Communication challenges in hospitals around the world (YEL2021)

Date:  06 April 2022

Communication challenges in hospitals around the world (YEL2021)

COMMUNICATION CHALLENGES IN HOSPITALS AROUND THE WORLD 

 

This article is brought to you by four members of the IHF Young Executive Leaders’ Alumni.

Authors, YEL2021: J. Antônio Cirino (Brazil), Taylor Johansen (Canada), Leandro Luis (Portugal), John Kueven (USA).

INTRODUCTION

Communication, as a discipline, is an important part of running a successful business. Indeed, business school graduates leave their academic studies with several core competencies – leadership training, strategy fundamentals, financial acumen, marketing know-how, and more. Organizations that are celebrated for their success are often those that have also mastered the art of communication. Communication is a systemic theme, present in all human relationships and has great relevance to organizations across different sectors. Healthcare is no exception; in fact, in this setting, the importance of communication is exacerbated because of its direct impact on human lives.

In this sense, communication management plays a crucial role in hospital administration. Strategic communication enables the development of policies and branding. Organizational communication defines the channels of internal discussion and solidifies the identity of the organization.  Institutional communication is focused on strengthening the hospital’s public image, and managing media channels contributes to this. Communication is crucial to helping patients find care pathways, and obtain information about their illnesses. Inside the hospital, communication has a lot to give to the professionals and patients, alike. In defining each one’s role, and as a driver of change and standardization of practices, communication is of critical importance. Good communication within hospitals can support outcomes, while lack of communication can pose a significant risk.

The reality is poor communication can cost lives with some estimates putting poor communication as a cause of up to one third of the more than 250,000 patient deaths that occur each year in the United States, for example, due to healthcare error.  It is critical that healthcare leaders ensure a systematic approach to how we communicate. Communication can foster a culture of transparency where patients and team members feel safe, feel heard, and feel informed. If communication is so important, then why is it so difficult?  There are a lot of factors that create challenges in communicating effectively.  In this article we will explore a few of those causes and offer some recommendations to healthcare leaders.

CHALLENGES AND RECOMMENDATIONS

Communication as a policy and accreditation requirement

As in other countries, Brazil identifies communication in hospitals as a challenge. When adverse events are analyzed by professionals of respective areas, communication is most often found to be the main source of failure. With the strengthening of the implementation of telemedicine, as well as procedures now even more mediated by technology as a result of Covid-19, it is more important than ever to think about communication.

The Brazilian Ministry of Health is constantly working on the basic goals of patient safety and among them there is the second one that directly treats the importance of effective communication between professionals and that also unfolds to rethink communication with patients and families. Through the National Accreditation Organization (ONA), one of the main accreditors in terms of volume of health accreditations in the world, based in Brazil, it has been possible to strengthen the importance of communication for everyone’s safety, such as by including a subsection of the requirements manual for the accreditation of health services in the specific country on the subject. In addition, initiatives such as the qualification of health units, such as the one carried out by the ONA and the Brazilian Hospital Federation – FBH, aim to improve this context.

Among the possible solutions that have been structured in the country in units of excellence and replicated to units still under development, are the declaration of a communication policy with the standards of conduct, methodology and work format in the hospital. Also, a care communication protocol, defining the language and format of the medical record, the shift change, the transition of care and several other essential routines. Finally, a strategic, organizational and institutional communication plan to outline the actions during the year at this hospital that will improve the relationship and management of the stakeholders involved, are some of the main recommendations.

Embedding communication within talent management

One of the challenges about running a hospital in Canada – like elsewhere in the world – is that there are so many different stakeholders to bring together. In medicine alone, there are hundreds of disciplines, specialties, sub-specialties, and care modalities. Hospitals are a place where licensed medical practitioners, allied health professionals, administrators, financial experts, IT specialists, strategists, researchers, donors, volunteers, and many others all converge. Unsurprisingly, emphasis is often placed on recruiting the best possible medical experts. Hospitals want to be known for top quality care, cutting edge research, and a home to superior clinical skill. Communication ability, while integral to leadership, risk management, and quality, is an area of skill that can sometimes be overshadowed by other personnel requirements.

A recommendation for hospital leaders is, therefore, to develop a mechanism by which communication acumen is routinely embedded within the hospital’s overall talent management strategy. For example, some hospitals require leadership selection processes to include a written examination in addition to a verbal interview. Human resource panelists can use the written component to help determine whether the candidate meets a minimum standard for communication ability (in addition to clinical content). Similarly, organizational development and learning initiatives should have a communication skill building component. Seldom do clinical training programs incorporate a robust communication curriculum, so it is important for employees to have the opportunity to continue crafting these skills throughout their careers.

Some may argue that communication tasks can simply rest with the hospital’s own communications department, and that this group is rightfully composed of marketing specialists and public relations experts. While logical, it is important to remember that any transfer of information between individuals constitutes communication. There are an infinitesimal number of these interactions daily – far beyond what could be centrally managed. Beyond that, many healthcare institutions have limited resources to allocate to administrative functions anyway. So, often hospital communications teams are small and must prioritize their time on executing pressing internal and external communications strategies.

Communication as a repeatable and clear process

The United States is a highly diverse country and that diversity can often cause communication challenges. Demographic differences such as education, race, gender, and other cultural differences make standardization of communication incredibly difficult. To overcome the demographic differences, organizations must establish clear channels that account for a variety of perspectives and interpretations.  As leaders, we must partner with target audiences to understand their unique interpretation of information. Established venues such as shared governance councils, medical executive committees, diversity, equity, and inclusion committees, patient family advisory committees, and other key groups are critical to review both language and methodology for communication.  Leveraging these groups may help ensure that the message intending to be sent is received correctly regardless of demographic differences.

Perhaps the largest challenge facing healthcare in the United States is a combination of staffing shortages and staffing fatigue caused by the global pandemic.  Often, communication takes time and in today’s healthcare environment time can be in short supply.  As leaders, we must ensure that how we are communicating and how we are asking our team members to communicate is efficient and can be embedded in the work our team is doing.  Leaders must ensure that technology is leveraged to reduce the burden on our team members and that we are not asking them to communicate unnecessary things, so that we avoid adding unnecessary tasks and work to the team.

Healthcare organizations use multiple forms of communication which means team members must be trained on to use those forms effectively.  As leaders, we must create processes that are repeatable and clear in how we communicate.  Often, we rely on snap decisions for communication including things like company wide emails, called meetings, or newsletters.  Although these forms of communication may help, the reality is that we often do them because they are easy for the leader, not because they are effective.  These types of communications must be part of a larger process that leverage a variety of tools in a variety of situations with clear expectations as to how each tool is used, when each tool is used, and how information is shared.  A true systematic approach to communication will set these expectations, ensure the expectations are deployed, and establish measurements for the effectiveness of the communication process. Creating a systematic approach is not easy and will require leadership to organize their processes.  If correctly done, a systematic approach to communication can yield higher quality, better engaged patients, informed team members, and an overall culture of transparency.

Communication, Health Information and Literacy 

Portugal experiences challenges with communication in healthcare related to the fact that it remains a paternalistic country. That is, medical decisions are made by physicians and patients rely heavily on them as the sole source of truth. This happens even knowing that the country provides health information in several websites, such as the National Health Service and Directorate-General of Health websites, allowing people to know more about health promotion and disease prevention. Even though there is certified health and healthcare information available, Portugal is still working to get more people advocating for their health information rights. This is particularly important in a time where social media seems to have taken place as a new and strong source of information about health, but where it lacks a filter that can guarantee the quality and truthfulness of it.

In the hospitals, the above assumptions lead to additional difficulties in managing information and communication with patients. The elder people, the high users of the hospital care, who have less digital skills and limited ability to search for health information still uncritically accept medical decisions. The younger generations, more digitally skilled, search for health information and ask about it in the clinical appointments, but need help to select secure and scientific based health information. This is the new challenge for hospital staff, namely healthcare professionals, they have to prescribe health information and help to reach more health literacy. The communication strategies in hospitals between the leaders and the healthcare professionals still rely on emails, telephone calls, newsletters and presencial meetings, even though, COVID-19 pandemics allowed us to use videoconferencing more as an useful alternative. This seems short for all the potential the new technologies give to us everyday and must be changed.

We live in a time where artificial intelligence and digital gadgets can send real-time patient data directly to healthcare workers to inform their care practices. Portugal is a leader in developing telehealth tools and strategies to strengthen the link between healthcare professionals and patients. Using websites, social media and video conferencing to reach people is turning into the new normal, and this allows patients to play a more active role in managing their own care. In Portuguese hospitals, this is more evident with the use of smartphones and applications to send information to patients, and also get data to make better decisions by the use of smart apps. Using these tools and strategies for internal and external communication must be the new standards for health and healthcare communication. They must be a secure channel of information and guidance for clear and correct information between the different health professionals and between them and the patients.

CONSIDERATIONS

One of the most difficult and yet most important things any leader must do is communicate. Communication ultimately crosses through every aspect of a hospital.  Everything we do as leaders requires us to think about how we communicate.  When we recruit and onboard, when we need to get critical information to team members, when we need to make changes –  all of these functions share one common criteria, which is the need for effective communication.

Regardless of the country and culture, it is clear that challenges with communication in hospital environments are shared. This article clearly demonstrates the value of learning from each other to develop solutions in one’s home country. Above all, communication needs to be a priority  in each organization’s strategy and must be focused on to support quality and safety for all.

 

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