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

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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

dianne.jacobs@comassgroup.com

Deborah L Cox,MBA,MS-CM,MT(ASCP)

678-640-2492

deborah.cox@comassgroup.com

www.comassgroup.com