My mom recently started yoga classes through her local hospital as a way to rebuild her strength following a couple unexpected health setbacks. The class required physician approval – seems simple, right? But determining the type of approval needed, getting it from her physician’s office, and communicating with the hospital involved several steps and crossed wires. If something as simple as starting yoga causes so much difficulty and frustration for the patient – how does this affect continuity of care? This question is important because keeping patients engaged with preventative healthcare and treatment is central to improving public health. Yet, unfortunately, unclear and difficult communications are all too common and not only make people avoid seeking care but also jeopardize quality of care.
In fact, poor or lacking communication is one of the biggest contributors to never events, or preventable mistakes that never should happen. These errors contribute to between 210,000 and 440,000 patient deaths annually with cost estimates upwards of $1 billion. While healthcare leaders continue to address communication errors with advances in technology, training, and an increased focus on appreciating the patient’s perspective and patient-driven care, these numbers have remained unchanged in recent years. To think about why this might be occurring, let’s dig deeper into the reasons for poor communication.
Miscommunication
Communication is a sine qua non for healthcare: its effectiveness is essential to delivering quality care. All the skill, expertise, and technology in the world will not be useful if the intended audience, whether a patient or a care team member, doesn’t understand what is communicated or lacks the commitment to act. When is miscommunication most likely to occur and hurt quality care? Researchers have found there are three key vulnerabilities:
1. Provider to patient communication that requires patient follow-up and action
2. Handoffs and transitions between care teams: handoffs between shifts and moving patients from one care setting to another
3. Delivering information and direction across the healthcare teams from administrators to doctors and support staff
Patient Communication
We’ll discuss handoffs and communications between healthcare professionals in future blogs, but for now let’s focus on patient communication. When providers communicate with patients, not only is the information conveyed crucial, but this provides an opportunity to build relationships and trust. The benefits of communication are often indirect; when providers effectively communicate, they solicit information and continued communication from the patient that improves the relationship and care. For example, a physician may explain a course of treatment and in doing so learns more to further guide a patient’s care.
But effective communication is by no means easy; particularly with the inherent barriers placed on providers. First, providers spend only 15 minutes on average with each patient, frequently with long periods of time (months to even a year) between visits. This makes building trust, an emotional connection, and understanding a challenge. Providers must clearly communicate often complex and stressful information while building commitment to a treatment plan in a dauntingly short amount of time. The consequences of communication are significant: not only are 80 percent of misdiagnoses linked to problems with communication, but satisfaction with communication is one of the main drivers of patient satisfaction and adherence to treatment.
Patient Communication
How can communication with patients be improved? Sometimes marrying a traditional theory with the insight and knowledge we have today can provide the greatest ideas. The eminent philosopher, Aristotle, whose ideas were the pillars of medieval philosophy hundreds of years later, distilled great communication into three elements: Ethos, Pathos, and Logos. Let’s walk through what each of these mean and how they apply to patient communication.
1. Ethos is credibility. Why should patients believe and act on what you are saying? This comes both from demonstrating technical expertise and showing integrity and character: following through with what one says they will do. While demonstrating technical expertise may be the easiest hurdle to cross in communicating, the consistency required for integrity takes considerable energy and constant attention. Only one omission over dozens of touchpoints with a patient can have huge effects on the quality and continuity of care.
2. Pathos is the emotional connection. This is built in part by showing patients that they matter: giving them undivided attention, showing enthusiasm and joy when their conditions improve, and demonstrating passionate concern about what happens to them. This element has the greatest potential to influence patient perspectives of competence and trust.
3. Logos means appealing to the patient’s sense of reason. While it would be easy to just quickly present a diagnosis and treatment plan, patient confidence and commitment are greater when they understand the why of both. Explaining the processes behind both what is causing pain or illness and the solution gives patients a reason to follow through with recommendations for treatment. Logos also requires providing rational means for solving the problem. To go back to my mom’s yoga class, often the hurdles and steps required to enter the class defied what seemed to be logical given the nature of the class.
Improving Communication and Care
If you analyze recent advances in patient communication through the lens of Aristotle’s elements of communication, we are headed in the right direction. We have smartphone apps and online tools to increase the frequency and richness of communication between visits and evidence-based training for teaching Pathos-related empathy and the skills required for emotional connection. How can we go a step further?
One approach is to examine which individual qualities (like values, personality, and ability) influence each of the three elements of communication. This can lead to evidence-based interventions to improve communication based on each unique provider. What if when hiring physicians, nurse practitioners, or physician assistants, leaders received information about each candidate and new hire’s capacity to communicate with patients? With this information in hand, consistent training and coaching can be tailored to each provider’s unique style, adding targeted tools that support the new provider’s success.
In addition to evaluating a candidate’s ability to communicate with patients, providers can also be evaluated for their ability to deliver your unique model for care and thrive within your culture. In our eBook, The What, Why, and When of Assessments, we review how assessments can improve the accuracy and efficiency of your hiring process. By addressing both the work environment, job demands, and hiring the right fit for your model of care, you can make the biggest gains in improving communication, care, and build remarkable care teams.
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