Listen before you speak: A new approach to patient safety efforts

Hospitals dedicate large quantities of time, effort and finances to safety improvements to reduce preventable harm to patients. However, the biggest piece of the puzzle is often overlooked: Communication.

According to a whitepaper published by The Institute of Healthcare Excellence, studies have shown that poor communication between members of the medical staff accounts for more than half of all preventable errors.

"Communication is a key component to the service piece of the quality equation, and we as a medical community haven't devoted enough resources to it," said William Maples, MD, executive director and CXO at the Institute for Healthcare Excellence.

After 14 years of studying the links between preventable harm and improved communication, Dr. Maples developed a peer-to-peer Communication in Healthcare training curriculum, the goal of which is to improve quality, patient satisfaction and operating performance by cultivating a culture of excellence through relationship-based communication.

Five key takeaways from Dr. Maples' research and training curriculum are shown below.

1. Get physicians on board. The single most important factor in patient satisfaction is his or her interaction with the physician, so a successful healthcare communication program should begin with physician involvement, according to Dr. Maples.

"The way physicians connect with patients, staff and each other really affects the culture and tone of the work environment. It impacts the health of the people they take care of — their outcomes, their safety, their ability to understand a plan and to have a healthier life," Dr. Maples said in the whitepaper.

2. Identify physician leaders. Because Communication in Healthcare centers on peer-to-peer training, it is important to pick out which physicians will act as leaders and support the effort to encourage relationship-based communication, and ultimately, train their colleagues to improve their communication skills, according to the report.

In this specific training curriculum, which can be implemented or serve as a model in hospitals and health systems, formal and informal physician leaders within the organization are recruited to complete a five-day training program. The program includes training in communication and facilitation skills, such as mindfulness and presence, listening, information gathering without changing the story, agenda-setting, appreciative debrief and using PEARLS — partnership, empathy, apology, respect, legitimization and support — to connect physicians, nurses, allied health staff and patients.

After the five days of training, physician leaders pass these lessons on to their peers.

3. Emphasize the importance of listening to patients. "We've lost the art of listening. We think we're saving time because we know best. On average, we interrupt our patients within 18 seconds and often change what they really want to tell us," Dr. Maples said in the report. "Up to 30 percent of the time, we completely miss why the patient is there to see us. We need to rekindle the skills of listening, of recognizing emotion in the room and responding appropriately."

Demonstrating appreciation to patients as well as colleagues shows respect and honor. It also prevents burnout and apathy, and re-instills joy and resiliency for providers. Making a concerted effort to improve listening is integral to this.

Strong communication has a clinical impact as well. According to Dr. Maples, patient satisfaction research shows that when physicians or nurses talk to patients and acknowledge their pain, patients gain better control of their pain. At the point of discharge, thorough communication may prevent unnecessary emergency department visits or readmissions.

"We can be great technicians, but unless people know how much we care, they don't care about how much we know. That's our challenge," Dr. Maples said in the report. "It's the moment-to-moment conversations, the way we interact, that let people know how much we care. If we don't get that right, the rest will not flourish."

4. Use communication as a tool to re-instill value into healthcare jobs. Most that enter the field of healthcare are driven by a strong sense of care and compassion for others. However, the daily rush of events can overshadow this sense as providers do their best to "get the job done," according to the report. However, Dr. Maples contends that offering physicians, nurses and other healthcare providers with training to improve skills of mindfulness, listening and information gathering allows this drive to resurface.

5. Be prepared to invest time. Because Communication in Healthcare is meant to transform an organization's culture, administrators and providers must be aware the change takes time. According to the report, Dr. Maples describes his process for cultivating a patient-centered culture with relationship-based communication as "a slow, sustained IV infusion rather than a quick fix."

It may take nine to 12 months to see any noticeable benefits and up to four years to observe the maximum benefit, according to the report. However, leaders who are deeply committed to creating such a culture can expect a 5:1 return on their investment, Dr. Maples wrote.

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