1.8. Support culture of effective communication 

1.8.1. Effective communication in work place 

Effective communication, which is timely, accurate, complete, unambiguous, and understood by the recipient, reduces errors and results in improved patient safety. Ineffective communication is reported as a significant contributing factor in medical errors and inadvertent patient harm. In addition to causing physical and emotional harm to patients and their families, adverse events are also financially costly. 

1.8.2. Elements of effective communication 

In healthcare, effective communication involves arriving at a shared understanding of a situation and in some instances a shared course of action. This requires a wide range of generic communication skills, from negotiation and listening, to goal setting and assertiveness, and being able to apply these generic skills in a variety of contexts and situations. Effective communication also requires individuals and teams having access to adequate and timely information necessary to perform their role effectively and appropriately. The use of technical terms and jargon, acronyms and abbreviations and diagrams to communicate can influence how well information is shared and therefore the effectiveness of communication. As in business, adhering to the five standards of effective communication in healthcare is likely to facilitate improvements in the exchange of information between healthcare professionals, and information should be: 

Complete- It answers all questions asked to a level that is satisfactory to those involved in the exchange of information 

Concise- Word expressions are shortened or omitted. It includes only relevant statements and avoids unnecessary repetition 

Concrete -The words used mean what they say; they are specific and considered. Accurate facts and figures are given. 

Clear -Short, familiar, conversational words are used to construct effective and understandable

Accurate -The level of language is apt for the occasion; ambiguous jargon is avoided, as are discriminatory or patronizing expressions. 

The World Health Organization Joint Commission reports that investing to improve communication within the healthcare setting can lead to: 

• Improved safety. 
• Improved quality of care and patient outcomes. 
• Decreased length of patient stay. 
• Improved patient and family satisfaction. 
• Enhanced staff morale and job satisfaction 

1.8.3. What factors contribute to communication failures in healthcare? 

There are several factors that could contribute to communication failure in health care settings. Some of these factors include: 

• Human factors; attitudes, behaviors, morale, memory failures, stress and fatigue of staff. 
• Distractions and interruptions. 
• Shift changes. 
• Gender, social and cultural differences. 
• Hierarchy or power distance relationships (for example, junior staff are reluctant to report or question senior staff). 
• Difference in training of doctors, nurses and paraprofessionals. 
• Time pressures and workload. 
• Limited ability to multitask even when highly skilled. 
• Lack of a shared mental model regarding what is to be achieved. 
• Lack of organization policies and / or protocols. 
• Organizational culture that discourages open communication. 
• Lack of defined roles and responsibilities among members of multidisciplinary teams 

1.8.4. A targeted approach for improved communication in healthcare 

Many factors have been reported as influencing effective communication in healthcare. These include individual abilities and characteristics, team behaviors and systemic factors and the lack of organizational support of a culture of safety. In addition, it has been suggested that improving communication requires a detailed understanding of the setting and context in which patient care is delivered and a commitment on behalf of a healthcare organization to a culture of safety and quality improvement, such as supporting team-based delivery of care. Sustainable improvements towards effective communication in healthcare settings involve synchronizing efforts across the three levels that is, the individual, the team and the organization. 

1.8.4.1. The individual 

a. Human factors, such as communication skills, fatigue and stress levels of staff, personality and attitudes, memory failures, and distractions and interruptions have been reported to influence the effectiveness of communication.

b. Individuals can develop many useful skills, including assertiveness, active listening and negotiation as a means of improving communication in healthcare. 

• Assertiveness — from time to time, a healthcare worker may feel it necessary to challenge a particular decision regarding patient care; however this may be difficult due to hierarchical power relationships between senior and junior doctors for example. Learning to be assertive, without being inattentive or aggressive is considered a positive move towards improved patient safety. 
• Active listening — this involves healthcare staff having the skills to listen, to stay focused on others‘ messages, and resist distractions. It also means keeping an open mind to others‘ ideas even if they disagree. You can tell if the healthcare professional you are talking to is a good listener from their eye contact, posture and facial expression. 
• Negotiating — this involves individuals developing self-awareness around differences in communication styles and skills to confer with health professionals from other disciplines, value others‘ perspectives and opinions and manage conflict if the situation arises. 

1.8.4.2. The team 

a. Multiple players are often involved in the management and delivery of patient care. Effective team communication essential in provision of health care to client‘s .While there is often an underlying assumption that healthcare professionals are inherently good communicators, the lack of formal training and assessment in this area would suggest otherwise. In critical work areas such as the operation theater, where there are different technical expertise and communication styles among members of multidisciplinary teams, communicating effectively is considered important if teams are to function optimally and ensure patient safety and quality of care. Members will have and this can compromise the effectiveness of communication. Skills development and training may be necessary to improve communication among teams. 

b. It has been reported that improved teamwork results in enhanced effectiveness, fewer and shorter patient delays, improved staff morale and job satisfaction, increased efficiency, and reduced levels of stress among staff 

c. The provision of feedback among teams assists in continuous improvement. Feedback is information provided for the purpose of improving team performance and should be focused on behaviors not personal attributes, and should be constructive and timely. 

1.8.4.3. The organization 

a. It has been reported that organizational culture plays an important role in facilitating and supporting effective communication across the organization. For example, open channels for communication, transparency and trust, assertiveness and strong leadership are considered important factors facilitating the effective flow of high quality information and the sharing of knowledge. An understanding of the workplace culture allows opportunities for targeted improvement such as enhancing communication among multidisciplinary teams. 

b. Leadership support — Communication within the health service can be improved with an organization providing strong leadership, through implementation of policies and procedures and identifying clinical leaders to drive improvements in communication and patient safety. 

c. Effective communication can be supported by a healthcare organization or institute which:

• Clearly links effective communication and teamwork to patient safety. 
• Clearly articulates the organization‘s expectation on how communication will be carried out. 
• Fosters a communication process that facilitates continuous improvement in patient safety and quality of care. 
• Assesses the current organizational culture of patient safety and identifies areas for improvement, for example, conducts an assessment of staff perceptions and current practice in the delivery and management of safe patient care. 
• Fosters and promotes a work culture that values cooperation, teamwork, openness, collaboration, honesty and respect for each other and promotes open and effective communication. 
• Creates an atmosphere where team members feel safe to speak up about issues relating to patient care regardless of their position or rank. 
• Provides resources and identifies appropriate communication strategies to ensure that information is effectively exchanged between people — depending on the situation, different communication methods may be required.