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Effective communication among healthcare workers
1. Izatty Lim 0308188 17 Jan 2014 Page 1
Effective Communication among Healthcare Workers
to Improve Patient Safety and Quality of Care
Name : Izatty Lim
Student ID : 0308188
Supervisor : Dr. Mohammed Jaweed (Surgery)
Dr. Wong Eng Hwa (Microbiology)
Course : Special Study Module
Course Coordinator : Dr. Uta Christine Dietrich
Date : 14 January 2014
2. Izatty Lim 0308188 17 Jan 2014 Page 2
Table of Contents Page
Introduction ................................................................................................................................................... 4
Effective Communication.............................................................................................................................. 6
Ways to improve communication.................................................................................................................. 8
Communication Failure................................................................................................................................. 9
Summary ................................................................................................................................................. 10
References ............................................................................................................................................... 11
3. Izatty Lim 0308188 17 Jan 2014 Page 3
Table of Figures Page
Figure 1. Adverse drug reaction in US 5
Figure 2. Five Standard of Effective Communication 7
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Introduction
In this modern era, the world had seen a lot of improvement and revolution in the medical
world, both in the new technology invented and new discovery that has been made. Despite of the
great achievement, the crucial basic skills needed in ensuring good quality of patient care do not
receive the attention they deserve. Extensive research have shown that despite of the knowledge
own by a physician, if he does not able to develop good communication skills, he may be of no
help.1
What we know is important, but deciding on what and how to deliver and share the
knowledge is just as essential to achieve quality patient care as a health professional. The quality
of communication among the workers in healthcare actually has been a long standing issue. There
are numerous medical errors that occur due to communication failures. A report from the Joint
Commission in America has stated that communication failure is main factor responsible for over
70% of sentinel events.2
Furthermore, based on an analysis of medication-related liability,
operational system failures, which is including poor team communication, is found to be the
causes for the most of the medication errors and adverse drug effects issues in a New England
malpractice insurance company database. Besides, communication was ranked as the third most
common risk management issues in all hospital-based claims by The Doctors Company/OHIC
Insurance.3
There are various types of communication in healthcare setting in which could be among
healthcare workers themselves or between healthcare workers and the patient. Among the
healthcare workers themselves is including communication between one physician and his
colleagues, one physician with other specialist, physician and the nurses and also between
physician and the lab workers. Communication is divided into two major group- verbal
communication and non-verbal communication. A verbal communication is reflected as an act of
transfer information, ideas and feeling through the use of mouth. It is the main way of face-to-
face interaction. Words, sounds, speaking and language are the key component in verbal
communication. As for the non-verbal communication, the main components are kinesics (body
movement), proxemics (using space to make contact or to provide privacy), haptics (touch),
oculesics (eye contact), chronemics (the use of time pausing, waiting, speeding up), olfactics
(smell), adornment (dress, cleanliness, jewelry, tattoos, piercings), posture (body position,
stance), locomotion (walking, jumping, swaying, and moving with the help of wheelchair), sound
symbols (grunting, ahs, pointed throat clearing), silence (long pauses, withholding information,
secrecy) and lastly vocalics (tone, timbre, volume).4
Non-verbal messages are made instinctively
or unconsciously and deliver their own strong meaning. The ability to empower both types of
communication skill will lead to an increase efficiency of work among the healthcare workers
thus may also lead to enhanced patient safety and satisfaction.21
Effective communication is a cornerstone of patient safety – The Joint Commission.5
By
referring to various study done by many insurance company, it can be concluded that many
accidents and medical errors can be avoided by improving communication quality in healthcare.
5. Izatty Lim 0308188 17 Jan 2014 Page 5
Figure 1 Adverse drug reaction in US.
(Adapted from “Healthcare Communication” by Bruce Hugman) 21
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Effective Communication
In the past, public demands and expectation were low, ineffective communication was not
seen as a threat. However, in the 21st
century, the revolution in communication has further
revolutionized people expectations. Over the years, modes of communication used in healthcare
are improving as time goes by. There are various modes of communication that have their own
advantages and disadvantages. Communicating through the telephone for example, it has enable a
real-time interaction to be conducted whenever needed but, it may also decrease efficiency by
disrupting patient flow which is also interrupting a particular session in order to facilitate other.
Next, we also have e-mail and electronic medical record. Both of these mode of communication
is providing us advantages that it is easily accessible and it is convenient for most of the
hospitalist but, both modes are lacking the human tough and system down is a common
hindrance.18 22
With all the modes we have, the new or the old fashion one, the importance of
effective interaction and communication among the healthcare giver remains the same. Efficiency
of communication in healthcare is directly related to quality patient care. 19 22
Effective communication is defined to be a reciprocal, interactive process. It is involving
two sides, sender and recipient, in which they need to ensure that the message or information has
been received and also understood.
In a doctor-patient interaction setting, healthcare professional(HCPs) have to make sure
that information are tailored based on the patient’s personality, need and abilities to ensure a
good understanding and engagement of the patient are achieved .An effective communication is
actually the core of quality patient care. The skills and ability to communicate well will lead to an
accurate, comprehensive diagnosis and HCPs will be able to detect emotional distress in patient
and response appropriately. This will then lead to the satisfaction of the patient with the care they
received and they will tend to agree with and follow the advice given.6
Drugs don’t work in patient that doesn’t take them. – C. Everett Koop, MD7
Besides communication between HCPs and patient, effective interaction among HCPs
themselves is also important. Among the healthcare providers, there are two types of
communication- intradisciplinary and interdisciplinary. Intradisplinary communications involve
members of the same health specialty. As for an example, when one cardiologist speaks to
another. While interdisciplinary communication is between different health practitioners such as
when a dietitian speaks to an occupational therapist.8
When these communications conducted
smoothly, an efficient professional work group can be formed, leading to less chance of repeated
unnecessary tests and less possibility of omissions in care.
7. Izatty Lim 0308188 17 Jan 2014 Page 7
Figure 2 Five Standard of Effective Communication.9
Complete The answer of all the question asked are obtained and satisfactory of communicator
involved is achieved
Concise Include only relevant statement and unnecessary repetition is avoided. Wordy
expressions are shortened.
Concrete The words used are precise and accurate facts or stats are given.
Clear Short, familiar, conversational words are used to form an effective and easily
understood message.
Accurate The level of language used is appropriate for the occasion- ambiguous jargon and
discriminatory expressions are avoided.
8. Izatty Lim 0308188 17 Jan 2014 Page 8
Ways to improve communication
There are 3 major factors influencing effective communication in healthcare- individual
ability and characteristic, team behaviors and systemic factors, and the lack of organizational
support of a safety culture. 10 11
For individual level, it is related to the human factors that influence the effectiveness of
communication, such as communication skills, personalities and attitudes, memory failures, stress
level, distractions and interruptions.10 12
An individual can develop various skills to help
improving communication quality in healthcare setting. One of the skills that will be useful is
assertiveness, which is referring to the quality of being self-assured and confident without acting
aggressive. Sometimes, a healthcare worker may notice the need to challenge a particular
decision regarding patient care; however, the situation is complicated and become difficult due to
the hierarchical power relationship between senior and junior doctors for example. In this kind of
situation, being assertive may help to improve patient safety.13
Another helpful skill would be the
ability to perform active listening. Active listening refer to the skill to listen, focus on the
information shared and resist interruptions. The skill is portrayed by the eye contact, posture and
facial expression of the listener.14
Besides, negotiating skill in a communication is useful as will
help an individual to develop self-awareness on the different communication style and skills to
confer with HCPs from other disciplines, respect other perspective and manage conflict if the
situation arises.15 23
In a healthcare team, members will have advanced technical training and usually have
different communication styles thus effective communication is important in order for the team to
function optimally and ensure patient safety and quality of care. Therefore, it is necessary to
provide more formal training and assessment to improve communication quality among teams.
Excellent teamwork which achieved through effective communication will then lead to increase
efficiency, less and shorter patient delays, improved staff morale and job satisfaction, and low
stress level among staff.16 17 23
At the organization level, effective communication can be supported by opening channels
for communication, transparency and trust, assertiveness and strong leadership. Healthcare
institution can contribute by providing resources and identifies appropriate communication style
and approach strategies so that information is effectively exchanged between people in various
kind of situation. Moreover, the organization should create a conducive environment where the
team members feel safe to share their own point of view about issues related to patient care
regardless of their position in the institution. In addition, the organization may try to implant a
work culture that values cooperation, teamwork, openness, collaboration, honesty and respect in
order to improve the communication quality in the healthcare institution.23
9. Izatty Lim 0308188 17 Jan 2014 Page 9
Communication Failure
. Breakdown in communication in healthcare setting can lead to various problems, from
mild to serious. Based on a study done by Fortis Memorial Research Institute, they have done a
survey among anesthesiologists regarding communications skills. They have found that poor
communication between team members is regarded as risk factors for mishaps and complaints.
Gawande et al. have conducted confidential interviews with surgeons on reported surgical
adverse events resulting from errors of care.20
There are 43% of adverse events were a direct
result of communication failures between two or more clinicians.20
Furthermore, an analysis done
by Lingard et al. shows that over 421 procedurally related communication events in a three
month time period, communication failures occurred in 129 cases (30%) of communication
events.20
Many factors may contribute to communication failure in healthcare. One of the most
common factors leading to communication breakdown is the human factor which refers to the
weakness and limitation as a normal human being. It is including negative attitudes and
behaviors, low morale, memory failures, stress and fatigue of staff. Due to this negative factors,
individual will tend to get easily distracted and interrupted by outside influences during
conversation thus making it a failure during communication. Changes of shift between worker
also leading to communication failure as the worker may having insomnia and due to the lack of
sleeping and rest, the worker may becoming passive and can’t communicate well between each
other in the healthcare setting. Gender, social and cultural differences are also one of the factors
that affect the communication failure. 23
Due to the system of employer and employee, a hierarchy or power distance relationships
is often happen in a professional working area especially in healthcare setting. This could lead to
communication breakdown as the junior are reluctant to report or question senior staff whenever
they have a different point of view which led to communication failure. Besides, a worker tend to
be ego and over-looked other workers as he/she may had a higher training experiences
background and is hardly accepting opinion from others which resulting a failure in the
communication between healthcare workers. Besides, in a medical field, an individual is more
likely to undergo a lot of time pressures and workload whereby without a doubt leading to stress
and is hardly to communicate which each worker.23
Limitations to do multitask even when the workers a highly skilled is also the main factor
that affected the communication breakdowns. Besides, lacking organization policies and protocol
also affected the communications breakdown because the worker is free to do anything without
any rules such as acting aggressively towards patients when in a bad mood. Lastly, the lack of
defined roles and responsibilities among members of multidisciplinary teams is a huge factor
whereby the worker isn’t doing their work respectively. This issue is highly contributing to
communication failure in healthcare.23
10. Izatty Lim 0308188 17 Jan 2014 Page 10
Summary
Communication skill is not only a basic skill needed in many professional careers, it is
also a skill that is crucial in conducting our daily life routines. We use our communication skill
often either consciously or subconsciously every day such as when talking to a friend, teaching
the students and chatting in the internet through various social media. Interaction between
humans nowadays has made easy with the various kind of advanced technology that we have. We
are now able to get connected with people all over the world with just one click and these modes
of communication will keep on revolving as the world keep spinning.
Despite of all the invented technologies that ease us in communication, the importance of
having good communication skill in order to have an effective communication is often
overlooked. Effective communication has a very important role in achieving success in a career,
especially as a healthcare professional. In a healthcare setting, there are various types of
communication happening between all the people in the setting including the doctors, nurses and
also the patients. The purposes of these communications are to solve problem, alleviate distress,
share information, make decision, persuade, convey feelings, form and maintain relationship, and
also for reassurance.6
Effective communication in healthcare will ensure these purposes are
successfully achieved.
There are many ways to improve communication in healthcare which is divided into three
levels- individuals, teams and organizations. There are direct relation between communication
efficiency and patient quality care where improved communication will also result in a better
patient quality care and also reduce medical errors. Nevertheless, there are also various factors
and common mistakes done by healthcare professionals contributing to communication failure in
healthcare.
As a conclusion, the importance of effective communication should be noted by all
healthcare providers. Besides, communication skills among the healthcare worker can be
improved from the early stage by proving sufficient education and training at the university level
to the students who will soon work in a healthcare setting. Therefore, healthcare communication
can be improved thus will also lead to improved patient safety and quality of care.7
11. Izatty Lim 0308188 17 Jan 2014 Page 11
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