Bridging the Communication Gaps On the Road to Patient-Centered Care
by Molly Procuniar, BSN-RN, BA, FF-P
Enhancing the patient's experience and improving patient satisfaction – they're not just about scoring high on patient surveys or securing referrals. There is growing evidence from respected organizations, including the Institute for Healthcare Improvement (IHI), that health care providers can improve clinical outcomes by aligning themselves with their patients' needs and by making patients part of the care team.
The concept of patient-centered care is not new; it was central to the Institute of Medicine's 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century. However, the IHI acknowledges it is a "multi-faceted challenge." It includes all aspects of a patient's culture, family situation, preferences, values, and lifestyle. Such all-encompassing care can make communication complicated, difficult and frustrating.
"The problem with communication...is the illusion that it has been accomplished." - George Bernard Shaw
Literacy, a Pervasive Problem
Literacy makes communication all the more challenging. The Agency for Healthcare Research and Quality (AHRQ) reports that over 20 percent of adults cannot read above the fifth grade level. With most health education material written at or above the10th grade level it means we're missing the mark!
But the problem is bigger than that. The National Network of Libraries of Medicine points out, "Health literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor's directions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations."
A High Price for Poor Communication
According to the National Patient Safety Foundation, problems related to health literacy and poor communication cost the US economy an estimated $100-200 billion a year. How?
"Ineffective communication between patients and providers can result in misdiagnosis, inappropriate treatment or medication errors," says Amy Wilson-Stronks, project director in the Division of Standards and Survey Methods and principal investigator for Hospitals, Language and Culture study at The Joint Commission. "When a provider cannot communicate effectively about a disease or treatment, or when a patient cannot describe their illness, they lack the basic connection needed to result in appropriate care. Appropriate communication is necessary for ensuring quality and safety in health care.1"
Likewise, if patients do not understand the information given to them upon discharge or when they leave their doctors' offices, they may be unable to care for themselves in a way that promotes their health and wellness. When instructions or patient education fails, it can ultimately lead to a return of illness, medical complications or readmission to the hospital.
The Joint Commission: a Strong Advocate
So it is with good reason that the Joint Commission is proposing requirements for the Hospital Accreditation Program, advancing effective communication, cultural competence and patient-centered care.
It is vitally important that care providers communicate to patients in a way that is culturally relevant, effective and within the scope of their literacy level. The Joint Commission includes several groups of patients to consider:
- Visually impaired
- Those inhibited by language or culture
- Hearing impaired
- Cognitively impaired
- Those impaired by disease or disability
- Those inhibited by health literacy
Powerful Approaches, Effective Paths
Each is a challenging prospect, but with advancements in information technology and digital printing, hospitals can create highly personalized documents and communication aids to enable their staff to communicate more effectively with their diverse patient populations. Companies, such as Standard Register, have augmented this capability with literacy and translation services to provide patients with important documents in formats that the IHI says "provides what people need and want." For instance, if the ADT demographics show a female patient is on Medicare, over 35, a smoker, speaks Farsi as her primary language and is visiting the hospital for a knee replacement by Dr Smith, the registration staff could:
- Print any Medicare-required documents in Farsi (ABN, MSP, or Important Message)
- Provide educational material in Farsi (risk of blood clots, smoking cessation, knee replacement FAQs)
- Provide preprinted packets, specified to Dr Smith's specific orders ahead of time
- Present the informed consent in Farsi with an English copy for medical staff; the signatures could be electronic
- Prepare the interpreter and staff in assessing at what comprehension level the material needs to be explained
Non-English speaking populations continue to grow and our communities struggle with health and wellness. Culturally-sensitive, clinically-relevant communications, adapted to the appropriate literacy level can be powerful tools for engaging the patients in our care.
1 November 11, 2009 joint news release, "Joint Commission, HHS Team Up in Language Access Education Effort"
Want to Continue the Discussion? Engage Molly on Linked In
About the Author
Molly Procuniar has over 12 years experience in healthcare as a registered nurse, paramedic and nursing technician. Her clinical experience includes working at two Distinguished Hospitals for Clinical Excellence with more than four Joint Commission disease-specific certifications. She has worked as an ER nurse in a 52-bed, urban emergency department with care flight attachment, as a neuro nurse at a Joint Commission-accredited Primary Stroke Center Magnet Facility with a Level I Trauma rating and is an EPIC-trained "super user."
For information and guidance in creating culturally relevant, literacy appropriate patient documentation and educational materials, contact healthcare@standardregister.com.
