Construction Miscommunication

How improved communication in facility construction could boost patient satisfaction

By Megan Headley

Communication can be one of the hardest skills for anyone to master. Yet in healthcare, miscommunication can pose grave challenges to patient safety and care quality. A 2016 malpractice study conducted by CRICO Strategies linked communication failures to 1,744 patient deaths in five years and $1.7 billion in malpractice costs.

But these communication problems may impact patients before they walk through your door—in fact, even before that front door is installed, according to Cathy Dolan-Schweitzer, president of the healthcare construction consultancy Health Well Done.

As Dolan-Schweitzer explains, “When you tell a story, you get the whole picture. You understand emotions, the characters; the way that people move their bodies all tells you what really is happening. When that happens, people are encouraged to participate as a team. It’s how you can establish a trusting and safe atmosphere to help people share their own wisdom and experience.”

And this is vitally important in construction, where thinking is often linear and data gathering is frequently the driving goal.

“If you want to build a patient-centered environment, it’s so important that you really understand what goes on in that environment,” Dolan-Schweitzer says. “And you don’t find that out unless people are sharing their own wisdom and experience.”

Administrators can encourage this storytelling approach to ensure that designers, contractors, and maintenance staff better understand how their decisions may impact all of a building’s occupants.

Stories that drive construction outcomes

Dolan-Schweitzer offers an example to illustrate how detail-rich storytelling can help improve building decisions.

She and her team were brought into Stamford Hospital in 2012 to build an electrophysiology (EP) cath lab. Stamford would be the first hospital in Connecticut to perform cryoballoon ablation to treat atrial fibrillation, and the facility needed an environment that could support the needs of its newly hired electrophysiologists.

Weekly project meetings followed a strict agenda, but as the construction team began collaborating, Dr. Sandhya Dhruvakumar and EP technician Dennis Piche shared stories that helped the construction team better visualize how this clinical team worked. The stories revealed that Piche, a Navy veteran, ran a tight ship. As a result, Dr. Dhruvakumar trusted Piche to make sure everything was going smoothly in the inner workings of the EP cath lab. ​Each story helped the contractors better visualize the primary point that ultimately drove this project: no cables on the floor.

This simple underlying standard would define five critical elements of the project: organization, teamwork, integration, safety, and workflow.

Understanding ongoing flow

Storytelling can also improve outcomes in smaller projects and routine maintenance, as Dolan-Schweitzer explains.

“Say you’re a construction superintendent and you’re working on a patient floor,” she says. “Now, you’re an outsider, so you may go up to the nurse and say, ‘Listen, tonight I’m going to close that hallway down from 10 p.m. to 2 a.m.; is that okay?’ The nurse says, ‘Yeah, that’s okay. Go ahead.’

“Well, you know what, the superintendent didn’t get enough information to really understand [the consequences]. If he said something like, ‘Hey, could you just tell me a story about what goes on here at night, what normally happens?’ Everybody loves to gossip, so the nurses might say, ‘Yeah, I can tell you some right now. The guy from the kitchen is not supposed to use this hallway, but they do because it’s faster for them to get up to deliver food; the infection preventionist does his rounds at 10 at night just to make sure that everything is okay …’ ”

Now that he has more details about how staff use the space, the construction superintendent can devise a new plan that may save time by proactively making room for these needs, while the staff will have fewer complaints about the construction process. Moreover, by gaining this information in advance, the contractor is able to maintain the building occupants’ trust while taking the appropriate steps to accommodate staff and patients.

“So, from a superintendent standpoint, it’s so important to ask people to tell a story so they can visualize all the things that somebody might not otherwise tell them,” Dolan-Schweitzer says.

Getting the story out

Believe it or not, says Dolan-Schweitzer, we’re all natural storytellers. “It’s literally in our DNA; the human mind is hardwired to think in very specific story-based terms that will resonate with us and help us to make sense out of our roles.”

She adds, “The neuroeconomist Paul Zak studies why stories have an effect on us, and he’s pointed out the two critical aspects that make a story effective. First, they must capture and hold our attention. Second, an effective story transfers us into the character’s role. As Zak says, this narrative transportation allows the listeners of stories to experience emotional stimulation, which is the very foundation of empathy. It’s easy to see, therefore, that the potential power that storytelling would have in the context of creating a patient-centered environment, where empathy and compassion underpin the delivery of care.”

Yet for the literal-minded who are focused on high-speed decision-making, it can take some practice to step back and ask for the story.

To get people acclimated to storytelling, Dolan-Schweitzer encourages starting it in project meetings. Ask contractors and engineers to share their story, or to discuss an interaction that they had with a patient—or that they experienced while a patient themselves.

Next, expand this practice to better understand how management and staff work. Dolan-Schweitzer offers her SPA tool as a guideline for understanding stories:

• Story: Ask a question that encourages storytelling. Listen for moments where patients or staff describe challenges, crises, or obstacles they face. Consider changes in emotion and tone of voice. Focus on turning points in the story, or on moments and events that impart special meaning.
• Point: Think about what this story reveals and prioritize three points that seem most important.
• Application: Apply information gleaned from these stories to make sense of, or changes to, data-driven decisions.

For more insight, Dolan-Schweitzer includes a chapter on storytelling in her forthcoming book, Health Well Done: A People-Centered Management Guide to Building Healthcare Environments.

About the Author

Megan Headley is a freelance writer and owner of ClearStory Publications. She has covered healthcare safety and operations for numerous publications. Headley can be reached at megan@clearstorypublications.com.