Improve communication at your healthcare system: 3 tips

More than 80% of healthcare quality experts say improving communication between patients and healthcare staff is the number one factor in improving the patient experience, according to a recent survey by ASQ, the global network of quality improvement professionals. Unfortunately, the reality is that the number one outcome of communication in many healthcare settings is miscommunication. 

Read: The growing importance of patient satisfaction and first call resolution

Why is this the case? Too often, the conversation between a healthcare provider and patient is simply one-way communication (monologue) versus two-way communication (dialogue).  The doctor communicates the diagnosis and treatment options while the patient and family members simply listen.  The doctor forgets (or simply doesn’t have time) to ask clarifying questions to ensure that the patient successfully understands the message. 

Michael O'TooleI witnessed this scenario many times between my father and many of his healthcare providers.  Both of us watched and heard the healthcare provider deliver the same message, yet we both had completely different understandings of what was said after the healthcare provider walked away. 

Asking clarifying questions and engaging in two-way communication does help.  For example, after one pharmacist reviewed all of my father's transplant medications and guidelines with us, the pharmacist asked a clarifying question: “So tell me how you would find the correct dosage of a particular medication.”  My father quickly replied with, “Look at the prescription label.”  The pharmacist politely reminded him what he had just stated moments earlier, “Always look at the patient portal for the correct medication dosages as transplant medication doses change frequently.”

Asking clarifying questions typically aids in better quality outcomes and an overall better patient experience.  However, it can backfire.  For example, a resident walked into my father’s room a few weeks after his lung transplant surgery and asked him if he had ever been on oxygen.  My dad replied jokingly, “Well, it wasn’t a cosmetic lung transplant.”  Although comical, my dad was shocked that a doctor would walk into his room without reading his medical chart.  There were countless other examples of poor communication between healthcare staff and my father.

Next: The struggle to balance productivity and communication

However, there was one doctor who stood out from the rest.  She was a pulmonologist who happened to work in a medical practice that was recently acquired by the healthcare system where I work.  She literally spent two hours with my father and mother on their first visit.  She spoke, listened empathetically and asked clarifying questions to make sure they understood.  She even used the white roll paper that is used to cover the surface of the patient table in the exam room as a makeshift white board.  She drew diagrams, pictures and defined, all of which my parents took home with them after their visit.  Keep in mind, my father had been seen by 12 other doctors in the prior two years (spending thousands of healthcare dollars on tests and services), none of which correctly diagnosed his condition (idiopathic pulmonary fibrosis) and none of whom spent more than 15 to 20 minutes talking to him. 

Ironically, the week following, I was reviewing a labor productivity report with an administrator of the medical practices where I work.  The report highlighted medical practices that had poor productivity scores and guess who was at the top of the list? It was that amazing pulmonologist who spent two hours with my father and who was the first physician to correctly diagnose his condition and offer him a treatment option (lung transplant) that ended up saving his live and drastically improving his quality of life.  Here is a great example of a physician who, although she had poor productivity numbers, delivered a fantastic patient experience that my dad still tells everyone about. 

As healthcare leaders, we sometimes focus on short-term financial gains (in this case- productivity) that result in the unintended consequence of higher overall healthcare costs (inaccurate diagnosis causing unnecessary tests and services).

Through this experience, I couldn’t help but wonder if the amount of time a doctor spends communicating with a patient and obtaining an accurate diagnosis or even overall patient outcomes is correlated.  And if that is true, how much could the U.S. healthcare delivery system save by avoiding unnecessary tests and services resulting from poor provider/patient communication?

Next: Three ways to improve communication

Here are three ways to help your organization improve the patient experience through better communication between healthcare staff and patients:

1. Incorporate effective communication as part of your health system’s mandatory all-staff safety training program.  Teach and use well-known effective communication tools such as ask clarifying questions, validate and verify, and use read and repeat backs.  At the health system where I work, we also teach effective communication in our customized lean six sigma program.  More specifically, we teach the need for two-way communication (dialogue) and empathetic listening.  People can learn to become better communicators with their colleagues and most importantly, with their patients and families. 

2. Make effective communication a cornerstone of your health system’s culture.  Beyond training healthcare staff, your leaders must model the behaviors of effective communication and your organization must reward and recognize those behaviors.   Select healthcare workers to serve as “secret shoppers” to audit interactions between clinicians and patients and family.  Develop a standard effective communication behavior audit tool to track compliance to specific communication behaviors such as validate and verify, ask clarifying questions, etc. Use the results to coach healthcare staff on improving their communication with patients and families.

3. As we move from volume based payments to value based payments, administrators must begin to evaluate physician and clinician productivity differently.  Instead of using the traditional approach of measuring physician productivity using relative value units, utilize a balance scorecard approach that encompasses quality outcomes (including patient experience) and cost.  In a volume-based model, highly productive physicians see the most number of patients and do the most amount of “chargeable” procedures/tests in the least amount of time. However, in a value-based model, highly productive physicians use the least amount of time to produce the best quality outcomes (including patient experience) at the lowest total cost of healthcare services provided to the patient.  Using this approach would incentivize physicians to spend more time communicating with their patients, resulting in better quality outcomes, better patient experience, and lower overall healthcare costs.

Michael O'Toole is an industrial and systems engineer and lean six sigma instructor who has spent the last 10 years working with healthcare systems all over the country implementing various performance improvement programs and initiatives aimed at improving financial/operational performance, quality, and the patient experience.   He spent the last six months assisting in his father’s challenging recovery from a lung transplant.  With frequent visits to the hospital and doctors’ offices, he learned firsthand what patients and their family members experience navigating a healthcare delivery system that is ripe with waste, inefficiency, and poor quality/service.