Good communication - The cornerstone of patient-centered care

Manjushree Takhellambam *

Patients' perceptions of quality of the healthcare they receive are highly dependent on the quality of their interactions with their healthcare clinician and team. Effective communication impacts patient safety, quality and patient satisfaction. In today's healthcare environment, most caregivers face the competing challenges of limited time for patient interaction.

How effectively clinicians communicate with patients has emerged as a very important issue in healthcare. Delivery of healthcare is a complex process which involves lot of human interaction between patients/families and healthcare workers and among healthcare workers as well.

Every patient is an individual who has his/her own special needs and what is important for one person may be insignificant for another. Good communication is the only way that helps health professionals to identify those individual needs. It plays a significant role in the outcome of the whole treatment.

The purpose of effective communication is to share a common meaning. In healthcare settings, non verbal communication is particularly important in establishing and maintaining a good relationship. Patients are sensitive to healthcare providers' nonverbal behaviors because they are often nervous and insecure and want to observe the true feelings of the provider.

In seeking information about their health and prognosis, patients not only pay attention to the information but also to the manner in which it is communicated. A subtle gesture, a change in vocal tone, or too little or too much eye contact may result in a very different interpretation of a message by a patient. Thus, often it is the providers' nonverbal behavior that leads the patient to trust or mistrust or like or dislike them.

Some areas like consenting, patient doctor interviews, and nursing assessment need to be stressed upon making the communication effective. Greeting, listening patiently, having a favorable body language which includes body posture, eye contact etc., showing empathy, avoid unnecessary medical jargon, clearing the doubts and confirming whether they have any questions are some of the practices for effective communication.

Diagnostic accuracy depends on the patient – clinician interaction. Most diagnostic decisions come from the history-taking component of the interview. Yet, studies of clinician-patient visits reveal that patients are often not provided the opportunity or time to tell their story/history, often due to interruptions, which compromise diagnostic accuracy.

Incomplete stories/istory leads to incomplete data upon which clinical decisions are made. Interruptions not only lead to inaccurate diagnosis but also create a hindrance in the relationship. Patient satisfaction increases when members of the healthcare team takes the problem seriously, explains information clearly, and tries to understand the patient's experience, and provides possible options. Researchers found that most litigations from patients are due to breakdown in communication between clinician and patient which led the patient perceive their clinicians as uncaring.

Some areas where communication leads to patient safety incidents are handing over, communication in emergency situations etc. There are various methods recommended by NABH(National Accreditation Board for Hospitals & Healthcare Providers) and JCI (Joint Commission International) for doing the handing over which are being practiced by most of the organisations.

Team collaboration is another essential component of quality care. When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, etc. Joint Commission cites communication failure as the leading root cause for medication errors, delays in treatment, and wrong-site surgeries. Effective clinical practice thus involves many instances where critical information must be accurately communicated.

Health care facilities have historically had a hierarchical organizational structure, with significant power distances between physicians and other health care professionals. This frequently leads to a culture of inhibition and restraint in communication, rather than a sense of open, safe communication.

Differences in education and training among professions often result in different communication styles and methods that further complicate the scenario and render communications ineffective. Although teamwork and effective communication are crucial for safe patient care, the educational curricula for most health care professions focus primarily on individual technical skills, neglecting teamwork and communication skills.

As a means of improving patient safety and outcomes, interventions should focus on integrating the critical attributes of collaboration including open communication, shared responsibilities for planning and problem solving, shared decision making and coordination.

In spite of being an important determinant of patient safety and satisfaction, communication is not a part of healthcare curriculum. Organizations have to try hard to improve communication skills of its staff as communication plays a major role in quality.

With the help of patient feedbacks, complaints and analysis of incidents, issues related to communication should be identified and appropriate training to concerned personnel should be given as a preventive action. The training can happen in the form of group discussions, role-plays, videos etc. The purpose of effective communication is to bring both the patient and health providers to a level of understanding that will aid the provider in delivering patient- centered care.