Communicating with patients and colleagues

How clinicians communicate with a patient can profoundly impact on a person’s care experience, and it has been shown that effective communication and engagement with patients can positively influence person’s health outcomes, reduce readmission to hospital following discharge, and prevent adverse events during care. An adverse event is an incident that results, or could have resulted, in harm to a patient or consumer. A near miss is a type of adverse event.

Effective patient-clinician communication involves two-way communication (spoken, written and non-verbal) that engages patients in decision making and care planning. It is tailored, honest, and respectful and there is an opportunity for clarification and feedback.

The table below describes the essential elements for effective patient-clinician communication, why each element is important to the safe delivery of high-quality care, and how the elements can influence patient outcomes.

Communicating effectively with patients, families and carers involves:

• Building relationship
• Providing structure
• Initiating the session
• Gathering information
• Explanation and planning (includes risk communication and shared decision making)
• Closing the session.
   

• Introducing yourself
• Requesting permission from the patient before doing anything to or for them
• Describing the roles of each person in the care team
• Letting the patient know who is responsible for their care at any point in time, and keeping them informed about their care plan
• Inviting the patient to participate in their transition of care; let them know they are welcome to ask questions or raise concerns
• When possible, and if they choose to, involving the patient’s family and carer in communication about their care
• Letting the patient know about any expected transitions of care, why they are happening and approximate timeframes (e.g. shift changes, moving wards, or going for a test or procedure)
• Re-checking the patient’s needs, preferences and goals and allow them time to tell you of any changes, concerns or questions about their care
• Acknowledging and addressing their pain, discomfort or distress, when appropriate
• Notifying the family and carer of any moves and/or changes to the patient’s care or health status.

To improve effective communication, clinicians may use specific, structured techniques to share information with each other. Examples of strategies and techniques include:

• Structured communication tools – Structured communication techniques can be used to standardise communication between two or more people. It helps to set expectations within the conversation and provide specific, relevant and critical informational elements that are going to be communicated every time a patient is discussed. One example is the ISOBAR tool, which stands for Introduction, Situation, Observation, Background, Assessment and Recommendation.
• Briefings – short, structured meetings where the team comes together to talk about a patient, procedure or situation. Good briefings set the tone for team interaction and ensure that every member of the team has a shared mental model of what is going to happen during the process, identify any risk points and avoid surprises. Successful briefings are concise, involve everyone on the care team, and demonstrate two-way (or multi-way) conversation.
• Debriefings – are the concise exchange that occurs after an event, process or procedure to identify what happened, what was learned, what went well and what can be done better next time. Effectiveness of a debriefing will depend on the effectiveness of the briefing. A debriefing conversation should focus on the common goal and have a positive tone.
• Critical language – is an agreed on set of terms or common language that indicates to all members of a patient care team that there is a problem or concern. This could include phrases like ‘I need some clarity’ or ‘I am worried about’. Teams that respond to critical language know that when this type of phrase is spoken they need to stop, take a moment and ensure that everyone on the team is on the same page.
• Common language – avoiding the use of acronyms and jargon that may exclude members of the care team who are not within the same profession and using plain language to ensure a shared understanding.
• Situational awareness – refers to the care team maintaining an awareness of the ‘big picture’ and thinking ahead to plan and discuss contingencies. There is an ongoing dialogue, which keeps members of the team up to date with what is happening and how they will respond if a situation changes.
• Check-Back or closed-loop communication – a strategy that ensures messages and information are received. It is a closed-loop strategy that is used to verify and validate information exchange between two people. The sender initiates a message, the receiver accepts the message and confirms what is communicated, and the send then verifies that the correct message was received.

Shared decision making is an essential part of planning care and involves the integration of a patient’s values, goals and concerns with the best available evidence about benefits, risks and uncertainties of treatment, in order to achieve appropriate health care decisions.

Research indicates that:

• Patients are less informed and involved in making decisions about their health care than they would like to be
• Shared decision making can improve satisfaction with care and leads to better quality decisions
• Patients using evidence-based decision aids have improved knowledge of the options, more accurate expectations of possible benefits and harms, and feel that they had greater participation in decision making than people receiving usual care
• Better-informed patients make different, often more conservative, less costly choices about treatment, because it is thought that information provides a realistic appreciation of likely benefits and risks of treatment and enables decisions about the potential outcomes in a more considered way.

For more information and resources see:

How to share decision making with your patient – Receives care

Effective teamwork and communication is critical to functioning safely in complex and dynamic situations, such as health care. They are essential to ensuring that a person receives continuous and coordinated care and enables groups to work together to navigate competing priorities, overcome issues that are associated with human factors and reduces the risk of error. Most importantly, it improves patient and family outcomes by improving the diagnostic and prognostic capabilities of health professionals.

Effective communication relies on a complex set of skills, including how well a person is able to interact with others, the ability to gather and synthesise relevant information, clinical reasoning, dealing with conflict or challenging conversations, and communication of information in a structured and meaningful way.

Principles for effective teamwork

Each health care team is unique, with its own purpose, size, setting, set of core members, and methods of communication. However, core principles that are important across all teams have been identified as: a shared understanding of who is part of the team, shared goals of care, clear roles and responsibilities, mutual trust and respect, effective communication and measurable processes and outcomes (see Table 1).

Communicating effectively with other members of the care team and teamwork

• Undertaking structured communication
• Using agreed and common language
• Using ‘check-back’ or closed-loop communication - a strategy that ensures messages and information are received
• Having situational awareness
• Documenting essential information.

Table 1: Key principles of teamwork

While effective communication is described in Table 1 as one principle that influences the reliability of a team, in practice effective communication is necessary across all principles.

For example, to establish shared team goals, members will have to effectively communicate with each other and the patient and their families. Similarly, clear roles and responsibilities requires team members to engage in open, honest and ongoing discussions about the level of preparation and capacities of each team member to best use individual skills, expertise and resources to meet shared goals. Therefore, strategies to improve interdisciplinary team communication will need to consider how communication can support all of these principles.

Ensuring the right care is given to the right patient is an essential part of safe care. Patient identification is an activity that is performed routinely in all care settings and can often been seen as a relatively unimportant task. However, it is vital that safety processes are adopted for common tasks to prevent simple mistakes that can lead to patient harm.

Mismatches between patients and their care can have significant consequences including death or major permanent loss of function. While not always resulting in harm, failure to correctly identify patients and match that information to an intended treatment or intervention may result in procedures being performed on the wrong person, wrong side or wrong site; medication errors; blood transfusion errors; and errors in diagnostic testing. The diligent use of checklists and tools to correctly identify patients and match them with their intended treatment helps prevent errors from occurring.