“The number one problem with communication in healthcare is that people ask things like, ‘is there blood in your urine?’ Patients say no, because they think they’re supposed to see literal blood. Doctors need to ask this in a much simpler way, such as, ‘Is your urine any color other than clear or pale yellow?’ We don’t like to talk about gross things. That’s something that happened with my husband, Fred. They just checked the box and ruled out cancer. He had orange urine for a year. But he didn’t know that meant blood in his urine. He made the assumption that he wasn’t drinking enough water. He knew his urine could get darker if he was dehydrated or if he ate different things.”
This is the beginning of a story Regina Holliday shared in a new report from The Experience Innovation Network, part of Vocera. Regina is a patient activist and artist, and founder of the Walking Gallery of Healthcare. The report is called Clinical Communication Deconstructed: A framework for successful, human-centered clinical communication.
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In creating the report, we examined clinical communication extensively, from every angle. We reviewed scores of academic studies. We spoke with experts in clinical communication, current leaders and frontline practitioners in clinical practice, and – of course – patients.
Our efforts uncovered numerous challenges as well as promising solutions and innovative protocols to promote effective clinical communication.
What Is Effective Clinical Communication?
Communication is the lifeblood that makes healthcare work. More than just listening for facts, communication is at the core of building sacred, trusted, and healing relationships among doctors, nurses, patients, and families.
As an outcome of our research, we put forth a definition of effective human-centered clinical communication: Communication that enhances healing through the compassionate, connected, accurate, timely, and effective exchange of information and intent between or among people in a way that achieves the intended objective. Objectives may include exchanging information, enhancing understanding, driving action, facilitating teamwork and trust, easing suffering, etc.
The Power of Effective Clinical Communication
The quality of clinical communication affects every critical outcome in healthcare. Here are a few statistics highlighted in the report (edited for brevity):
- Cost: A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies.[i]
- Sentinel events: According to The Joint Commission, communication was the third most common root cause of sentinel events in 2014.[ii]
- Clinical outcomes: In interviews with cancer patients who perceived an avoidable and problematic event had occurred during their treatments, 47% believed the error stemmed from communication breakdowns alone.[iii]
Effective Clinical Communication Centers on Human Connection
A few themes rose loud and clear through our research, but one stood out above all others: The effectiveness of clinical communication depends on shared purpose and relationships. While tools and technologies can expedite access to the right person at the right time, the human connection between people will color the quality and efficacy of their communication regardless of the tool. While policies and protocols may define certain procedural aspects of communication, people and their trust and respect for one another will shape the tone, clarity, and completeness of a clinical exchange.
In clinical communication, as in so much of healthcare, human experience is paramount. The relationships team members foster with one another, the respect and transparency leaders instill in their culture, and the ways that individual clinicians safeguard the healing connections they share with patients and families are as important as any policy, protocol, or technology.
Framework for Effective Human-Centered Clinical Communication
What we learned through our research led us to create a framework for effective, human-centered clinical communication. It includes seven elements.
Table: The framework for effective human-centered clinical communication
The report deconstructs each element, exploring it in depth. Throughout, more than twenty healthcare leaders share their perspectives and insights. Sixteen comprehensive case studies demonstrate leading practices that have made a difference for caregivers and patients. Seven patients share their stories about how communication makes a difference in healing. Self-assessment questions at the end of each section help you gauge your system’s strengths and opportunities for improvement in each element area.
Recurring themes include:
- Building relationships that enhance communication
- Fostering well-being of physicians and nurses
- Facilitating patient relationships and caring for the whole person
- Helping people love their jobs again
- Learning how to truly listen
The report concludes by summarizing what leaders across healthcare should do to navigate the changes organizations will face as science, technology, and industry pressures evolve.
[i] Ritu Agarwal, M. B. A., Sands, D. Z., & Jorge Díaz Schneider BS, M. B. A. (2010). Quantifying the economic impact of communication inefficiencies in US hospitals. Journal of Healthcare Management, 55(4), 265. https://www.ncbi.nlm.nih.gov/pubmed/20812527
[ii] Joint Commission. (2015). Sentinel event statistics released for 2014. http://www.jointcommission.org/assets/1/23/jconline_April_29_15.pdf
[iii] Mazor, K. M., Roblin, D. W., Greene, S. M., Lemay, C. A., Firneno, C. L., Calvi, J., … Gallagher, T. H. (2012). Toward Patient-Centered Cancer Care: Patient Perceptions of Problematic Events, Impact, and Response. Journal of Clinical Oncology, 30(15), 1784–1790. http://doi.org/10.1200/JCO.2011.38.1384 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383179/pdf/zlj1784.pdf