What the doctors wanted us to hear: “You CANNOT, under ANY circumstances, send your 83-year-old diabetic, dialysis-dependent father back to his house where your 78-year-old mother, who’s showing signs of dementia, is his primary caregiver.”
What my brothers and I heard: “You know, it might be time to think about considering the possibility that your dad should move to a facility where he can get better round-the-clock medical care.”
This conversation happened after my dad was hospitalized because his insulin pump was out of insulin for two days. His blood sugar rose to somewhere around 2,000 and his body dropped to the floor in the middle of the night. This was a dangerous diabetic coma.
Now, looking back, we realize the doctors knew what they were talking about. We know we should have found an assisted living facility or nursing home right away.
But here’s the thing. The doctors likely had that same conversation with hundreds of patients and their families over the years. They must have thought the message was clear and that we got it and would comply.
But for my family, it was the first time we ever had that conversation. We didn’t understand the seriousness of what they were saying. Besides, my dad seemed fine after their excellent treatment. So the message didn’t take.
And three days later, my dad was back in the hospital.
The question is, what could the doctors have done differently? How could they have helped us see how truly fragile my father’s condition was?
That question is what I want to cover in this article. And I hope healthcare leaders will read this and consider ways to improve the way clinicians communicate with patients and families.
Because I’m your customer. I’m not a clinician. I’m an observer who did in-depth research and thinking about my family’s hospital experience. I’m also an IT guy at a hospital, so I’m familiar with healthcare terminology. And I’m a systems guy who believes many problems can be fixed better by working on the system rather than individual behaviors of people.
So that’s what I’m going to do here. I’ll look at the patient communication system and offer six strategies for improving the system.
Thanks in advance for considering my ideas.
For this article, patient communication is:
It’s no surprise that patients are unhappy with arrogant doctors who have the bedside manner of a sliver. But the tremendous benefits of consistent, effective patient communication seem disproportional to the financial cost and effort it requires.
We have studies going back 35 years that prove the power of excellent patient communication:
“As an element of best practice, the effectiveness of patient-clinician communication can be as important as that of a diagnostic or treatment tool and should be the product of similarly systematic assessment and evaluation.” – Institute of Medicine
That quote from the Institute of Medicine is worth a second look. The Journal of the American Osteopathic Association said it this way: “Research has shown that effective patient-physician communication can improve a patient’s health as quantifiably as many drugs.”
Effective communication is as helpful as many drugs!
Here’s a list of foundational tips for good communication with patients:
These are essential communication skills for every clinician to learn and practice.
But there’s also a system layer that can raise the quality and effectiveness of patient communications.
This is where the systems approach comes in. I’m going to introduce several strategies that any organization can implement. You don’t have to use all of them, but there’s a dynamic synergy between them. They feed off each other and build on each other. The more strategies you implement, the stronger your organization’s communications system you’ll have.
I love this strategy because it’s easy to remember. Just three steps with two ingredients formed like a sandwich. Or an Oreo.
Ask-Tell-Ask works well when a patient or family member is ending their office visit or being discharged from the hospital. It allows you to make sure they understand what happened and what they should do after they leave.
There are variants of Ask-Tell-Ask, but in general, it works like this:
Seek first to understand, then to be understood. That’s how Steven Covey summarizes empathic listening in his bestseller, The 7 Habits of Highly Effective People.
The strategy of empathic listening is especially useful when discussing a patient’s health care because it can be a highly emotional interaction. Empathic listening helps you deeply understand the patient and their unique challenges and goals. It can give you an insightful answer to the question, “how does this patient feel?”
Here’s a good summary of seeking first to understand, then to be understood, which is a perfect strategy to use during the Ask-Tell-Ask technique. We’re building our patient communication system.
We expect patients and their families to respect healthcare workers. They depend on the care team to get and keep them healthy.
But patient outcomes improve in an atmosphere of mutual respect where patients feel like their care team members return the respect. Because if patients feel respected by their doctors and nurses, they’ll take a more active role in their health. Coaching increases patient engagement. Patients ask better questions and offer helpful suggestions. And you’ll get a truer picture of your patient’s perspectives.
Now, the idea of mutual respect is foreign to most patients. They believe their role is to listen to what the clinicians say and then do it. So how do you get them to expect mutual respect, and to act as if they are a valuable and respected member of their health care team?
Researchers at Tufts University discovered the answer in the 20-minute coaching session. While patients were waiting for their physician, a coach helped them figure out what they wanted to get from their time with the physician. The coach provided tips for overcoming anxiety, timidity, and embarrassment when talking with the physician.
The researchers reported these results:
Imagine how lively the Ask-Tell-Ask session will be after patients have been coached to expect mutual respect. Our system of communication strategies is growing stronger.
The last ten years gave us dramatic improvements in secure, HIPAA-compliant options for patient communication using mobile devices. An example is TigerConnect’s TigerTouch system.
TigerTouch allows patients to communicate with their physician and other care team members through an app on their Smartphone. The app supports not only phone calls and text messages but also photo sharing and video conferencing.
Two common TigerTouch workflows are pre-op preparation and post-discharge follow-up. They keep the patient engaged with their care team, which drives results like lower readmissions and quality patient care.
A telecommunications system like TigerTouch is the perfect extension of a coaching program that trains patients to expect mutual respect. Coached patients will immediately see the value of telecommunications technology in their health journey. Our communications system is evolving into a long term, comprehensive system now!
TigerTouch is part of a suite of clinical communications software solutions. They support not only communications between care teams and patients but also bring substantial improvements to care team communications.
Peter Drucker told us, “if you can’t measure it, you can’t improve it.”
We can also observe that “you get what you measure.” This means that if people know you’re monitoring something, they’re going to make an effort to get better scores.
Putting these two statements together makes the final strategy’s value leap out at us. You must measure the efforts and effectiveness of patient communication. Otherwise, four things will happen:
I suggest you add communication questions to your patient satisfaction survey AND your employee surveys. If clinicians know you measure it, they’ll know it matters to leadership, and they’ll adjust behavior to reflect the awareness.
Also, as you implement the other strategies, add questions to your surveys so you can measure how well your employees are adopting the strategies.
Here, then, are my six simple strategies for mastering patient communication.
1. Institute a process to measure the effectiveness of patient communication. NOTE: This should be the first strategy you implement. If it’s not, all other strategies are at risk of failure until you begin measuring them.
You may implement the next five strategies in any sequence.
2. Encourage clinical staff to continuously improve the basics listed in the “How do you Communicate Effectively with Patients?” section above.
3. Roll out Ask-Tell-Ask throughout your organization. Develop a short training video to demonstrate and support the Ask-Tell-Ask strategy.
4. Roll out Empathic Listening as an organization-wide patient communication strategy. Develop a brief training video to demonstrate and support it.
5. Coach your patients to expect mutual respect. Identify clinical and non-clinical staff who are excited about this strategy. They will be your coaches.
6. Implement telecommunications technology so your patients can engage regularly with their care team. Consider a complete healthcare communication platform.
Your new patient communication system will benefit from any of these strategies you can implement. You don’t need them all. However, if you can implement all six throughout your organization, you’ll experience a strong synergy and can expect a lasting, effective patient communication system.