Effective Communication for Patient Safety

Medical errors, delays in care, bias and misunderstandings are most often the result in communication failures.  In fact, most lawsuits filed by patients and/or their families are the result of communication issues that sometimes lead to poor outcomes.  This is why it is so important for patients and their family caregivers to pay attention, speak up and advocate for themselves throughout their course of treatment and care processes.  The greatest risk is to assume that professional caregivers know what they are doing.  Keep in mind, they are human and imperfect like the rest of us.  Doctors and nurses can also be very busy... juggling the needs of multiple patients during a limited amount of time. Most importantly, they may have never lived and struggled with the health challenge(s) you or your loved one faces.

The following is a list of potential red flags and tips.  Red flags are those signs and feelings you get where you think a caregiver has forgotten about you, didn't understand you or might be inadvertently doing something wrong - giving you the wrong medication, taking an x-ray of the wrong body part, or documenting something that is incorrect in the medical record.  There is no way I can capture every possible communication failure, but I've tried to address some of the most common... observed during a long hospital and healthcare career.  Feel free to add examples you have observed to make this post more robust.

1. Each of us has bias that comes from our life experiences.  How many times have you made a judgement about a person and then later realized you were incorrect.  It can be easy for us to jump to conclusions or make assumptions about another person.  While healthcare professionals try not to let bias seep into their treatment of a patient or care decisions, it can still be a risk.  The best way to minimize the potential of bias is to fully communicate your symptoms, medical history and background relevant to your condition/care needs.  Also, ask questions to ensure that the healthcare professional has an accurate understanding of your situation.
2. Sometimes patients don't feel they have truly been heard.  When this happens, I suggest using CUS words.  No, these aren't bad words... it is a communication and teamwork strategy used by healthcare professionals.  They should also be used by non-healthcare professional members of the care team, such as, patients and their family/friend caregivers.  Use these exact words and you may certainly get their attention.

   I am Concerned!

   I am Uncomfortable!

   This is a Safety Issue!

3. Other times, a patient or family caregiver may feel as though they aren't believed - perhaps making it up or have ulterior motives - such as seeking pain medications. Some patients also find that the clinicians think this is all in their head - a psychiatric issue.  Here, too, CUS is an excellent strategy.  But, so is asking for/finding another clinician to provide a second opinion and/or requesting a consultation from a specialist.  If one still feels they aren't being believed, find someone who can advocate for the patient.  This could include a physician who already has a relationship with the patient, a friend or family member working in the healthcare industry or  representatives of local government or non-profit organizations who advocate for patients: Area Agency on Aging, Long-term Care Ombudsman, Disease Specific Associations, Adult/Child Protective Services, state licensing agencies, your  healthcare insurance company, etc.
4. If you simply want to ensure that there hasn't been any misunderstanding, flip a common patient education technique back on the healthcare professional.  When receiving discharge instructions or other education on their condition, patients may be asked to repeat back what they just heard from their doctor, nurse or other healthcare professional.  If you want to be sure that you have been heard and the healthcare team has an accurate understanding of your needs, respectfully ask professionals to repeat back what they heard you say.

At the end of the day, you may still feel frustrated.  You can ask to speak with patient advocates in the organization who are tasked with addressing patient complaints or conflicts between the healthcare team and patient.  If an advocate isn't available, ask to speak with the Nurse Manager, Nursing Supervisor, Director of Nursing, Medical Director, Patient Safety Officer, Risk Manager or Administrator.  Each of the people in these roles should be interested in minimizing conflict and risk, ensuring high quality care and improving patient outcomes/safety.  If you find they are not,  ask for a copy of your medical record and look for another healthcare organization/professional.

One last thing you can do... fill out a feedback/complaint form and see how the organization responds (if your condition isn't urgent).  And, always complete any patient satisfaction survey you may receive.  Hospitals, clinics, physicians and other care providers/facilities are increasingly having a portion of their revenue from insurance tied to patient satisfaction scores.  This change is being implemented by both private and public payers as an effort to reduce medical errors and improve patient outcomes.  Why?  Because, we know how important communications and teamwork are to high quality and safe care at a reasonable cost.