Communication within the healthcare system is a critical factor for a variety of reasons, including increased patient knowledge and understanding, greater adherence to treatment, greater understanding on the part of patients, and an improvement in safety and treatment outcomes. Therefore, the success of healthcare interactions is dependent on effective communication strategies. A variety of stakeholders are involved in healthcare interactions, most particularly the patient or client, who is accompanied by a supportive network, which might include family and friends. In addition, healthcare professionals form a large component of the healthcare system, together with administrative support. Healthcare is a high-reliability system with strong technical interdependencies.
One form of communication that is generally viewed as critical is the independent communicator model, in which information is shared between the patient and the multidisciplinary professional group. There are emotional aspects to this form of communication, such as providing empathy and emotional support. It is thus not surprising that much of the burden for change rests with the healthcare professional. This chapter begins by discussing the Queensland University of Technology Health Belief Model, which depicts the various cognitive stages the healthcare professional goes through within the communication process, from the decision to share information with the patient to managing miscommunication. Rapid expansion of and changes to healthcare have increased the diversity within healthcare.
The Importance of Effective Communication in Healthcare
Effective communication is a fundamental aspect of the provision of quality healthcare. Clear communication between healthcare providers and value transfer to patients can lead to better comprehension of clinicians’ recommendations and greater adherence to treatment plans. Effective clinician-patient communication can also mitigate misunderstandings that can lead to patient dissatisfaction, provider burnout, and malpractice litigation. A patient’s and family members’ satisfaction with communication in the healthcare environment influences their perception of the clinicians’ technical abilities and can lead to either trust or nonadherence to technical recommendations. Moreover, the act of disclosing bad news, when done poorly, can lead to significant emotional stress for the healthcare provider due to failure to relieve suffering and results in both compassionate fatigue and moral distress. The clinical encounter also has economic relevance. For example, if patients feel that clinicians do not value what the patients say, patients may feel they need to return to the office frequently to repeat their story, leading to increased healthcare costs. Communication is implicit in much of what comprises an effective establishment of rapport and a comprehensive patient encounter. A positive healthcare experience will often result in greater degrees of patient satisfaction, even if the patient doesn’t get immediate physical benefits from the care. Additionally, clinicians may need to communicate bad news regarding poor prognoses, and they need to do so in a compassionate manner.
Barriers to Effective Communication with Healthcare Providers
The provision of culturally effective healthcare is directly related to the ability to communicate successfully. However, many barriers exist related to communication between patients and healthcare providers, such as a healthcare provider’s emotional disconnection from the patient, distractions and interruptions during patient encounters, and lack of organizational support for effective communication. The importance of these barriers across six hospitals illustrates the need to identify these barriers for the development of effective communication interventions that improve the healthcare experience in more positive ways.
The barriers and potential solutions discussed in the subsequent sections were compatible with the typology system but were not specifically categorized as a typology of either interpersonal, organizational, or contextual barriers. Interpersonal barriers can be improved through training curricula aimed at fostering provider and patient self-awareness. Organizational barriers require systemwide structures and processes in support of effective provider education; for example, comprehensive assessment and documentation of patient feelings should routinely occur as part of care planning and delivery, and patients’ responses should be used to guide the delivery of care. Researchers, practitioners, and other stakeholders need to be aware of the barriers that hinder positive communication in order to adequately address them and prepare strategies that seek to prevent or minimize their impact.
Failure to respond to negative emotions can seriously impair healthcare providers’ ability to encourage appropriate problem-solving, lifestyle change, medication adherence, and provide needed education. Thus, going beyond simple behavior modification to the deeper level of attitudinal, cognitive, and emotional functioning can help patients prepare for a deeper level of healthy functioning. To improve these techniques, practitioners should enhance their understanding of the typical responses to racism-related stress as well as the effects of responses from the provider.
Language and Cultural Barriers
Language differences can impact healthcare communication in a number of ways. When a patient is unable to effectively convey signs, symptoms, and feelings to a healthcare provider, there can be misunderstandings that lead to poorer health outcomes. Even when language barriers are present, patients often still have certain expectations of care and actions that the healthcare professionals should execute. Patient expectations and these predefined actions are based upon a variety of issues, including their social and cultural background. Each individual comes with his or her own set of beliefs, behaviors, and social backings in terms of social or family values, culture, and practices. Culture is a set of beliefs, values, and assumptions about life that are widely shared among a group of people and constitute their identity.
Although these beliefs and customs can vary significantly, it is important for people in the healthcare field to appreciate the impact that a patient’s heritage, culture, religion, and language can potentially have on his or her health experiences. Differences among nurses and healthcare professionals and patients in values, customs, and cultural practices can affect responses in a variety of ways. Being able to understand and accommodate these beliefs, customs, and cultural practices can also increase the patients’ and family members’ belief and faith in the healthcare professionals and increase the likelihood that they will follow the predefined form of care as directed by the healthcare professionals. This is known as cultural comfort or culturally competent care. Culturally competent care is care that is provided while respecting and honoring the individual values, beliefs, and customs of each person.
Technological Barriers
While there are many advantages to communication technologies, one main drawback is that not everyone has access to them. This has the potential to become an issue if a more technology-based communication is being promoted. Limited access to appropriate technology is not the only barrier for this solution, though. An additional concern was that some people did not possess the necessary digital literacy to engage in electronic methods. If providers were to choose to favor electronic methods of communication, it is necessary for them to ensure that all patients can navigate these systems.
Improvements in technology have allowed for a shift from paper patient files to electronic health records. EHRs are used to improve provider coordination, but there is potential for them to be utilized as a tool to facilitate patient-provider communication. This could involve patients accessing their medical information, such as appointment scheduling, current and previous prescriptions, and test results via apps designed by the facilities where they receive care. This method can decrease the amount of time providers spend on the phone and allow patients increased access to their own information. It is worth considering, though, that relying predominantly on electronic methods might make some patients feel distanced from their provider. Quantitative results showed that a substantial amount of patients believed that their healthcare provider should combine technology use with personal interaction. The same results revealed that patients felt they did not possess enough information to fully utilize EHRs. Even if patients do have the technical proficiency to utilize these systems, they might feel too overwhelmed in electronic interfaces to be confident in doing so. While some patients advocated for more direct communication, this did not necessarily indicate that they felt that too much direct communication was occurring. It was instead more of an appeal for enhanced one-to-one dialogue.
Strategies for Overcoming Communication Barriers
The Cone of Learning details how well we remember different types of things that we hear, see, or do. At the top of the cone, we have reading and lecture, and the items that we remember only 10% of after two weeks are the things that we hear or see in the media. This cone illustrates concepts that we are discussing in healthcare today. When we are talking with our patients, we need to talk to them in very clear, simple terms. If a patient repeats something back to me, especially when I am speaking about their care plan, it is probably an indication that they understand what I am saying. We want to be able to empower our patients to have a voice in the care that they receive and to be an active part of the healthcare decisions that are being made. Active listening skills can also help us be more effective communicators. It is important to spend time listening to a patient’s concerns without interrupting them. Communication should be done in a sensitive, compassionate, and patient-centered way.
It is important to make sure that the person receiving our message has understood it. This can be done utilizing the teach-back method or by simply asking open-ended questions to the patient and listening to what they have to say. Feedback can be viewed as an important part of the iterative process that we undergo when communicating. When negative feedback is given, it should be received thoughtfully and non-defensively. In healthcare, we have come to understand the importance of providing patient-centered care. Providing care to our patients is a two-sided exchange between the healthcare provider and the patients themselves. This is an exchange of information, which can involve technical language, but also has an emotional component. It is important to establish rapport with the patient. Active and empathetic listening are important parts of creating a good communication environment. It is also important to keep an open and non-defensive attitude when receiving feedback.
Use of Plain Language and Avoiding Medical Jargon
Making health care more understandable. One component of Working Together for Patient-Centered Care is to ensure clients and patients are well-informed. This involves providing information in a manner that is easily understood. Many clients have difficulty understanding health information because there are too many complicated terms. Using plain language is a communication skill that reduces barriers between health care providers and their clients and patients. More than 80 million adults in the United States have only basic or below-basic health literacy. As many as 9 out of 10 patients have difficulty understanding and using health information.
When health care providers use medical jargon, they often sound impatient and uncaring to clients who are already overwhelmed by their health care experience. Guiding principles for the development of quality health information and services are applicable to health professionals and all others.
- Use plain language when communicating or developing health information.
- Provide culturally and socially relevant information.
- Ensure the health information or services you as a health professional provide are clear and easy for the consumer to use.
- Say things in a way that patients, family, and consumers can understand.
- Present new ideas, instructions, and explanations in ways that the listener can relate to and follow. Nursing staff will find many useful hints and tips in a booklet to help explain things better to clients and patients. There is a strong emphasis on using example sentences and/or analogies that describe medical information in terms understandable to a consumer.
Active Listening Techniques
One important aspect of good communication is the ability to listen actively. During active listening, you show that you are concentrating and that you are interested. You give the speaker your full attention, and you respond to what he or she has said in a constructive manner. In active listening, several elements are important. First, active listening shows that the person who is listening is interested. This body language or nonverbal communication can demonstrate interest or disinterest because it conveys the thoughts and feelings of the listener. Another element of active listening is providing feedback, which involves using either verbal or nonverbal components of communication that indicate that the listener hears and understands the speaker’s message. Third, empathy or the ability to place oneself in the speaker’s position plays a key role in our understanding of another individual. Sharing the speaker’s emotion does not mean acting the same; it means showing the speaker that his or her feelings are understood. There are several strategies for developing these skills. Healthcare providers who participate in a visitor observation exercise tend to enhance their communication abilities with patients by improving their listening skills as part of training. In the context of medicine, active and reflective listening skills are important when obtaining a patient history in order to elicit their presenting problems. Several physical examination techniques are driven by the need to listen to the patient accurately. These include the patient’s open-ended invitation for a complete history and the recording of unfiltered or unmodified messages by the provider. Two communication techniques, paraphrasing or summarizing and clarifying questions, are especially important. An actively listening healthcare provider also increases patient satisfaction. Many previous studies have shown that patients who receive the necessary listening care and are satisfied with the time spent by a physician have better outcomes. Adequate communication between doctor and patient results in greater patient knowledge, trust, and recall of the message, improving medical care and patient decision-making. There are some difficulties in showing empathy, however, including a workload in which extended periods should lead to the completion of several actions, especially in specialties where productivity is measured by the number of patients seen.
Building Trust and Rapport with Healthcare Providers
There are several key components to developing trust and rapport between patients and their healthcare providers. Effective communication is one of the most commonly listed essential components of a strong patient-clinician relationship. Trust is vital in encouraging patients to speak up, ask questions, and feel comfortable. Empathy is seen as a significant component of trust, respect, and a supportive atmosphere. This relationship is not merely superficial. Patients who perceive their healthcare providers as more empathetic are more likely to fully disclose information. The relationship can be one of mutual acceptance or a chronic model, both of which should result in strong patient-provider relationships. The relationship changes power structures so that the patient is more responsible for the way health is managed.
Many list shared decision-making as a tool for increasing trust. Shared decision-making involves conveying to the patients that they have some say about the care they will receive and solutions that are effective with open, honest discussions. Often, the patient initiates shared decision-making discussions with the physician. Providers can use a variety of strategies to build trust and develop rapport with patients. Patients have to feel that their voices are heard. This commitment often means that the person has to use body language and tone of voice that are warm and respectful, being careful not to interrupt, rush, or jump to conclusions. Cultivating empathy and being aware of the impact of prejudice and stereotypes is also an important skill for providers. Building such long-term relationships should be the goal of healthcare interactions. These relationships encourage long-term compliance and better health outcomes. When relationships go poorly, it is essential to provide honest, transparent answers to the unfortunate components of a patient’s medical history.
Effective communication has become an increasingly important aspect of healthcare delivery. Research findings increasingly demonstrate a strong correlation between communication with healthcare staff, patient satisfaction rates, and patients’ treatment outcomes, such as pain control, lower levels of anxiety, depression, and irritation, and potentially shorter hospital stays. This important evolution of clinical care, necessitating increasingly known demands, means that more emphasis should be put on the education and development of communication skills for healthcare providers, while research should be directed toward proposing this area. To advance the field of allied healthcare communication, further investigation of the factors influencing both the professional group and the different groups of clients is needed. Particularly, future research should focus on evaluating the effects of different population parameters and general practitioner demographics on patient satisfaction rates, as well as investigating if these influence the relationship between general practitioner communication strategies and patient satisfaction.
It is widely recognized that the nature of the populations that healthcare professionals engage with is evolving, thus meaning advances in clinical communication are essential. It is thus logical that stakeholders at all levels will continue to develop new and innovative ways of promoting self-efficacy and advocating for further funding support for future research and training in this important area. Finally, we can conclude that primarily because of the already diverse nature of patients engaging with healthcare services, it is essential that more emphasis is placed on investigating the patient-general practitioner relationship more closely and further developing and integrating effective communication strategies. Building on the findings of this literature, this study is designed to evaluate the effect of general clinical specialist communication strategies on satisfaction with specialist care in gastroenterology and hepatology clinics.