In the last post, we looked at the behavioural competencies of effective teamwork, and in this post we will review the role of communication within healthcare teams. The importance of effective communication to safe healthcare was emphasised by M. Leonard and colleagues in their paper titled The human factor: the critical importance of effective teamwork and communication in providing safe care. They argued that the delivery of ‘high quality, safe patient care‘ relies on ‘effective communication and teamwork’, and they pointed out that ‘communication failures are an extremely common cause of inadvertent patient harm‘ – accounting for more than 70% of adverse events.
There are certain basic qualities which go into making communication effective. Some of these defining characteristics, according to Leonard and colleagues, are:
- An environment that enables speaking up and expressing concerns
- A shared common ‘critical language‘ to alert about ‘unsafe situations‘
- A standardised communication tool
On the other hand, the book Safety at the Sharp End: A Guide to Non-Technical Skills, defines effective communication in terms of its core elements which are:
- Proper timing
- Active listening
- Feedback – ensuring that the message has been received or understood
Another critical component of safe and effective communication is what Sarah Peyre referred to as closed-loop communication. Exploring this in an article titled CRICO Operating Room Team Training Collaborative: Closed Loop Communication, she defined it in terms of three team abilities:
- The ability to exchange clear, concise information
- The ability to acknowledge receipt of that information
- The ability to confirm its correct understanding
Perspective-taking is another underrated element of effective communication which is discussed by Boaz Keysar and Dale J. Barr in the book Heuristics and Biases: The Psychology of Intuitive Judgment‘. They highlighted the fact that speakers, anchored on their own internal states, may wrongly assume that what they are saying is clear, and that their listeners can infer their intentions. Referring to this attitude as the ‘illusion of transparency‘, Keysar and Barr stressed that ‘all utterances can convey more than one intention’, and this is more likely to result when the speaker is busy or under ‘cognitive load‘, and when the message is ambiguous or contains abbreviations or specialist phrases. To mitigate the effects of the illusion of transparency, they urged speakers to take the perspectives of their listeners into account at all times.
Michael Eysenk and Mark Keane also explored the use of perspective-taking in reducing the risks of the illusion of transparency. Writing in the book Cognitive Psychology: A Student’s Handbook, 6th Edition, they advised speakers to take full account of the knowledge of their listeners, and use this to adopt a ‘common ground‘ between them where they share ‘mutual knowledge and beliefs‘. Acknowledging that perspective-taking is ‘often too cognitively demanding‘, they said it is easier to achieve when listeners are enabled to explicitly state when they have difficulty understanding the speaker. Wachter also advised that, when communication is ambiguous, the listener should do ‘whatever it takes‘ to be certain of the information, and not to conform to the ‘culture of low expectations which enables faulty and ambiguous communication to lead to errors’.
Whilst most healthcare communication is verbal, other forms of communication are equally important and have their particular competencies. For example, addressing non-verbal communication in his book Subliminal, Leonard Mlodinow stressed the importance of listeners to be proficient in recognising the three categories of non-verbal communication which are:
- Body movements
- Paralanguage such as pitch of voice and pauses
- Proxemics – the use of personal space
Writing is another important non-verbal method of healthcare communication, and Eysenk and Keane categorised it into three stages which writers must take into account to ensure that their communication is effective, and these are planning, sentence generation, and revision. To ensure that written communication is effective, John Hayes and Linda Flower, in their paper titled Writing research and the writer, recommended the following strategies:
- Drawing an outline
- Using short sentences
- Paying attention to the needs of the reader
- Spending time on revision
- Avoiding the knowledge effect – ‘the tendency to assume that other people share the knowledge we possess’
Three excellent books explore the art of written communication, and you may read my reviews of these books in my sister blog, The Doctors Bookshelf:
In the next post, we will look at the communication tools of effective team work.