of it. It requires a consistent and deliberate effort to weave communication best practices into the culture of an organization, continually evaluate the effectiveness of those practices through patient and workforce surveys, and hold individuals and teams across the organization accountable for their role in advancing communication excellence.

To achieve this, it is necessary to understand that in today’s healthcare culture, the manner in which information is conveyed is as important as the information itself. This is because care delivery involves countless patient handoffs between providers, units, departments, and facilities, as well as interactions with multiple administrative and care professionals of various backgrounds and levels of training. Every handoff and interaction—whether it’s among caregivers or between caregiver and patient—involves an exchange of information. To be effective from clinical, administrative, and interpersonal perspectives, the information shared must be accurate, thorough, and clear, and the sharing itself must be open, honest, and compassionate.

A robust body of evidence supports the argument that good communication skills are an essential competency skill for delivering value-based, patient-centered care. Multiple studies have linked improved communication to better patient outcomes, safer work environments, decreased adverse events, decreased transfer delays, and shortened lengths of stay (Disch, 2012). One literature review demonstrates consistently positive associations between caregiver communication behaviors and patient outcomes, including patient recall, patient understanding, and patient adherence to therapy (King & Hope, 2013).

The extent and quality of caregivers’ communication with patients and with each other have also been shown to drive how patients perceive their care experience. For example, effective communication among care team members and with patients and their families has been linked to an increased likelihood for patients to recommend the organization and to rate their overall care more highly (Fulton, Malott, & Ayala, 2010).

Research from Press Ganey has identified nurse communication in particular as a “rising tide measure.” Specifically, when hospitals improve nurse communications with patients, they see associated gains in other patient experience measures: responsiveness of hospital staff, pain management, communication about medication, and overall patient experience scores (Press Ganey, 2013).

Further, communication is a cornerstone of workforce engagement. Strong communication among healthcare team members has been shown to influence the quality of working relationships and job satisfaction (AHRQ, 2017), and clear communication about task division and responsibilities has been linked to reduced workforce turnover, particularly among nursing staff (DiMeglio et al., 2005).

Taken together, these data suggest that, when healthcare professionals communicate effectively—conveying critical information in a timely or easily understandable manner, clearly spelling out orders or instructions, and answering questions thoroughly and thoughtfully—they deliver safer and higher-quality care. Research indicates that the care is also more cost-efficient and cost-effective—essential considerations in the value-based healthcare equation.

Poor communication among care team members and with patients, family members, and postacute care facilities at discharge can result in confusion around follow-up care and medications, potentially leading to unnecessary readmissions and preventable malpractice litigation. In one study using six years of data from nearly 3,000 acute care hospitals, researchers determined that communication between caregivers and patients has the largest impact on reducing readmissions. Specifically, the results indicate that a hospital would, on average, reduce its readmission rate by 5% if it were to prioritize patient communication in addition to complying with evidence-based standards of care (Senot, Chandrasekaran, Ward, Tucker, & Moffatt-Bruce, 2015).

By educating patients at discharge and giving clear, specific discharge instructions to postacute care providers, hospitals can reduce readmissions and increase patient loyalty, which indirectly influences the operational bottom line.

The fact that communication affects the safety, quality, and experience of care as well as caregiver engagement is consistent with research linking these critical performance areas to the patient-centeredness of care. It also aligns with the findings from new cross-domain analyses indicating that these elements are highly interrelated with one another and with financial outcomes (Press Ganey, 2017).

To the degree that communication is the common thread binding each of these areas, and that improvement in any of these areas can influence performance across all of them, health systems seeking to improve the safety, quality, and patient-centeredness of their care must identify and break down barriers to effective communication and adopt strategies that strengthen caregivers’ professional and interpersonal communication skills.

Toward this end, a number of evidence-based best practices can enhance communication skills and improve outcomes. Some examples include:

• Implementing a comprehensive provider/team communication strategy comprising a standardized communication tool, such as the Situation, Background, Assessment, Recommendation (SBAR) technique, to facilitate prompt and appropriate communication about patient status; daily, multidisciplinary patient-centered rounds using a daily goals sheet; and care team huddles during every shift.
• Investing in communication skills training for all staff. Good communication skills are not innate; they are taught, and they require practice and monitoring.
• Making leadership support for communication initiatives highly visible. Leaders must create an environment of open communication by modeling appropriate behavior, setting expectations, and investing in support systems within the structure of the organization. Leaders and managers at all levels of the organization should promote patient-centered communication as a requirement for providing safe, high-quality care.

The ability to explain, listen, and empathize can profoundly impact relationships with patients and colleagues, which in turn can influence individual and organizational performance on clinical quality, experience of care, and financial outcomes. For this reason, health systems should invest in monitoring and developing these skills in the current workforce, and the industry as a whole should support initiatives that focus on building these skills in the physicians, nurses, and healthcare workers of tomorrow.

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About the author

James Merlino, MD, is the president and chief medical officer, strategic consulting, Press Ganey Associates.

 

References

Agency for Healthcare Research and Quality. (2017) Team strategies and tools to enhance performance and patient safety (TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/qual/teamstepps/

DiMeglio, K., Padula, C., Piatek, C., Korber, S., Barrett, A., Ducharme, M. … Corry, K. (2005). Group cohesion and nurse satisfaction: Examination of a team-building approach. Journal of Nursing Administration, 35(3), 110–120.

Disch, J. (2012). Teamwork and collaboration. In G. Sherwood & K. Barnsteiner (Eds.), Quality and safety in nursing: A competency approach to improving outcomes (1^st ed.) Ames, Iowa: John Wiley & Sons, Inc.

Fulton, B. R., Malott, D. L., Jr., & Ayala, L. (2010). Award-winning outpatient service: Finding the common thread. The Journal of Medical Practice Management, 25(4), 202–206.

King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: A narrative review. Journal of Graduate Medical Education, 5(3), 385–393.

Press Ganey. (2013). Nurse communication: A rising tide measure. Performance Insights. Press Ganey Associates.

Press Ganey. (2017). Achieving excellence: The convergence of safety, quality, experience and caregiver engagement. 2017 Strategic Insights Report. Press Ganey Associates.

Senot, C., Chandrasekaran, A., Ward, P. T., Tucker, A. L., & Moffatt-Bruce, S. D. (2015, July 21). The impact of combining conformance and experiential quality on hospitals’ readmissions and cost performance. Management Science, 62(3), 829–848. doi:10.1287/mnsc.2014.2141