Failure to effectively communicate is one of the most cited underlying causes of negligence claims and complaints within the Australian healthcare system1. In recognition of the importance of developing effective clinical and non-clinical communication skills, patient-clinician communication competencies are reflected across all of the National Safety and Quality Health Service (NSQHS) Standards2.
Developing your communication skills
While effective communication is a core competency in healthcare, it is one that may not come so easily to some and requires skill. The good news is that this skill can be learned and improved with practice3.
Building rapport with patients. Choose an adequate time to formally introduce yourself and break the ice by engaging in small talk about the weather, current news, sport or entertainment.
- Busy, high-stimulus environments with lots of people
- Speaking about emotionally-charged topics
- Approaching someone when they are distracted, stressed or anxious about an unrelated matter.
Be mindful of your body language and non-verbal communication. Actions speak louder than words. Your posture, tone, gestures and any nonverbal signals you use to communicate convey your emotions. Consider adopting positive body language by:
- Taking a moment to exercise calm and to control your posture, tone and nonverbal communication before engaging in a situation you anticipate may prove difficult to manage.
- Maintaining eye contact – it conveys honesty, openness and interest in the other party.
- Relaxing your facial expressions
- Avoiding crossing your arms, keep them just in front of you.
- Getting down to the level of the person with whom you are interacting. For instance, if your patient is in a bed crouch down rather than towering over them while maintaining an appropriate distance.
- Using a calm and caring tone to de-escalate difficult interactions – known as the “emotional contagion effect4” where your emotions, tone of voice and attitude leads to the reflexive mimicking of the same behavior by individuals in close proximity.
Speak slowly, avoid slangs and jargon. One way to make sure you are understood is to avoid using complex medical terminology or slangs that may be difficult to interpret for some patients. Things to avoid:
- Raising your voice – instead try speaking with greater clarity
- Using words and terminology that is not appropriate for the audience – for example, use the word ‘medicine’ instead of ‘drugs’ with patients, to avoid confusions.
Communicating effectively with other healthcare practitioners
Successful communication and transfer of information between healthcare practitioners is a fundamental aspect of patient centred care, patient safety and achieving high quality care outcomes. Several frameworks have been developed to foster effective teamwork and communication5. You may consider:
- SHARED Framework.
- SITUATION: reason for communication. Who are you? Why are you communicating? Who are you communicating about?
- HISTORY: any relevant information about a patient’s current presentation.
- ASSESSMENT: observations, tests, assessments & results.
- RISK: relevant and important information to keep the patient safe.
- EXPECTATION: What needs to be done? In what time frame and by whom? Anticipated responses & outcomes.
- DOCUMENTATION: Important and relevant information written in the appropriate clinical record.
Medical Board Code of Conduct (Dental Board has similar requirements)
3.2 Good patient care
- Recognise the limits of your competence and scope of practice and work within those limits.
- Maintain clear, contemporaneous, and accurate records.
- Take steps to alleviate patient symptoms and distress, whether or not a cure is possible.
- Assess the balance of benefit and harm in all clinical-management decisions.
- Communicate effectively with patients.
- Support the patient’s right to seek a second opinion.
- Consult and take advice from colleagues, when appropriate.
4.3 Effective communication
- Listen actively.
- Ask open-ended questions.
- Ask patients how they manage their condition.
- Inform of the need and nature of treatment.
- Discuss available options of treatment.
- Inform of risks associated to treatments.
- Answer questions and maintain dialogue about their progress.
- Meet cultural/linguistic needs.
6.2 Coordinating care
- Convey all the relevant information in a timely manner.
- Facilitate the central coordinating role of the general practitioner.
- Advocate the benefit of a general practitioner to a patient who does not already have one.
- Ensure that it is clear to the patient, the family and colleagues, who has ultimate responsibility for coordinating the care of the patient.
- Understand your individual role as part of the team and fulfilling the responsibilities associated with that role.
- Advocate for a clear delineation of roles and responsibilities, including that there is a recognised team leader or coordinator.
- Communicate effectively with other team members.
- Inform patients about the roles of team members.
- Act as a positive role model for team members.
- Support students and practitioners receiving supervision within the team.
5.4 Discrimination, bullying and sexual harassment
There is no place for discrimination (including racism),17 bullying18 and sexual harassment19 in the medical profession or in healthcare in Australia.
- Be fair and show respect for peers, colleagues, co-workers, students on healthcare teams and patients.
- Do not discriminate against, bully or sexually harass others.
- Provide constructive and respectful feedback to colleagues, trainees, international medical graduates and students, including when their performance does not meet accepted standards.
- Be open to receiving constructive feedback.
- Do or say something about discrimination, bullying or sexual harassment by others when you see it and reporting it when appropriate.
- Refer your concerns about discrimination, bullying or sexual harassment to the Medical Board when there is ongoing and/or serious risk to patients, students, trainees, colleagues or healthcare teams (in addition to mandatory reporting obligations).
Other MIPS resources
- Communication: It doesn't have to be so clinical
- Contemporary patient communications - are they safe?
- Practising with care - Resolving difficult patient interactions
- Mobile communications - Risks & Benefits
- The poor communicator
- Limit risks to you and your patient
- Working under pressure and avoiding legal hazards