Breaking Down the Communication Barrier

Dr  Bridget Duffy picPhysicians, nurses and patients don't talk like they used to. There is a noticable lack of communication between these three parties, and it is decreasing patient care quality and satisfaction, says M. Bridget Duffy, MD, CMO of San Jose, Calif.-based Vocera Communications.

"The number one thing broken is communication," says Dr. Duffy, referring to the healthcare system. "From the time a person is diagnosed with a condition, while they're [in the hospital] and after they leave, communication is the key," she says.

Patient satisfaction is an integral part of a successful healthcare program, according to Dr. Duffy, who says every organization's top priority should center around this element.

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"One CEO said to me, 'My goal is to be the safest hospital in America,'" Dr. Duffy recalls. "Today it's not enough. Today our top strategic priority is to create an ideal healing experience and address the patient experience."

The broken system
It is said time and time again: the key to any relationship is communication. Yet a lack of communication remains the biggest barrier to patient satisfaction and patient experience, and it is the number one cause of adverse events, Dr. Duffy says. "There's a breakdown in the relationship from the absence of a voice or a connection by voice," she said. "It's the loss of the narrative."

This disconnect is present in different processes of the healthcare system and often mirrors breakdowns in leadership and hospital culture, Dr. Duffy says. One such element that disrupts the physician/nurse dialogue is the electronic health record.

The EHR has been praised for its data aggregation and analysis capabilites, but Dr. Duffy sees it as a communication barrier between physicians, nurses and patients. "It's a necessary tool, but we've lost the narrative of a doctor and nurse talking to each other about the patient. Instead, we enter our plan into a computer versus having a dialogue with somebody by voice," she says.

These new technologies are removing the physical presence of physicians and nurses from patients' bedsides, inhibiting the physician/nurse relationship once prevalent in healthcare settings. "[Physicians] knew every nurse by name, where their kids were going to college. They knew everything about the patient because they would round together at the bedside," Dr. Duffy says. "They really lost their own relationship and the way they communicated with each other."

Reconstructing communication
If communication issues are alleviated, Dr. Duffy sees potential for improved patient satisfaction and care quality in several healthcare processes.

To begin, healthcare providers should focus on balancing empathy and efficiency. The human experience is a significant player in patient satisfaction, but it tends to fall to the wayside when healthcare systems look to improve efficiency in their processes, Dr. Duffy says. "Efficiency is about taking out seven types of waste," she says. "Organizations should identify the gaps in empathy and communication and develop clinical and process innovations that improve the human experience that they can put back into the system....That creates an ideal experience for the patient."

Technological innovations are often efficiency driving tools, but instead of completely disregarding technological efficiency for the sake of bolstering communication, hospitals can use technology to enhance communication if it is integrated in an appropriate manner.

For example, the patient discharge process is full of paperwork and lengthy instructions that can be overwhelming to patients and time consuming for nurses. Instead of giving patients "sheets of meaningless paperwork," Dr. Duffy suggests implementing an application that creates an audio and visual recording of the discharge instructions to add a point of human contact to the process.

Transitions and handoffs between units and floors also present a risk for miscommunication that could be remedied by appropriately integrated technology. Instead of solely relying on paper checklists and verbal communication, Dr. Duffy suggests developing an electronic handoff system that can help ensure vital information is not omitted.

Patient-centered outcomes
Addressing these communication barriers provides the obvious benefit of better care for patients, and patient satisfaction drives improvement in other key hospital metrics.

"There's a direct correlation between patient experience and quality and safety," Dr. Duffy says. "When you truly listen to the voice of patients and understand what matters most to them, you improve compliance, engagement and loyalty to the organization."

Healthcare technology is a perpetually innovative field that will continue to introduce tools and devices that will expand the scope of what is humanly possibly, but healthcare providers cannot solely rely on technological advances to help people get better.

"One of my mentors early in my career said only 20 percent of healing is linked to technology. The other 80 percent is human-to-human interaction and the relationship the doctor has with the patient," Dr. Duffy says, and she sees more healthcare providers re-centering their priorities on their patients.

"The whole country is finally focused on what matters to patients," she says. "I believe the organizations making the greatest strides in improving the quality and safety and financial keys are those that are focused on improving the patient experience."

More Articles on Communication:

The Indispensable "5 C's" of Effective Communication in the Era of Obamacare
7 Recent Findings on Communication in Healthcare
AHRQ Communication Report Shows Significant Knowledge Gaps

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