Communication Skills in Healthcare

1. Communication
Assumptions
Fatigue
Distractions
HIPAA

2. The Concept of Communication Skills
in Medicine
https://www.skillpro.com/webinar/communicating-to-reduce-misunderstanding-and-conflict-7/
Communication…
Just because you’re talking
doesn’t mean you are communicating

3. Effective communication is a skill all
healthcare professionals need, but one that
not all are naturally good at.
In the art of medicine there are three factors---the disease ,the
patient , and the doctor….
It is not easy for the ordinary people to understand why they are
ill or why they get better or worse , but if it is explained by
someone else , it can seem quite a simple matter---if the doctor
fails to make himself understood he may miss the truth of the
illness.
The forgotten
Art
Elliot-Binns E
3

4. 4
Objectives
 Describe the importance of communication
 Recognize the connection between communication and
medical error
 Define communication and discuss the standards of effective
communication
 Describe strategies for information exchange
 Identify barriers, tools, strategies, and outcomes to
communication

5. 5

6. 6
Importance of Communication
Ineffective communication is a root cause of nearly 66
percent of all sentinel events reported*
* (The Joint Commission Root Causes and Percentages for Sentinel Events (All
Categories) January 1995−December 2005)

7. 7
 The process by which information is exchanged between
individuals, departments, or organizations
 The lifeline of the
Core Team
 Effective when it
permeates every
aspect of an
organization
Communication is…
Assumptions
Fatigue
Distractions
HIPAA

8. 8.PRINCIPLES OF COMMUNICATION
CLARITY
ADEQUACY
ATTENTION
CONSISTENCY

9. Communication with peers
Mutual trust & respect
Exchange information
Ask your seniors

10. Communication & Medical care
● Good communication should be established between the
patient , the family and the treating multidisciplinary team.
● Patient & family should be encouraged to participate and
verbalize in the ward round discussion about:
 Offered medical care & treatment
 Rehabilitation
 Follow- up/re-admission plans
 Doubts & worries.
 Proper information to patient and family regarding services
available and how they can utilize them.

11. Communication skills: Some techniques
●PRACTICE- fluent dialogue with patient
●USE- silence effectively, allowing patient enough
time to express thoughts or feelings
●ENCOURAGE- patients with your supportive words
●UTILIZE - non-verbal communication

12. Listening vs Hearing
●Hearing - a passive activity; no effort
●Listening
 Attention
 Active involvement
 Full understanding
 Takes time and effort

13. Barriers to effective communication
●Personal attitudes
●Ignorance
●Human failings (tiredness, stress)
●Language
●Poor time management
●Strenuous working environment

14. Conclusion
●Effective communication is the key to success
in professional career.
●Good communication is essential for proper
doctor-patient relationship and help avoids
problems of misunderstanding.

15. Understanding why breakdown in
communication occurs
 Not including all stakeholders in the conversation
 Individuals are afraid of speaking up for fear of blame or
having an opinion being dismissed
 Nurses, doctors and other clinicians have all been taught to
communicate in different ways

16. Improving communication takes two forms
Improving the
mechanisms
for
communicating
Improving the
message being
communicated

17. How do we get everyone to leave with the
same message?
The
Message
Identify all of
your
stakeholders
Undertake a
stakeholder
analysis
All want to
improve
Role play
and train

18. I
S
B
A
R The I-SBAR team

19. Key driver
 Communication remains the foundation of patient safety.
 Numerous reviews of SI indicated poor levels of communication
in the handover of patient details contributed to the incident
 Improved communication = improved care

20. What is I-SBAR?
 Communication framework- avoid failures in
communication
 Originating from the nuclear submarine service
 Used extensively in medicine
 Safety focused
 Sets expectations
 Teamwork
 Acute clinical situations

21. I – S – B – A – R
• Identify – yourself and the patient
• Situation – what is the problem
•Background –information to contextualise the problem
•Assessment – your clinical assessment and prediction
•Recommendation – what you think should happen

22. Factors interfering with patient
satisfaction
 Poor communication
 Physician insensitivity
 Office foul ups eg Appointment delay

23. Principles Facilitating Communication
Process
 The rapport
 Time factor
 The message
 The attitudes

24. Rapport
 The development of communication skills that instill
in patients a sense of
confidence and trust by conveying sincerity and an
interest in their care and well-being.

25. Communication in the Consultation
Positive doctor behavior
At first contact
* Make the patient feel comfortable.
* Be unhurried and relaxed.
* Focus firmly on the patient.
* Use open ended questions.
* Make appropriate reassuring gestures.

26. Active listening
Listening includes four essential elements:
 Checking facts
 Checking feelings
 Encouragement
 reflection

27. Attitudes
Caring Responsibility
Empathy Trust
Respect Sensitivity
Interest Confidence
Concern Competence

28. Communicating Strategies
 Modify language
 Avoid jargon
 Clear explanations
 Clear treatment instructions
 Evaluate pt’s understanding
 Summarize and repeat
 Avoid uncertainty
 Avoid inappropriate reassurance

29. Follow up
 Ensure pt obtains results
 Ensure any promised follow-up is carried out.
 Arrange referral if inadequate response to Rx
 Act as an advocate if necessary.

30. The four key factors affecting
communication
The doctor
The patient
The environment
The message

31. Difficulties in Communication
Effective communication depends on four factors:
1. The doctor (sender)
2. The patient (recipient)
3. The message
4. The environment

32. The doctor Personal factors that influence
communication
 Age elderly , young
 Sex opposite
 Senses deafness , speech
 Competence health understanding ,
professional training
social awareness, empathy

33.  Attitude bias patient
attending
other doctors.
 Communication style
 Differences religion , sexual
practices,social class,
ethnic groups

34. Patient
Patient characteristics that influence consultation
 Age adolescent, elderly
 Sex opposite
 Senses deaf, blind, speech impairment
 Handicapped
 Illness acutely ill, injured

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Standards of
Effective Communication
 Complete
 Communicate all relevant information
 Clear
 Convey information that is plainly understood
 Brief
 Communicate the information in a concise manner
 Timely
 Offer and request information in an appropriate timeframe
 Verify authenticity
 Validate or acknowledge information

36. 36
Brief Clear
Timely

37. 37
Information Exchange Strategies
 Situation–Background– Assessment– Recommendation
(SBAR)
 Call-Out
 Check-Back
 Handoff

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SBAR provides…
 A framework for team members to effectively
communicate information to one another
 Communicate the following information:
 Situation―What is going on with the resident?
 Background―What is the clinical background or
context?
 Assessment―What do I think the problem is?
 Recommendation―What would I recommend?
Remember to introduce yourself.

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SBAR Example

40. 40
SBAR Exercise
 Create an SBAR example based on your
role.
 Situation – What is happening?
 Background – What is the background?
 Assessment – What do I think the
problem is?
 Recommendation – What would I
recommend?

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Call-Out is…
A strategy used to communicate
important or critical information
 It informs all team members
simultaneously during
emergency situations
 It helps team members
anticipate next steps
…On your unit, what information
would you want called out?

42. 42
Check-Back is…

43. Handoff
The transfer of information (along with authority and
responsibility) during transitions in care
To include an opportunity to ask questions, clarify, and
confirm

44. Handoff
 Optimized Information
 Responsibility–Accountability
 Uncertainty
 Verbal Structure
 Checklists
 IT Support
 Acknowledgment
Great opportunity for quality and safety

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“I PASS THE BATON”
Introduction: Introduce yourself and your role/job (include resident)
Patient/Resident: Identifiers, age, sex, location
Assessment: Relevant diagnoses and complaints, vital signs and
symptoms
Situation: Current status (e.g., ADL status, intake, elimination,
behavior, cognition), including code status, level of
uncertainty, recent changes, and response to treatment
Safety: Critical lab values/reports, allergies, and alerts (falls,
isolation, etc.)
THE
Background: Other diagnoses, previous episodes, current medications,
history
Actions: What actions were taken or are required? Provide brief
rationale
Timing: Level of urgency and explicit timing and prioritization of
actions
Ownership: Who is responsible (nurse/doctor/APRN/nursing assistant)?
Include patient/family responsibilities
Next: What will happen next? Anticipated changes?
What is the plan? Are there contingency plans?

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Communication Challenges
 Language barrier
 Distractions
 Physical proximity
 Personalities
 Workload
 Varying communication styles
 Conflict
 Lack of information verification
 Shift change Great
Opportunity for
Quality and Safety

47. Effective Communication
General information:
• Communication includes verbal and non-verbal messages
- Spoken words
- Written words
- Body language
- Listening, not interrupting
• Communication is impacted by the physical environment,
the people involved, their culture and individual
characteristics
• Effective communication happens when a message is
shared and easily understood by the patient
Source: PNTC

48. Common Communication Barriers and
Solutions
Common Barriers
 Physical environment
 Not listening to the patient
- Being distracted
- Judging the patient
- Information overload
- Focusing on a personal agenda
 Misperception of patient’s meaning
- Stereotyping and generalizing
- Rushing
- Distorted focus
- Making assumptions
- Getting mixed signals
 Poor verbal communication by navigator
- Lacking clarity
- Using stereotypes and generalizations
- Jumping to conclusions
- Dysfunctional responses
- Lacking confidence
Solutions
 Quiet, private, non-distracting location
 Effective listening
- Stop, look, listen
- Be empathetic
- Ask questions
 Accurate perception
- Analyze your own perceptions
- Work to improve them
- Focus on others
 Improved verbal communication
- Focus on the issue, not the person
- Be genuine rather than manipulative
- Empathize rather than remain detached
- Be flexible towards others
- Value yourself and your own experiences
- Present yourself as an equal rather than a
superior
- Use affirming responses
Source: University of Waterloo Centre for Teaching Excellence. n.d.

49. Strategies for Improving Communication
Active/Reflec
tive Listening
Open-Ended
Questions
Affirmations
Summarizing
Source: PNTC

50. Active/Reflective Listening
Active listening includes:
• Making appropriate eye contact early in the interaction
• Asking open-ended questions
• Attending to verbal and non-verbal cues
• Clarifying the information provided by the patient
• Clarifying the patient’s understanding of the information
provided by the doctor
Reflective listening includes:
• Statements that capture and return to patients something
about what they have just said and/or makes a guess about
an unspoken meaning
Sources: Commonwealth of Australia National Health and Medical Research Council. 2004;
Miller et al. 2002

51. Video
Click here to watch the video

52. Active/Reflective Listening
 Making eye contact with the patient
 Making a guess about meaning – “That sounds stressful,
being the sole provider”
 Asking an open ended question – “How do you take care of
yourself?”

53. Checkpoint
Which of the following would be considered active listening?
a) Asking open-ended questions to keep the
conversation going
b) Interrupting the patient to share a story about another
patient who had a similar situation
c) Paying attention to the patient’s spoken words alone
d) Guessing you know what the patient means

54. Open-ended Questions
What are open-ended
questions?
 Cannot be answered with “yes”
or “no”
 Allow for a fuller, richer
discussion
 Are non-judgmental
 Let the patients you work with
think out loud
 Allow them to do most of the
talking, using their own words
 Let them know the conversation
is about them
Open-ended Question Starters
Tell me about…
To what extent…
What does…
Help me understand…
How did you…
What, if any…
Source: Miller et al. 2002

55. Affirmations
I appreciate that
you are willing to
meet with me
today.
You handled
yourself really well
in that situation.
I’ve enjoyed
talking with you
today.
You are clearly a
very resourceful
person to cope
with such
difficulties for so
long.
That’s a good
suggestion.
It seems like you
are a very
spirited, strong-
willed person in a
way.
If I were in your
shoes, I don’t
know if I could
have managed
nearly so well.
Source: Miller et al. 2002

56. Summarizing
What is a Summary?
A summary restates the
key parts of the
conversation. The
summary may include:
• Thoughts
• Concerns
• Plans
• Reflections
How to Use a Summary
A summary can be useful in a
number of ways. It can help
the person:
• Recall the conversation
• Think of new ideas
• Plan their next steps
• Feel more confident
about moving forward
• Reinforce conversation
• Show you’ve been
listening
Source: Miller et al. 2002

57. Tips for Conversations
Summarize to make sure you understood
Ask more questions
Wait for patient to say more
Reflect back
Allow patient to answer
Ask open ended questions

58. Supporting Open Communication between
Patient and Provider
Build trusting
relationship
Share
information and
preferences
Discuss feelings
Be aware of
factors that may
affect a patient’s
communication
Source: National Cancer Institute - Communication in Cancer Care. 2013

59. Tips for Patients
 Be assertive
 Use “I” messages
 Active listening
 Match what you say in words with what you “say”
without words
 Express your feelings
Source: Cancer Survival Toolbox©. n.d.

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Barriers to Team Effectiveness
TOOLS and
STRATEGIES
Brief
Huddle
Debrief
STEP
Cross-Monitoring
Feedback
Advocacy and Assertion
Two-Challenge Rule
CUS
DESC Script
Collaboration
SBAR
Call-Out
Check-Back
Handoff
OUTCOMES
 Shared Mental
Model
 Adaptability
 Team Orientation
 Mutual Trust
 Team Performance
 Resident Safety!!
BARRIERS
 Inconsistency in Team
Membership
 Lack of Time
 Lack of Information Sharing
 Hierarchy
 Defensiveness
 Conventional Thinking
 Complacency
 Varying Communication
Styles
 Conflict
 Lack of Coordination and
Followup With Co-Workers
 Distractions
 Fatigue
 Workload
 Misinterpretation of Cues
 Lack of Role Clarity

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Teamwork Actions
 Communicate with team members in a brief, clear, and timely
format
 Seek information from all available sources
 Verify and share information
 Practice communication tools and strategies daily (SBAR, call-
out, check-back, handoff)

62. Be Patient
 One of the most important considerations when communication
with older adults is allowing them time.
 Showing any signs of stress or impatience could cause them to
shut down and close off from you.
 It is important to show your patient respect, regardless of their
age or cognitive ability, and dedicate the right amount of time to
allow them to express themselves, so to get the whole story.
 Another challenge you may encounter when communicating
with some older people is that they may not feel comfortable
speaking openly with medical professionals, like doctors.
 If you are their nurse, and available for their concerns, they may
be more willing to talk to you than to the doctor, who may only
spend five minutes in the room.
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63.  Using complicated medical terminology, or ‘jargon’, isn’t a
good way to talk to any patient, but it is particularly detrimental
when speaking with the older patient.
 Be mindful to put things so they are easy to understand, but
without coming across as condescending.
 Try to use language that is simple, clear and non-threatening,
while staying honest and true.
 Base your language on the questions put to you and the
cognitive ability of the patient you are speaking with.
 Be prepared to repeat yourself and express concepts in
several different ways to make sure your message is
understood.
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Watch Your
Language

64.  iSoBAR is a standardised mnemonic to improve
clinical communication.
 It stands for identification
Situation
Observation
Background/history
Agree to a plan (actions)
and Responsibility and Risk management.
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What is iSoBAR?

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 Speak slowly:
 Certain words sound very similar to one another if they are
spoken quickly.Take the time to speak slowly and carefully to
ensure your words are less likely to be mistaken by others.
 Speech volume:
 When communicating with some people, especially those who
are older, the inclination might be to raise your voice
dramatically in an effort to be understood. Instead of speaking
louder, try speaking with more clarity.
 Avoid slang and jargon:
 A common mistake that many health professionals make is to
use bigger and more complicated words.
 Another common mistake is the use of slang terms that are not
fitting or appropriate. Avoid both of these mistakes for better
communication

66.  Speak to your audience:
 What you say to a doctor or a fellow nurse might be very
different to what you would say to a patient and their family.
Use the word ‘medicine’ rather than ‘drug’ when talking to
patients. Many people associate the word ‘drug’ with illicit
substances, whereas health professionals view the word ‘drug’
as any pharmaceutical. Choose your words to fit the situation
and the audience.
 Use body language:
 The majority of human communication is understood to be
through body-language (Mehrabian 1972), despite our words.
Be conscious of what your body is saying and whether it is in
agreement with your words. Don’t send mix messages.
 Listen:
 Communication is a two-way street. One of the most important
communication skills is the ability to stop and listen actively and
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67.  Reflect:
 If you are a little unclear of what someone has said, reflect by
repeating what they have said in your own words, back to the
person. If you have misunderstood, this gives the person a
chance to clarify their meaning and shows you are actively
listening.
 Foreign Languages:
 It might sound strange, but learning a new language puts you in
better touch with your native tongue and can open your eyes to
the way you use the words you already know.

Don’t Forget Other Methods of
Communication:
 In addition to speaking and listening, don’t forget that there are
other skills that you should work on, such as reading, writing
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