Communication Matters
The medical community is paying more and more attention to communication with their patients due in part to financial incentives from payors such as Medicare and Medicaid, new models of care such as the patient-centered health home, competition among providers as a result of the Affordable Care Act, and perhaps most importantly, the simple recognition that better communication results in better patient care.
Provider-patient communication
Poor provider-patient communication drives up costs, and hurts the quality of care, since doctors may not hear the patient’s concerns and may miss important cues – including whether or not there may be underlying behavioral health issues. Patients who don’t understand their doctors are less likely to follow their treatment regiments, leading to poorer health outcomes. On the other hand, patients who do communicate well with their doctors are more likely to stick to their treatment plans and manage chronic disease such as diabetes, hypertension and cancer.
In a report produced by the SAMHSA/HRSA Center for Integrated Health Solutions, researchers identified interpersonal communication as a core competency for delivering integrated care by providers and all levels of staff, whether in the front office or back office. The report defines interpersonal communication as:
The ability to establish rapport quickly and communicate effectively with consumers of healthcare, their family members, and other providers. Examples include: active listening; conveying information in a jargon-free, non-judgmental manner; using terminology common to the setting in which care is delivered; and adapting to the preferred mode of communication of the consumers and families served.
Staff communication
The front office staff that check-in the patient, as well as the back office staff who are part of the medical team, are also essential in assuring good communication and customer service. Acknowledging the patient and family members right away, making eye contact, informing patients of longer than usual wait times, taking the time to answer questions, and showing appreciation and concern, will increase patient satisfaction.
Communication needs of special populations:
In addition to creating a health care environment where good communication is expected and supported, health care providers need to understand the unique communication needs of certain patient populations, such as patients who have behavioral health conditions, are not proficient in English, who are from other cultures, who have disabilities, or who have low literacy levels.
Check out the toolkit!
On this page you will find resources on general communication for all staff, clinician training, staff training and assessment, and communicating with special populations. Also provided are links to articles and other resources that offer strategies to improve communication in medical settings.
Tips for more effective interactions
Four simple things can make for a much more effective interaction (Drawn from Kaiser Permanente and featured in Frankel R, et al., Evaluating the patient’s primary problem(s). In Stewart M, Roter D, Communicating with Medical Patients, Sage Publications, 1989):
- Invest in the Beginning: Create rapport quickly; elicit the patient’s concerns; let the patient know what to expect
- Elicit the Patient’s Perspective: Ask for patient ideas; determine patient’s specific request or goal; explore the impact on the patient’s life
- Demonstrate Empathy: Be open to the patient’s emotions; make empathetic statements; convey empathy nonverbally (pause, touch, facial expressions)
- Invest in the End: Deliver diagnosis in terms of original concern; explain rationale for tests and treatments; summarize visit and review next steps
Tips for behavioral health provider communication
Behavioral healthcare providers who work with clients toward behavior health changes often share common issues related to communications overload and resistance to change. A few tips from Joan Kenerson King, Integrated Health Senior Consultant, for the National Council for Behavioral Health, can help overcome these complications:
- Collaborate with your client rather than directing and offering choices, whenever possible. Relying only on your expertise and not engaging the individual’s expertise about his or her own experience may lead to passiveness and half-hearted commitments.
- Share small amounts of information. Then, stop and check understanding before offering further information. Providing too much information at one time can lead the person to feel overwhelmed.
- Create opportunities for your client to voice his or her need for change and to express optimism about his or her ability to change. Attempting to force behavior change can lead to resistance and creates a power struggle that nobody wins.
Tools
General tips
- Caring Communication Skill: Giving the Gift of Positive Regard (.doc) — Customize this handout to help staff strengthen patient relationships and effectively appreciate, thank, or admire a patient, family member, or coworker.
- Fact Sheet: The Skills That Communicate Caring (.doc) — Customize this fact sheet for your organization.
- Caring Communication Skill: Explaining Positive Intent Fact Sheet (.doc) — Customize this fact sheet for your organization.
- Greetings Self-Check(.doc) — Use this short self assessment to see how you’re doing, then customize it for use throughout your organization.
- Assess Staff Greetings(.doc) — Customize and use this tool to review how staff are doing.
- AIDET in the Medical Practice: More Important than Ever (website) — Consider implementing this tool. The link provides a description of the Studer Group’s Five Fundamentals of Communication: Acknowledge, Introduce, Duration, Explanation, Thank you.
Clinician training
- AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety offers several resources to improving the patient experience. Although they address a hospital stay, most of the principles can be applied to an outpatient setting.
- We Are Partners in Your Care (.pdf) — Illustrates in flyer format how staff work to make sure clients get the best care possible. (Need to link correct flier)
- Overview of Communication Competencies (.pdf) —Identifies behaviors to help clinicians build partnerships with patients and families, leading to better health care quality and safety.
- Communication throughout the patient’s stay (.doc) — Suggests behaviors on how to engage patients and families.
- Three Keys to Improving Doctor-Patient Communication (.doc) — Offers a tool with three suggested actions.
- Tips For Provider Communication With Patients (.doc) — Provides a helpful summary of tips broken out by stages of a visit.
- Building Partnerships for Safe Care: Observation Form and Checklist for Clinicians (.doc) — Offers a tool to review how clinicians are doing.
Staff training and assessment
- Explaining Your Positive Intent: Worksheet for Staff Practice (.doc) — Includes a short worksheet with an exercise to engage your team in identifying statements of positive intent they can use regularly in situations they handle daily.
- Caring Communication Skills: Observation and Feedback Checklist (.doc) — Offers a tool to review how staff are doing.
- Shifting The Approach To Care (.doc) — This three pager covers how to Build on Principles of The Recovery Model, Encourage Self-Management For Mental Health And Substance Abuse Conditions, Use Person-Centered vs. Illness-Centered Treatment, and Promote Engagement Of Mental Health Clients In Health Care Settings.
Special populations
- Tips for Communicating with a Person with Mental Health Problems” (.doc)
- Advancing effective communication, cultural competence, and patient- and family-centered care: A roadmap for hospitals. The Joint Commission. (2010). Oakbrook Terrace, IL. See Appendix E for numerous references.
- The Joint Commission’s Health Equity provides links to numerous educational resources on advancing communication, cultural competence and patient- and family-centered care, as well as describing how to work effectively with special populations such as the LGBT community and limited English proficient (LEP) individuals. Although many of these publications are geared to hospitals, much of what they say also applies to the outpatient setting.
- Waiting Room Environment Policy and Procedure for Accommodating Persons with Mental Health Conditions (.doc) — Offers suggestions on how to review and improve your waiting area.
Articles
- Looking inward: Community health centers focus on staff to improve the patient experience. California HealthCare Foundation.
- Improving physicians’ communication skills. Hospital and Health Networks.
- Core Competencies for Integrated Behavioral Health and Primary Care. SAMHSA-HRSA Center for Integrated Health Solutions.
- Facts about Patient-Centered Communications. The Joint Commission’s efforts to improve communication between health care professionals and patients.
- The talking cure for health care: Improving the ways doctors communicate with their patients can lead to lower costs. The Wall Street Journal.