Question

Interview at least three people from cultures other than your own and ask them if they have ever encountered any communication problems with an HCP that resulted from cultural differences. Discuss specifically what the sources of these problems were. How as an HCP would you approach these situations differently?

Answer 1

Common problems

Communication problems happened between providers, as well as between providers and patients. In some cases, a combination of both issues caused patient harm.

The most common provider-to-provider communication breakdowns were:

• miscommunication about the patient’s condition
• poor documentation, and
• failure to read the patient’s medical record.

And common provider-to-patient communication issues involved:

• inadequate informed consent
• unsympathetic response to a patient’s complaint
• inadequate education (such as about medications)
• incomplete follow-up instructions
• no or wrong information given to patient, and
• miscommunication due to language barrier.

Causes of breakdowns

While each case is different, CRICO identified several common problems that play a role in communication breakdowns in hospitals, such as workload pressure, problems with a hospital’s electronic health records (EHR) system, workplace culture – and even just distractions.

There are also unexpected circumstances that cause communication breakdowns – including familiarity. CRICO cites a study that found more communication breakdowns occur among people who know each other than between strangers. Reason: People think they can use shortcuts in how they express themselves because they assume the other party will understand.

However, this assumption can be deadly in the hospital setting.

How to fight back

There are several strategies hospitals have successfully used to fight the costly, dangerous problem of miscommunication.

Besides regular teamwork training with a focus on making sure clinicians communicate clearly and directly with each other, some have tried to eliminate miscommunications in an area where they commonly occur: patient handoffs.

Hospitals have cut down on misinformation using the I-PASS method during shift changes and other transitions of care. I-PASS is a mnemonic facilities can adapt to ensure all of the following information is communicated when providers perform handoffs:

• illness severity
• patient summary
• action list
• situation awareness and contingency planning
• synthesis by receiver

Nine hospitals used this strategy as part of a research study to boost patient safety. These facilities saw a 30% decrease in preventable medical errors due to improved communication of key information.

Other ways hospitals have improved communication include:

• role playing and safety drills so providers can practice the communication skills they learned in training
• direct observation of procedures by department chairs to identify and correct gaps in teamwork, and
• EHR updates that help doctors better document important details about the patient’s condition.

Whatever tactic your facility chooses, it needs to make sure all forms of communication involving clinicians are top-notch. Developing and enhancing providers’ written and oral communication skills can prevent big errors that both hurt patients and bring negative attention to your hospital.