High-qual­ity health­care isn’t pos­si­ble with­out ef­fec­tive, proac­tive com­mu­ni­ca­tion

Modern Healthcare - - COMMENT | GUEST EXPERT - By Dr. Stu­art Marcus In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­care.com/op-ed. Send drafts to As­sis­tant Man­ag­ing Edi­tor David May at dmay@mod­ern­health­care.com.

Health­care is the great equal­izer. Pa­tients aren’t wear­ing power ties or fac­tory uni­forms when they come un­der our care. The pro­to­cols and com­mu­ni­ca­tion skills nec­es­sary to safely and ef­fec­tively treat their ill­nesses cross all so­cial bound­aries.

When we look at er­rors in health­care, one of the root causes most of­ten iden­ti­fied is fail­ure of com­mu­ni­ca­tion among providers, or be­tween providers and pa­tients. And we know that one of the most im­por­tant tools for en­hanc­ing out­comes and pa­tient ex­pe­ri­ence is com­mu­ni­ca­tion with pa­tients and their fam­ily mem­bers all along the con­tin­uum of care, from the ini­tial en­counter pre-hos­pi­tal­iza­tion through the hos­pi­tal stay and in fol­low-up. An in­creas­ingly di­verse com­mu­nity and provider work­force can present sig­nif­i­cant chal­lenges to com­mu­ni­cat­ing ef­fec­tively.

Based in Bridge­port, Conn., St. Vin­cent’s Med­i­cal Cen­ter, the pri­mary teach­ing hos­pi­tal for the Frank H. Net­ter MD School of Medicine at Quin­nip­iac Univer­sity, serves a highly di­verse pa­tient base. Ap­prox­i­mately 45% of the nearly 150,000 peo­ple liv­ing in Bridge­port speak a lan­guage other than English at home. While our health sys­tem is for­tu­nate to have such a di­verse com­mu­nity, this at times can lead to cul­tural mis­align­ment and put us at risk for mis­com­mu­ni­ca­tion that can have ex­tremely se­ri­ous con­se­quences.

Our goal, like that of all hos­pi­tals and other health­care providers striv­ing to do their best, is to pro­vide high­qual­ity, per­son­al­ized, com­pas­sion­ate and re­spect­ful care to ev­ery­body who comes through our doors—and ef­fec­tive com­mu­ni­ca­tion is at the heart of that mis­sion.

Like the pa­tients we serve, the makeup of our hos­pi­tal staff is also broadly di­verse. In fact, the diver­sity in med­i­cal schools, res­i­dency pro­grams and prac­tic­ing providers is the great­est I have seen over the course of 30 years in health­care and is present in all spe­cial­ties, es­pe­cially pri­mary care. Ef­fec­tive com­mu­ni­ca­tion in this en­vi­ron­ment must be pur­pose­ful, struc­tured, ac­ces­si­ble and trans­par­ent.

Com­mu­ni­ca­tion may be just a sin­gle com­po­nent of the high-re­li­a­bil­ity or­ga­ni­za­tion model be­ing adopted by a grow­ing num­ber of the coun­try’s 4,653 acute-care hos­pi­tals, but it needs to be viewed as one of the most im­por­tant com­po­nents. In fact, sen­tinel event data col­lected by the Joint Com­mis­sion from 2004 through the third quar­ter of 2015 re­veal that lapses in com­mu­ni­ca­tion are con­sis­tently among the top three root causes of these events.

To be rec­og­nized as a model high-re­li­a­bil­ity or­ga­ni­za­tion—as the Joint Com­mis­sion has iden­ti­fied St. Vin­cent’s—a hos­pi­tal must be pre­oc­cu­pied with pre­vent­ing fail­ure. A cul­ture of pa­tient safety helps to en­sure the right mes­sage gets com­mu­ni­cated at the right time. We train our teams in best prac­tices to en­sure high-qual­ity com­mu­ni­ca­tion at all lev­els be­tween pa­tients, fam­i­lies, physi­cians, nurses, ther­a­pists, tech­nol­o­gists and hos­pi­tal staff.

All our hos­pi­tal staff, med­i­cal staff, res­i­dents and stu­dents are taught high-re­li­a­bil­ity tech­niques, which in­clude learn­ing how to com­mu­ni­cate with greater trans­parency us­ing spe­cific, eas­ily rec­og­niz­able phrases. For ex­am­ple, when they hear another provider say, “I’m un­com­fort­able” or “I’m con­cerned,” it’s time to pause, dis­cuss the con­cern, and re­assess the sit­u­a­tion be­fore pro­ceed­ing safely or al­ter­ing course. If some­one in the room says, “This is a safety is­sue” or “We have to stop,” that is a high­er­level alert that means do not pro­ceed; ev­ery­one needs to stop, lis­ten and take im­me­di­ate ac­tion to pre­vent im­mi­nent harm from oc­cur­ring.

Ef­fec­tive com­mu­ni­ca­tion is also non­ver­bal. It’s as sim­ple as vis­i­ble hand-wash­ing upon en­ter­ing a room, in­tro­duc­ing your­self clearly, sit­ting down, main­tain­ing eye con­tact and en­gag­ing in con­ver­sa­tion at a level that a pa­tient and fam­ily can re­late to and un­der­stand. Un­der­stand­ing is as­sessed by hav­ing im­por­tant in­for­ma­tion re­peated back by the pa­tient or fam­ily.

For pa­tients and fam­i­lies with lan­guage bar­ri­ers, it’s a best prac­tice to use trained in­ter­preters rather than have fam­ily mem­bers in­ter­pret health­care in­for­ma­tion. This en­sures ac­cu­racy and avoids fam­ily bi­ases from be­ing in­tro­duced. Trained in­ter­preters on-site are the best so­lu­tion, but tech­nol­ogy so­lu­tions also en­able an off-site trans­la­tor to in­ter­pret the con­ver­sa­tion.

Hos­pi­tals must as­sess their abil­ity to com­mu­ni­cate ef­fec­tively with pa­tients and their fam­i­lies in real time by us­ing the teach-back ap­proach, as well as by mon­i­tor­ing pa­tient-safety met­rics. Hos­pi­tal Con­sumer As­sess­ment of Health­care Providers and Sys­tems scores, which mea­sure many as­pects of pa­tient ex­pe­ri­ence, in­clud­ing ad­e­quacy of com­mu­ni­ca­tion, re­veal suc­cess over time.

Shar­ing a sin­gle­ness of pur­pose to de­liver highly re­li­able health­care to all and main­tain­ing a peak level of trans­parency with ef­fec­tive com­mu­ni­ca­tion must be an en­ter­prise man­date. It will keep you on your game ev­ery day.

Dr. Stu­art Marcus is CEO of St. Vin­cent’s Med­i­cal Cen­ter in Bridge­port, Conn., part of As­cen­sion Health.

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