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 high-quality, 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 higher-level 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.