Quick Safety Issue 29: Advancing patient-provider communication and activating patients (Updated April 2022)

November 29, 2016

Update: April 2022

Issue:

Communication both among healthcare team members and between patients and providers is essential to high quality and safe care. Most improvement efforts to date have centered on provider-provider communication during transitions of care or during high-risk periods such as preprocedural time-outs. However, equally important for patient safety is adequacy of patient-provider communication allowing for patient activation and, as a result, their ability to become further engaged in their care.¹ Activated – engaged – patients are more likely to follow medical advice and subsequently are less likely to require hospital readmission, experience harm, or suffer poor health outcomes.^2,3,4

While much prior attention has focused on communication challenges related to patients with physical communication limitations (e.g., prior stroke) or psychiatric co-morbidities (e.g., psychosis), it must be recognized that failures in patient-provider communication can result in harm even in the absence of a disability.⁵ Common types of errors traced to patient-provider communication include those related to misdiagnosis and medication error.^6-10

Conversely, strong patient-provider communication has been tied to increased patient experience,^11,12,13 decreased emotional stress,^14-16 improved treatment adherence and compliance,^17-21 improved health outcomes^22-24 and increased caregiver satisfaction and decreased burnout.^25-27 Despite this, evidence suggests that rather than providers learning these communication skills through medical education, skills related to talking with patients erode over the course of training.^28,29,30

Elements of strong communication

Among the elements of strong patient-provider communication are:

Clear expectation setting.^31,32
A patient-centered approach to communication that ensures patients play an active role in the dialogue.^33,34
Expression of empathy.^34-37
A focus on clear information exchange and patient education that promotes the understanding and retention of key information.³⁸

These skills, sometimes thought to be inherent, are non-technical skills that can be systematically trained. Communication training courses have been shown to be effective, with multiple programs showing impacts in patient-perceived empathy, patient-centeredness, and satisfaction with care.^18,35,39-45 Literature also has demonstrated the value of such training programs to staff.^11,46

A patient-centered approach to care also can help healthcare organizations assess and enhance patient activation. Achieving this requires leadership engagement in the effort to establish patient-centered care as a top priority throughout the healthcare organization. This includes adopting the following principles:^1,2

Patient safety guides all decision making.
Patients and families are partners at every level of care.
Patient- and family-centered care is verifiable, rewarded and celebrated.
In most situations, the licensed independent practitioner responsible for the patient’s care, or his or her designee, discloses to the patient and family any unanticipated outcomes of care, treatment and services. There are a few situations in which the organization may select another caregiver to disclose this information.
Though Joint Commission standards do not require apology, evidence suggests that patients benefit—and are less likely to pursue litigation—when physicians disclose harm, express sympathy and apologize.
The hospital has a focus on measurement, learning and improvement.
Staff and licensed independent practitioners must be fully engaged in patient- and family-centered care as demonstrated by their skills, knowledge and competence in compassionate communication.

Safety Actions to Consider:

Organizations can create a clinician focus on patient-provider communication by obtaining a strong commitment from senior leadership, sustaining focus on staff satisfaction, committing to active measurement, supporting accountability, offering incentives and nurturing a culture that supports change and learning.^23,47-49 Healthcare organizations can take a number of actions to help improve patient-provider communication, including:

Conducting an internal assessment of your organization’s current communication training programs and explicit institutional focus on the value of patient-provider communication.
Demonstrating clear institutional commitment to patient-provider communication.
Providing training for frontline staff in communication skills and tactics.
Measuring clinicians’ communication-focused skills using, for example, patient experience and scores related to communication competency. This information also can be used as a basis for determining goals to improve performance.

Further, to achieve the best outcomes, patients and families must be more actively engaged in decisions about their care and have broad access to information and support. Healthcare organizations can adopt a number of strategies to support and improve patient activation, including:²

Promoting culture change.
Adopting transitional care models.
Leveraging health information technology capabilities including online patient portals and real-time mobile device-based communication platforms.

Resources:

Note: This is not an all-inclusive list.

Contributors:

Emily Aaronson, MD, MPH, Emergency Medicine Attending, Associate Chief Quality Officer, Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston. Dr. Aaronson also was a 2016 Joint Commission Fellow.
Jonathan Sonis, MD, MHCM, Emergency Medicine Attending, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital, Boston.

Legal disclaimer: This material is meant as an information piece only; it is not a standard or a Sentinel Event Alert. The intent of Quick Safety is to raise awareness and to be helpful to Joint Commission-accredited organizations. The information in this publication is derived from actual events that occur in health care.

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