The Power of Words:
Why Communication Matters
Dianne M Jacobs, MSN, RN
October 12, 2013
Objectives
Examine the impact of communication in healthcare
Discuss the value of teaching and measuring
communication competency.
Why Communication Matters: It is widely acknowledged that failures of teamwork and communication–not simply technical proficiency – cause the majority of medical errors and injuries in hospitals and other healthcare facilities. TJC reports that from 1995 – 2004, communication errors were the root cause for medication errors, delays in treatment and wrong site surgery
Press Ganey researchers identify
Communication with Nurses as a “rising tide”
measure within the value-based purchasing
(VBP) framework.
Performance Insights series
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Analysis of HCAHPS results for more than 3,000 U.S. acute care hospitals demonstrates:
a relationship between performance in the Communication with Nurses patient experience-of-care dimension
and
Responsiveness of Hospital Staff Pain Management Communication about Medicines Overall Rating of Hospital
1
Hospital could potentially affect 15% of the VBP
incentive payments by focusing on one metric:
As a “rising tide” metric, focused efforts on
improving communications between nurses and
patients will lead to meaningful gains in other
dimensions, increased service reliability and can
mitigate Medicare pay-for-performance risk.
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Impact of ineffective communication
techniques and incivility in the workplace:
Costly errors
Diminished teamwork
Decreased quality of patient care
Decreased reimbursements
Increased stress
Increased absenteeism
High turnover rates
Increased labor costs
Difficulty in recruiting new staff
INCIVILITY EXPERIENCES
17.1 = average number of times Americans encounter incivility in a 7-day week,
or 2.4 times per day
8.5 = average number of times Americans encounter incivility in real life/offline in a week
8.6 = average number of times Americans encounter incivility online in a week
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Of Americans surveyed… 50% have ended a friendship because another person
was uncivil 48% have defriended, blocked or hidden someone
online because of uncivil behavior 43% expect to experience incivility in the next
24 hours 26% have quit a job because it was an
uncivil workplace 24% have personally experienced cyberbullying
(threefold increase since 2011) 19% of parents have transferred their child to a
different school because of incivility at school
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3
0
100
200
300
400
500
600
700
800
900
1000
Nurses surveyed Witnessed lateral
violence
Victim of lateral violence
Incivility kills… …morale…communication…trust…respect…
teamwork…productivity…budget…satisfaction…
and the best strategic initiatives.
and if left unchecked leaves an organization vulnerable to serious errors in patient care.
Soft skills : personal attributes that enhance an individual’s interactions, job performance and career prospects
Hard skills: a person's technical skill set and ability to perform a certain type of task or activity
It's often said that hard skills will get you an interview but you need soft skills to get (and keep) the job.
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communication
teamwork
leadership
empathy
good manners
negotiation
sociability
the ability to teach
Soft skills are abilities that can be practiced but
require the individual to genuinely like other
people.
Just as we would not accept a staff member to
lack technical proficiency we must not accept a
lack of proficiency in soft skills, also referred to as
relational skills.
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Latin: communis, common
Merriam-Webster: com·mu·ni·ca·tion noun \kə-ˌmyü-nə-ˈkā-shən\
the act or process of using words, sounds, signs, or behaviors to express or exchange information or to express your ideas, thoughts, feelings, etc., to someone else
a message that is given to someone : a letter, telephone call, etc.
communications : the ways of sending information to people by using technology
Sociologist view: “a mechanism through which human relations exist”
Psychologist view: “the process by which an individual (the communicator) transmits stimuli(usually verbal symbols) to modify the behavior of the other individuals (communicates)
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Referred to the study of communication as “rhetoric”:
language that is intended to influence people and that may not be honest or reasonable
the art or skill of speaking or writing formally and effectively, especially as a way to persuade or influence people
Identifies 3 elements: ◦ Speaker ◦ Subject ◦ Person addressed*
*holds the key to whether or not communication takes place
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Better understand each other and connect
Disseminate information Share emotions and or thoughts from one to another to
intentionally create harmony or dissonance with the sender and receiver.
Send your message effectively to the receiver/readers.
Links people who believe in a common cause, together with a view to strengthen relationships.
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Verbal – the words we choose
Paraverbal – how we say the words
Non-verbal – body language
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Physiology Voice Tones Words
Posture Gesture Facial Expression
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0%
10%
20%
30%
40%
50%
Reading Talking Writing Listening
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I know you believe you understand what you think I said, but I am not sure you realize that what you heard is not what I meant.
Requires concentration and energy
Involves a psychological connection with the speaker
Includes a desire and willingness to try and see things from another's perspective
Requires that we suspend judgment and evaluation 7
Retain 50% of what was said, immediately after what was said
Within 48 hours, drops 50% to 25% efficiency
Speak at the rate of 125 words per minute
Mental capacity to understand someone speaking at 400 words per minute
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Ten worst listening habits: Decide subject matter uninteresting Criticize the delivery Become too stimulated Listen only for facts Try to outline everything that is said Fake attention Tolerate or create distractions Evade the difficult Submit to emotional words Waste thought power
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Expression of interest
Leaning forward
Nodding head
Verbalization such as “Uh-Huh and “Go on…”
Frequent validation
Attempt to fully understand
Personal values and expectations Personality differences Hierarchy Disruptive behavior Culture and ethnicity Generational differences Gender Historical interprofessional and
intraprofessional rivalries Differences in language and jargon Differences in schedules and professional
routines
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Varying levels of preparation, qualifications, and
status
Differences in requirements, regulations, and
norms of professional education
Fears of diluted professional identity
Differences in accountability, payment, and
rewards
Concerns regarding clinical responsibility
Complexity of care
Emphasis on rapid decision making
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Face-to-face process of interacting that focuses on
advancing the physical and emotional well-being of
a patient
Involves
• Collecting information to determine illness
• Assessing and modifying behavior
• Providing health education
Trust Empathy Respect Congruence Self awareness Listening
Being fully present Gentle eye contact Kind facial expression Warm tone of voice Expressive hand and
body gestures Relaxed disposition Slow speech rate Brevity The words themselves
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Active listening
Sharing
Observations
Empathy
Hope
Humor
Feelings
Touch
Silence
Providing information
Clarifying
Focusing
Paraphrasing
Asking relevant questions
Summarizing
Self – Disclosure
Confrontation
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Failure to address incivility in the workplace can derail the best strategic initiatives
Staff do not feel safe nor confident in the communication skills required to speak up about a safety issue
A huge reliance on advanced technology coupled with failure to embrace and master communication and team building skills can actually cause enhanced technology to work against success and safety
Describe the situation (“When …happened,”)
Explore or express your thoughts, feelings or
concerns giving the benefit of the doubt (“Was it your intent to…?”)
Specify what you want them to do differently next time (“In the future, would you…?”)
Consequence-state the positive consequence
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Name or mirror the emotion “You seem very anxious.” Understand the emotion “It can be stressful to learn something new like this that is so
important to your health.” Respect the patient “You did a great job with both your glucose testing and insulin
injection today.” Support the patient using powerful words “I’ll work with you again in the morning and I’ll let the home
health nurse know you’d like her there right away on Tuesday morning to work with you.”
Explore the emotion further “Tell me more about specific concerns you have about managing
your diabetes at home.”
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Just because we are talking doesn’t mean we are communicating
Words are powerful – choose and use them wisely
Proficiency in communication skills is just as crucial as proficiency in technical skills and should be a part of core competencies.
Communication with nurses Provide training for and measure competency of communication skills Hire the right people Engage staff Adopt measurable professional behavioral
standards Link standards to performance evaluations and
hold all staff accountable
What else would you add?
Dianne M Jacobs,MSN,RN
864-901-6612
Deborah L Cox,MBA,MS-CM,MT(ASCP)
678-640-2492
www.comassgroup.com