“Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to open good communication with the patient, he or she may be of no help.” 1
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies conducted during the past three decades show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care.
Patients’ perceptions of the quality of the healthcare they received are highly dependent on the quality of their interactions with their healthcare clinician and team 2,3. There is a wealth of research data that supports the benefits of effective communication and health outcomes for patients and healthcare teams. The connection that a patient feels with his or her clinician can ultimately improve their health mediated through participation in their care, adherence to treatment, and patient self-management. 4, 5, 6, 7,8, 9
Yet, it is estimated that one-third of adults with chronic illnesses underused their prescription medication due to cost concerns; yet they fail to communicate this information to their physician 10. Another study found that less than half of hospitalized patients could identify their diagnoses or the names of their medication(s) at discharge, an indication of ineffective communication with their physicians. 11
The Institute of Medicine (IOM) Report on Health Professions and Training 12 has identified that doctors and other health professionals lack adequate training in providing high quality healthcare to patients. The IOM 12called upon educators and licensing organizations to strengthen health professional training requirements in the delivery of patient-centered care. The patient-centered care model 13 underscores the essential features of healthcare communication which relies heavily on core communication skills, such as open-ended inquiry, reflective listening and empathy, as a way to respond to the unique needs, values and preference of individual patients 14.
Healthcare Communication Outcomes
A clinician may conduct as many as 150,000 patient interviews during a typical career. If viewed as a healthcare procedure, the patient interview is the most commonly used procedure that the clinician will employ. Yet communication training for clinicians and other healthcare professionals historically has received far less attention throughout the training process than have other clinical tasks.
This is so even as evidence continues to mount that a structured approach to communication measurably improves healthcare delivery.
- Most diagnostic decisions come from the history-takingcomponent of the interview 15.. Yet, studies of clinician-patient visits reveal that patients are often not provided the opportunity or time to tell their story / history, often due to interruptions, which compromise diagnostic accuracy. Incomplete stories /history leads to incomplete data upon which clinical decisions are made.
- When interruptions occur, the patient may perceive that what they are saying is not important and leads to patients being reticent to offer additional information.
- The bottom line is that when patients are interrupted, it is a deterrent to collecting essential information and it hinders the relationship.
Adherence is defined as the extent to which a patient’s behavior corresponds with agreed upon recommendations from a healthcare provider 16. Certainly, we are all aware of the huge problem of non-adherence in health care. For instance, a Health Care Quality Survey 17conducted by the Commonwealth fund found that 25% of Americans report they did not follow their clinician’s advice and provides the reasons cited in this survey:
39% disagreed with what the clinician wanted to do (in terms of recommended treatment)
27% were concerned about cost
25% found the instructions too difficult to follow
20% felt it was against their personal beliefs
And 7% reported they did not understand what they were suppose to do
The core elements comprising patient satisfaction 18 include:
- Expectations: Providing an opportunity for the patient to tell their story.
- Communication: patient satisfaction increased when members of the healthcare team took the problem seriously, explained information clearly, and tried to understand the patient’s experience, and provided viable options.
- Control:Patient satisfaction is improved when patients are encouraged to express their ideas, concerns and expectations.
- Decision-making: Patient satisfaction increased when the importance of their social and mental functioning as much as their physical functioning was acknowledged.
- Time spent:Patient satisfaction rates improved as the length of the healthcare visit increases.
- Clinical team: Although it is clear that the patient first concern is their clinician, they also value the team for which the clinician works.
- Referrals:Patient satisfaction increases when their healthcare team initiates referrals relieving the patient of this responsibility.
- Continuity of care: Patient satisfaction increases when they receive continuing care from the same healthcare provider(s).
- Dignity: As expected, patients who are treated with respect and who are invited to partner in their healthcare decisions report greater satisfaction.
- An estimated one-third of adverse events are attributed to human error and system errors 19.
- Research conducted during the 10 year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors during that period.
- This means that when health care team members do not communicate effectively, patient care often suffers.
- Further, medical error vulnerability is increased when healthcare team members are under stress, are in high-task situations, and when they are not communicating clearly or effectively 19.
Why is team satisfaction important?
- Communication among healthcare team members influences the quality of working relationships, job satisfaction and profound impacts patient safety 19.
- When communication about tasks and responsibilities are done well, research evidence has shown significant reduction in nurse turnover 20 and improved job satisfaction because it facilitates a culture of mutual support 21.
- Larson and Yao 22 found a direct relationship between clinicians’ level of satisfaction and their ability to build rapport and express care and warmth with patients.
What are the elements that contribute to healthcare team satisfaction: Feeling supported, e.g., administratively and inter-personally, respected, valued, understood, listened to, having a clear understanding of role, work equity and fair compensation.
- According to Huntington and Kuhn 23, the “root cause” of malpractice claims is a breakdown in communication between physician and patient.
- Previous research 24 that examined plaintiff depositions found that 71% of the malpractice claims were initiated as a result of a physician-patient relationship problem. Closer inspection found that most litigious patients perceived their physician as uncaring 24. The same researchers found that one out of four plaintiffs in malpractice cases reported poor delivery of medical information, with 13% citing poor listening on the part of the physician 24.
Research evidence indicates that there are strong positive relationships between a healthcare team member’s communication skills and a patient’s capacity to follow through with medical recommendations, self-manage a chronic medical condition, and adopt preventive health behaviors. Studies show that the clinician’s ability to explain, listen and empathize can have a profound effect on biological and functional health outcomes as well as patient satisfaction and experience of care. Further, communication among healthcare team members influences the quality of working relationships, job satisfaction and has a profound impact on patient safety.
Clinicians and other members of the healthcare team conduct thousands of patient interactions during their career. The call to action from the Institute of Medicine (IOM) Report on Health Professions and Training 12underscores the importance of communication training for clinicians and members of the healthcare team. Similar to other healthcare procedures, communication skills can be learned and improved upon. Improvement in communication skills requires commitment and practice.
Given the wealth of evidence linking ineffective clinician-patient communication with increased malpractice risk, nonadherence, patient and clinician dissatisfaction, and poor patient health outcomes, the necessity of addressing communication skill deficits is of the utmost importance.
1. Asnani MR. (2009). Patient-physician communication. WestIndian Med J,58(4):357-61. pubmed
2. Clark, P. A. (2003). Medical practices’ sensitivity to patients’ needs: Opportunities and practices for improvement. Journal of Ambulatory Care Management, 26(2), 110-123. pubmed
3. Wanzer, M. B., Booth-Butterfield, M. & Gruber, K. (2004). Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Care Communication, 16(3), 363-384. pubmed
4. Duffy, F. D., Gordon, G. H., Whelan, G., Cole-Kelly, K., & Frankel, R. (2004). Assessing competence in communication and interpersonal skills: The Kalamazoo II report. Academic Medicine, 79, 495-507. pubmed
5. Heisler, M., Bouknight, R. R., Hayward, R. A., Smith, D. M., & Kerr, E. A. (2002). The relative importance of physician communication, participatory decision-making, and patient understanding in diabetes self-management. Journal of General Internal Medicine, 17, 243-252. pubmed
6. Renzi, C., Abeni, D., Picardi, A., Agostini, E., Melchi, C. F., Pasquini, P., Prudu, P., & Braga, M. (2001). Factors associated with patient satisfaction with care among dermatological outpatients. British Journal of Dermatology, 145, 617-623. pubmed
7. Safran, D. G., Taira, D., Rogers, W. H., Kosinski, M., Ware, J. E., & Tarlov, A. R. (1998). Linking primary care performance to outcomes of care. Journal of Family Practice, 47(3), 213-220. pubmed
8. Sullivan, L. M., Stein, M. D., Savetsky, J. B., & Samet, J. H. (2000). The doctor-patient relationship and HIV-infected patients’ satisfaction with primary care physicians. Journal of General Internal Medicine, 15, 462-469. pubmed
9. Zachariae, R., Pederson, C. G., Jensen, A. B., Ehrnrooth, E., Rossen, P. B., Von der Maase, H. (2003). Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British Journal of Cancer, 88, 658-665. pubmed
10. Piette, J. D., Heisler, M., & Wagner, T. H. (2004). Cost-related medication underuse among chronically ill adults: The treatments people forgo, how often, and who is at risk. American Journal of Public Health, 94(10), 1782-1787. pubmed
11. Makaryus, A. N., & Friedman, E. A. (2005). Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clinic Proceedings, 80(8), 991-994. pubmed
12. Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, D.C.: National Academies Press
13. Stewart MA. (1995). Effective physician-patient communication and health outcomes: A review. Canadian Medical Association Journal. 152:1423-1433. pubmed
14. Stewart M, Brown J, Donner A, et al. (2000). The impact of patient-centered care on outcomes. J Fam Pract.;49:805-807. pubmed
15. Peterson, M. C., Holbrook, J., Von Hales, D., Smith, N. L., & Staker, L. V. (1992). Contributions of the history, physical examination and laboratory investigation in making medical diagnoses. Western Journal of Medicine, 156, 163-165. pubmed
16. World Health Organization. (2003) Adherence to long-term therapies: Evidence for action. Switzerland: WHO Library Cataloguing. World Health Organization
17. Davis, K., Schoenbaum, S. C., Collins, K. S., Tenney, K., Hughes, D. L., & Audet, A. M. (2002). Room for improvement: Patients report on the quality of their health care. New York: Commonwealth Fund
18. Thiedke CC. (January 2007). What do we really know about patient satisfaction? Family Practice Management, 33-36. pubmed
19. Team strategies and tools to enhance performance and patient safety (TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Quality http://www.ahrq.gov/qual/teamstepps/
20. Lein C., & Wills CE. (2007). Using patient-centered interviewing skills to manage complex patient encounters in primary care. American Academy of Nurse Practitioners, 19:215-220. pubmed
21. DiMeglio K, Lucas, S. Lucas, & Padula, C. (2005). Group Cohesion and Nurse Satisfaction. Journal of Nursing Administration. 35:3 , 110-120. pubmed
22. Larson, E. B., & Yao, X. (2005). Clinical empathy as emotional labor in the patient-physician relationship. Journal of American Medical Association, 293(9), 100-1106. pubmed
23. Huntington, B., & Kuhn, N. (2003). Communication gaffes: A root cause of malpractice claims. Baylor University Medical Center Proceedings, 16, 157-161. pubmed
24. Beckman, H. B., Markakis, K. M., Suchman, A. L., & Frankel, R. M. (1994). The doctor-patient relationship and malpractice. Lessons from plaintiff depositions. Archives of Internal Medicine, 154(12) 1365-1370. pubmed
To contribute to understandings about acceptability and risks entailed in video-based research on healthcare communication. To generate recommendations for non-covert video-based research on healthcare communication − with a focus on maximising its acceptability to participants, and managing and reducing its risks.
A literature review and synthesis of (a) empirical research on participant acceptability and risks of video recording; (b) regulations of professional and governmental bodies; (c) reviews and commentaries; (d) guidance and recommendations. These were gathered across several academic and professional fields (including medical, educational, and social scientific).
36 publications were included in the review and synthesis (7 regulatory documents, 7 empirical, 4 reviews/commentaries, 18 guidance/recommendations). In the context of research aiming in some way to improve healthcare communication:
Most people regard video-based research as acceptable and worthwhile, whilst also carrying risks.
Concerns that recording could be detrimental to healthcare delivery are not confirmed by existing evidence.
Numerous procedures to enhance acceptability and feasibility have been documented, and our recommendations collate these.
Conclusion and practice implications
The recommendations are designed to support deliberations and decisions about individual studies and to support ethical scrutiny of proposed research studies. Whilst preliminary, it is nevertheless the most comprehensive and detailed currently available.