This basic skill for physician leaders requires effectively processing input, then sharing it through different skills and methods. Here, the author shares tips from his experience to improve operations and ensure patient safety.
If you search online for the term “physician communication,” you’ll find an abundance of articles and books about the finer points of patient communication.
Successful and productive patient communication — what some people call the “language of caring” — is indeed critical to facilitate accurate diagnoses, establish rapport, ensure adherence with care plans, and maintain open and trusting relationships.
But equally as important — and arguably more important — is the need for clear, accurate and sensitive communications with the patient’s extended care team. There are many nuances to that communication, and physician leaders must be highly attuned to any breakdown in those communications, lest they lead to patient harm.
In my years in private practice as an OB-GYN, as an obstetrics hospitalist, and then as chief medical officer for Ob Hospitalist Group, I‘ve learned — often through trial and error — that facilitating optimal communications with a care team is much more than sharing test results or reviewing patient orders. Those are basic and necessary duties of anyone in clinical care. Leading a care team, whether at the community practice, hospital or administrative level, requires processing all information that comes in, and then communicating it out through different skills and different modalities, to help every member of the team be successful.
My key learnings might be helpful to other physician leaders who seek to improve operations, facilitate team success, and ensure patient health and safety.
Wear a white coat — and many sets of ears. Physicians are trained in science and medicine; leaders need additional skills in communication across a broad variety of audiences in a health care setting.
Consider, for example, an OB hospitalist. Adding another person during labor management creates the potential for misunderstanding, overlooked safety protocols, inadequate communication with the patient, and even medical errors. To maximize the chance of a positive experience, the hospitalist needs to be a skilled communicator.
As a result, the hospitalist’s team must engage in numerous communication chains. She works with the patient and the patient’s family to make sure they have a clear understanding of their clinical condition. In addition, the hospitalist must help the patient understand how she fits into the patient’s care team. Throughout the patient’s hospital stay, the hospitalist communicates with the nursing staff and the other members of the health care team. At times, these interactions require a balancing act recognizing the roles of both the hospitalist and the primary obstetrical provider. Finally, the hospitalist needs to relay the clinical course to the patient’s primary obstetrician, allowing for the best possible continuity of care. Miscommunication in any of these chains creates the potential for poor working relationships — and in the worst case, harm to the patient.
The hospitalist group serves as an anchor point on labor and delivery, interacting with and serving as the touchpoint for all of these stakeholders before, during and after delivery. Many of these stakeholders will offer input on another’s performance after the actual event. That’s the time to be especially conscious of verbal and nonverbal cues that can be shared with relevant parties in the future.
Read your audience. Leaders need to be able to pick up on verbal, direct and indirect cues — especially when those cues are about a member of their medical team. A highly charged medical environment, whether in an office setting or an emergent situation, creates a dynamic situation in which many parties may interpret information in very different ways. One good way for physician leaders to filter input is for them to ask themselves: Is it real? Is it true? Is it productive?
Upon hearing a colleague weigh in with feedback about a patient encounter, it’s critical to first assess the reality of a situation. We each bring our own backgrounds, experiences and personal styles to what we hear, observe and learn, and what might be “real” to one member of the care team might not reflect reality across the board. The best leaders listen, appreciate feedback and consider information within a broader perspective.
The second task is to determine whether the information is, in fact, true. It’s not common for physicians to work together in a care setting. Much of the information they receive will be secondhand, so it’s important to take the time to determine the truth of what happened before reaching a conclusion.
If the information is real and true, it must be considered in a broad context of whether it is productive. For example, the fictional Dr. Smith is a good clinician but does not have a warm and bubbly personality. The nursing staff raises concerns because they think he is cold and doesn’t open up to them. This personality does not affect his ability to provide excellent care to the patients. The feedback is real and it is true; however, it is not likely going to be productive to share with the physician. People’s personalities are difficult — if not impossible— to change. Care team leads must assess pieces of input through the end goal: patient safety, positive outcomes, and professional growth and success. If sharing feedback can be done with those constructive goals in mind, then the answer is probably that it’s worth sharing with the individual in question.
Tailor your messages to your audience. Physician leaders must provide feedback to individual physicians with sensitivity to acuity of information, timing and how that message is received, with the goal of helping each team member be successful.
To accomplish that, physician leaders must get to know their team on a personal level. This investment is always worth making, to better understand how information is best received. Obviously, patient safety issues trump all other factors, and must be communicated quickly and directly, in person or by telephone. But other information, such as interpersonal communication issues or disagreement over care strategy, probably can wait until a shift change, a casual conversation in the elevator, or even a scheduled visit, delivered in a respectful manner that allows the team member to digest the information and make changes to his or her behavior accordingly.
Similarly, leaders who ask “what” rather than “why” questions cultivate a more secure team. Instead of asking why something happened, questions about what could have been done differently give individuals an opportunity to question their own actions without judgments or fear of retribution.
Above all, leaders must communicate that their goal is to help each team member do well, both individually and as part of the care team. When team members understand that, they will be equally committed to working collaboratively toward a culture of safety and success.
Mark N. Simon, MD, MMM, CPE, is chief medical officer for South Carolina-based Ob Hospitalist Group, the nation’s largest provider of OB hospitalist services.