According to the Office of Disease Prevention and Health Promotion in the United States, “Health communication is the study and use of communication strategies to inform and influence individual and community decisions that affect health. It links the fields of communication and health and is increasingly recognized as a necessary element of efforts to improve personal and public health”. The World Health Organization in 1999 stated that it is a “public responsibility that citizens receive extensive, accurate, and timely information on health and health care through various communication channel.” In this paper, an examination of the importance of effective, and therapeutic communication will be discussed and the sequel of ineffective communication.
Patient care almost always involves several individuals starting from their physicians, to their nurse and many other disciplines involved with their care, all-needing to share patient information amongst each other. Communication failures are a large contributor to adverse clinical events and outcomes. From the administrative point of view, poor communication can have significant economic repercussions.
Several various factors depend on high quality health care services such as staff knowledge, and staff attitudes, as well as their perception of the information received. Lets take a look at staff attitudes. In order to be productive nursing professional, it is not enough to have a healthy relationship with your client but to also have a healthy working environment amongst other professionals. Having conflicts within the work places adds great tension between working colleagues, which then can inadvertently have a negative effect on patient care. Tension within the work place can hinder any productive collaboration and lead to poor communications to one another, again potentially jeopardizing patient outcomes. It is important that rules of conduct are followed and clear expectations of behaviors being made. A society of collegiality is fundamental for a health work environment that is to deliver high quality of patient care.
Studies have been conducted and have pinpointed miscommunication as a major causative factor in sentinel events, that is, errors resulting in a serious injury or unnecessary death (Leonard & Bonacum, 2008). Studies have shown that miscommunication during “handoff” occur when one nurse reports to another nurse transferring responsibility to him/her. Thus, having a negative effect on patient outcome. Looking at it globally, it not only increases the patient’s length of stay, but an increased cost of hospitalization. Besides risks to client safety, poor communication is also related to patient dissatisfaction and places hospitals at risks for malpractice lawsuits.
In light of the increasing errors made from poor communications, initiatives have been developed. There is a collaborative agreement made that requires improving communication. Best nurse-physician collaborative communication has empirically been associated with lower risk for negative client outcomes and greater satisfaction. Research studies support this concept (DeVoe, Wallace, Pandhi, Solotaroff, & Fryer, 2008; Elder Brungs, Nagy, Kudel, & Render, 2008). Because of this need for greater communication it has caused the push for standardization of health care practices. “Standardization is among the best methods to improve quality and reduce cost of care…even if the standard is as simple as a checklist” (Mathews & Pronovost, 2008, p. 2914). According to Amato-Vealey, Barba, & Vealey, safe communication regarding client issues needs to be clear-cut, timely, accurate, complete, open, and understood by the receiver in order to reduce errors (2008). So with the increased importance of improving communication and highlighting the need for creating a better climate of patient safety, there is a need to have open communication that is centered on the patient.
Governing bodies took aim at healthcare communication in an attempt to standardize communication amongst health care professionals and preventing medical errors due to poor communication. Organizations include: 1. IOM’s 8 goals. IOM specifically mandated that hospitals have structured handoff protocols. 2. AHRQ in the Department of Health and Human Services, their role is to prevent medical errors and promote patient safety. Through funding they have established the “best practice” evidence-based protocols. 3. The World Health Organization (WHO) developed 9 solutions for patient safety, number 2 is “correctly identifying the patient,” and number 3 is “better communication during patient hand-off”.
Communication between physicians and nurses has been traditionally on a hierarchical power differences. The difference between the two professions intimidates nurses. Historically nurses are used to working with a physician who make treatment decisions individually rather than consulting. Now physicians are working closely with nurses, collaborating care to meet patients needs. To close the gap between nurse to physician communication, nursing schools have added communication developmental skills to their curriculum.
Implementing measures specified by best practice evidence and sharing decision-making about the client’s care require that physicians correspondingly relinquish some autonomy (Mathews & Pronovost, 2008). Effective teamwork requires openness to new concepts, honesty, and open lines of communication. To successfully achieve this both physicians and nurse need to think about their roles.
Standardization tools have been developed in light of the urgency for patient safety due to medical error resulting from poor communication. Such standards would include the implementation of the SBAR reporting tool that was created by Bonacum, Leonard and Kaiser Permanente Northern California Regional administrators. Embraced by Bonacum (2009), its principles were based on the communication styles within the nuclear submarines, in that it in tales a structured way of communicating crucial information while leaving out the excess sideline talk. This tool helps eliminate the intimidation of the nurse to physician because it is used as a guideline that aids the nurse in providing precise, and to the point information. In its true essence, SBAR simplifies verbal communication between nurses and doctors as well as amongst other colleagues. SBAR acronym stands for; “S” situation, “B” background, “A” assessments, and “R” recommendation. SBAR has also been proven effective in other healthcare agencies such as rehabilitation centers.
As organizations continue to strive to meet high quality of care, other means of communication has been realized such as the need of collaboration. Collaboration is an effective way to meet patient safety. Five levels of collaboration based on, Kramer and Schmalenberg’s research are: collegial (equal in power but different); collaborative (mutual but not equal power); student-teacher (physicians have the power but are friendly and willing to inform nurses); neutral; and negative (physicians have total power and are disruptive to nurses, who then feel frustrated or hostel). According to (Arnold & Boggs, 2011), poor teamwork along with poor communication resulted in the majority of reportable errors. Boone and associates (2008), recommend that physicians and nurses attend jointly, team building workshops that share communication training to develop a culture of “us” rather than “them”.
To summarize the importance of effective communication and how it relates to patient outcome, true understanding of who the stakeholders are and how the development of standardized ways of communication can reduce sentinel events which in turn keeps hospital costs down for both patients and hospitals is imperative. Through collaboration among team members and strict adherence to the SBAR tools, patient safety can be maximized.