Introduction
Effective communication is essential in all forms of human interactions, but it is particularly important in healthcare given that suboptimal doctor-nurse or practitioner-patient interaction leads to low patient outcomes. As a result, ineffective communication can cause poor quality of care. Failure in communication mostly occurs during shift change, when a patient’s care is handed over to an incoming care provider. When inaccurate, ambiguous, or incomplete information is exchanged during handovers, the probability of occurrence of medical errors increases. In some cases, poor communication has led to wrong diagnoses, treatment procedures, and medical prescriptions. Reviewing various categories of interactions within the healthcare system will enable an in-depth understanding of the effects of poor communication.
Impact on Healthcare
As the demand for multi-disciplinary delivery of care increases, there is a need to address the complexity of patient needs. There are numerous levels of communication in a healthcare facility, which can be broadly categorized into two groups: physician-nurse and nurse-patient interactions (Tan et al., 2017). Nurses and physicians constitute the most essential personnel providing direct care to patients; hence, effective communication between them is critical. However, gaps in information exchange are still prevalent, impacting quality, safety, and patient outcomes. With the existence of numerous contributing factors that hinder effective communication between physicians and nurses, the most prevalent ones relate to the innate nature of these professionals and the clinical environment in which they work (Tan et al., 2017). Additional contributing factors include their perceived understanding of each other’s roles, a practice environment that is considered disrupting, physician dominance over nurses, and their inherent ways of communicating.
Such complexities and challenges have been directly linked to unintentional patient outcomes, including prolonging patients’ stay in hospitals and subsequent harm resulting from treatment delays or errors in diagnosis. According to Kee et al. (2018), mistakes that arise from ineffective communication among different healthcare professionals constitute the second highest cause of sentinel events, accounting for between 210,000 and 440,000 deaths annually in the United States. Besides, the healthcare practitioners are also adversely affected by suboptimal interactions. Poor nurse-physician communication contributes to an increase in generating feelings of diminishing value, job dissatisfaction, and attrition in the nursing workforce (Tan et al., 2017). Ineffective interactions can be a result of faulty policies and procedures, poor documentation, and workload pressures. For instance, during a malpractice lawsuit conducted by CRICO, the defendant was accused of withholding information pertaining to abdominal pains experienced by a patient prior to a scheduled operation (Kee et al., 2018). The patient suffered from internal bleeding and later died due to hemorrhage.
Consequently, interactions between a patient and their primary caregiver are considered a fundamental component of care quality and safety. In the past decade, there has been a growing emphasis on providing patient-centered care, while maintaining autonomy, exemplifying the significance of effective provider-patient communication (Kee et al., 2018). Despite the efforts, poor communication skills among nurses and physicians are the main underlying reason for the increase in patient complaints. Creating an effective interpersonal relationship between doctors and patients provides a platform whereby the affected person can share vital information that is essential to have a correct diagnosis (Okpala, 2020). On the other hand, it enables physicians to have a better understanding of underlying problems, their causes, and patient needs.
Conversely, a breakdown in communication between the two parties is usually manifested in patient dissatisfaction with the services provided. In most malpractice claims, arbitrators attribute the effects of ineffective communication to the contrasting perspectives of doctors and patients. In this case, patients tend to prefer communication theories based on psychological models, as opposed to biomedical forms of interactions (Kee et al., 2018). On the other hand, doctors believe that they possess quality communication skills. Some of the issues arising from poor interpersonal communication between patients and clinicians include a reduction in the quality of care, high wastage( resulting in high cost of healthcare), and poor patient outcomes.
Communication Techniques Compared and Contrasted
Healthcare providers are aware of the numerous benefits that may result from effective communication. In order to realize these advantages, caregivers are encouraged to interchangeably utilize two forms of interaction: verbal and non-verbal methods. While there has been a continuous emphasis on improving verbal communication, researchers suggest that a majority of daily interactions are based on non-verbal cues (MedPro, 2018). The ability to use and understand unwritten or spoken communication is a powerful tool that can improve the relationship between patients and practitioners by reinforcing mutual understanding. However, non-verbal communication relies heavily on an individual’s situational awareness that enables one to identify potential body language and other cues that have the potential of being problematic.
There is a wide array of strategies that can be adopted by caregivers to consciously improve their non-verbal techniques. The most important one is smiling and maintaining appropriate eye contact that may not be interpreted as staring. Actively listening and showing interest while the patient is talking increases the likelihood of clients disclosing more information regarding their illness (MedPro, 2018). In this case, clinicians are advised to avoid distractive behaviors, such as yawning, fidgeting, constantly looking at the clock, or peeping out of the window. To display an engaging demeanor, physicians should sit down whenever it is possible and lean forward, and occasionally nod to indicate that they are attentive (Delgado, 2017). Lastly, maintain a relaxed posture by avoiding crossed arms or legs, as these gestures can be interpreted as disapproval, disinterest, or judgment.
Comparatively, verbal communication has received widespread emphasis as an important contributor to the formation of effective interpersonal relationships. While non-verbal models constitute only hand and body gestures, the verbal approach includes speech or written messages. In the medical field, this type of communication is extensively used to disseminate information regarding the facility or patient care. Verbal communication is particularly relied upon during the handover processes that usually take place during a shift change (Okpala, 2020). Professionals in the same specialization, such as nurses regularly consult with their colleagues on the different means of handling situations in a holistic manner. For example, a pediatric nurse might discuss the condition of a child under their care with a family practitioner or a general doctor.
Clinicians spend a considerable amount of time verbally communicating with their patients. It is important that the information is clearly conveyed and understood, especially regarding post-discharge instructions, such as prescribed medication and home-based hospitalization. Additionally, effective communication significantly improves a patient’s literacy on their health. In this case, doctors are expected to elaborate on difficult medical terms that might not be understood by their clients. Moreover, in the event that primary caregivers are unable to provide patients with the expected level of care depending on their diagnosis, doctors are required to refer them to specialists. Studies indicate that over 25% of primary caregivers who refer their patients to other professionals do not perform follow-ups to ensure that their clients are receiving the required medical attention (Delgado, 2017). This transference of care requires prior communication between the involved physicians, preferably over the phone or a physical meeting where the patient’s needs are clearly expressed while delineating their expectations on the continuity of health services.
Interdepartmental communication is important for all stakeholders involved in providing care. For example, hospital administrators rely on communication from doctors and nurses on issues pertaining to supplies, scheduling needs, turnover rates, and staffing needs (Okpala, 2020). While both communication models provide a wide variety of benefits, it is important to recognize how elements of either technique can interact and strengthen message delivery. However, a mismatch between verbal and non-verbal cues can result in inconsistent communication that leads to confusion. In healthcare, the inconsistencies can result in muddled messages that prevent patients from attaining the intended quality of care.
Effect of Systems of Power on Communication
Healthcare systems are inherently political, with structured hierarchical power dynamics. The sociological understanding of power is founded on the discovery and description of relative strength which might be equal or unequal and subject to change. According to Delgado (2017), based on the fact that power is not innate, authority can be acquired through the possession of influence or particular expertise. Hence, there is a need for social workers, especially healthcare providers, to properly understand their rankings within a power structure. Communication within a power imbalanced organizational structure is important, particularly when workers are expected to adhere to agency procedures whereby one person is accountable to several levels within the line of management. Since the employment of healthcare workers is dependent on their ability to satisfy their supervisors while maintaining quality care for clients, their power is usually diminished. This scenario is evident when student interns or graduate trainees are considered.
The powerlessness of social workers is restricted mainly based on statutory, budgetary, and procedural constraints instituted by high-ranking professionals. Feelings of helplessness can have adverse effects on how caregivers perform their tasks. Operating effectively under such circumstances relies on the ability to develop confidence, which is derived from commitment and a clear understanding of the different perspectives and significant value of their work (Delgado, 2017). The inescapable nature of power imbalances can interfere with effective communication by setting terms of interactions while restricting alternative avenues of discussion. Such practices can elicit strong emotions from those affected, causing further interference. However, these imbalances can be conveyed through proper communication channels, either verbally or non-verbally, and to relevant authorities.
Conclusion
Communication has been highlighted as the most important means of providing quality care. However, ineffective interaction can result in unfavorable outcomes, including patient death. An analysis of interdisciplinary levels of communications identified two broad categories: nurse-physician and caregiver-patient interactions. Poor communication between nurses and doctors might result in sentinel events, such as prolonged hospitalization and death. Alternatively, a breakdown of interpersonal relationships between clinicians and their patients contributes to low quality of care, poor diagnosis outcomes, and a general increase in the cost of healthcare attributed to wastage of resources. Two of the most prevalent communication techniques used to disseminate information between different healthcare stakeholders include verbal and non-verbal cues. An imbalance of power formed through hierarchical structures of management has a negative impact on communication.
References
Delgado, S. A. (2017) Increasing nurses’ palliative care communication skills. American Journal of Critical Care, 26(5), 372-372. Web.
Kee, J. W., Khoo, H. S., Lim, I., & Koh, M. Y. (2018). Communication skills in patient-doctor interactions: learning from patient complaints. Health Professions Education, 4(2), 97-106. Web.
MedPro Group. (2018). Nonverbal communication as an essential element of patient-centered care. Web.
Okpala, P. (2020). Addressing power dynamics in interprofessional health care teams. International Journal of Healthcare Management, 1, 1-12. Web.
Tan, T. C., Zhou, H., & Kelly, M. (2017). Nurse–physician communication – An integrated review. Journal of Clinical Nursing, 26(23-24), 3974-3989. Web.