By Matt Phillion
Healthcare continues to struggle with mastering interpersonal communication. Studies have found that communication challenges or breakdowns, from circumventing protocols and rules to micromanagement and disrespect, can lead to poor outcomes and medical errors.
Oklahoma State University (OSU) teamed up with Crucial Learning to address interpersonal communication among its medical students in three main categories: assumptions of incompetence, poor teamwork, and disrespect. The effort focused on the seven most crucial conversations in healthcare, with the goal of empowering staff to better communicate with each other.
Emily Gregory, MD, chief growth officer with Crucial Learning, cites the 2005 study Silence Kills as a reveal of how communication challenges can broadly contribute to medical errors in healthcare. “If anything, the numbers may be worse now.”
OSU determined that communication and interpersonal skills were presenting a problem, and saw that teamwork, job satisfaction, and safety were all impacted by professionalism and interpersonal communication.
“Most medical school curriculums don’t have a standardized, measurable way to teach these skills,” says Gregory. So OSU and Crucial Learning took a group of first-year residents through the Crucial Conversations course for skill development.
“Their outcome measures and metrics went up,” says Gregory. Surveying other physicians, nurses, and clinical staff, OSU found that participants’ teamwork and collaboration had all improved.
“What I think is super interesting about this is that at face value, of course if we have better teamwork we’ll have better results,” says Gregory. “But what’s cool to me is you can take someone who’s been through all these years of education and can still teach them how to communicate better.”
Taught, not inherent
No matter how advanced people are in their studies or career, they can still have room to grow in terms of communication skills. This runs up against the mistaken notion that interpersonal skills are natural and not learnable, Gregory notes.
“Sometimes we have this idea that communication and teamwork are inherent qualities,” she says. “Someone might think they just are a good communicator. They don’t think it’s something that can be taught, and that’s why we don’t teach it. What we’re seeing is that there are consequences when we don’t teach these skills.”
When teaching is provided, meanwhile, students can change profoundly and rapidly, Gregory says. “It’s a crucial intervention. These people have gone to school forever, but in two days—16 hours’ worth of time—these residents have learned something and walk away better at teamwork interfacing with nursing, floor staff, and more. And all of that translates into better patient outcomes.”
It’s a small amount of training for a huge return, she says. “These are busy professionals. They may say, ‘I can’t take two days for a course.’ But in the decades medical professionals go to school, two days is not a lot to get a significant bang for your buck, and it cuts across so many areas” in healthcare, says Gregory.
A pool of shared meaning
According to the learning model’s core methodology, there is a pool of shared meaning between people, and conversations are best when both sides can contribute, says Gregory.
“This is how you promote inclusion—you literally make sure everyone is included,” she says. “It’s not getting to yes, it’s not telling someone what to do, it’s [figuring out how to] work together so everyone is heard.”
This can often be a challenge for physicians, particularly when newer physicians are working with veteran nurses, so the methodology concentrates on including input from all sides.
“Our staff have such a wealth of knowledge and experience,” says Gregory. “So it’s not ‘how can I, the physician, tell you how to do what I want you to do?’ It’s ‘how can I explain what I need, and how can I hear your expertise and respect and value that?’ That’s why this works so well—in areas of different power hierarchies, it levels the playing field so everyone can be heard.”
One of the tricks to improving communication and interpersonal skills is helping students identify and acknowledge a past conversation that went badly.
“It depends on a person’s personal experience. If you can bring into the classroom when you’ve had a crucial conversation go badly, I can teach you how to have that conversation better,” says Gregory. “If we can get them to acknowledge they’ve had some bad conversations in the past, I think we can get them to a place to behave in a different way.”
How students process the behaviors of others can also represent an area for improvement.
“What we do as people is sometimes see a poor communicator and make a value judgment about that person as a human being: ‘That person is arrogant, condescending, patronizing.’ And so consequently we, as leaders, don’t say we have to train that person; we manage them or tell them they’ve got to change,” says Gregory. “I find the challenge to be more on the side of leadership making decisions on how to empower people.”
We tend to cement ourselves, or other people, into certain categories, Gregory says. For example, we might simply call someone a jerk rather than a bad communicator who needs to improve their skills. This behavior stems partially from “not having a way of articulating what those skills are,” she explains. “You know good communication when you see it but can’t really say what it is or what someone did that was so great.”
Learning to articulate those factors actually isn’t complex, says Gregory. But regardless, people often need help doing so. It’s something of a stereotype, but many who enter the healthcare field are concrete in their thinking and need specific examples to help them change their mindset.
“We can call out: Here’s what you need to do, here’s a map for how to navigate those conversations,” she says. “It’s not rocket science, it’s good social science, that articulation that allows us to say, ‘I saw something that was amazing.’ It can be broken down into discrete skills and pieces. Good communication can feel magical, but it doesn’t help people to do it unless you can break down it down for them.”
A long time of toleration
Healthcare has also had a tendency to tolerate subpar communication skills.
“For a long time, people thought they had to tolerate disruptive behavior. It happens in all industries, but in healthcare it might be because we thought, ‘Well, as long as she’s a great surgeon,’ ” says Gregory. “But what we’re starting to learn here is as the research shows, no individual one person can be good enough to overcome the impact of poor teamwork. No surgeon can be good enough if they’ve created a toxic environment in the OR.” In such a case, bad outcomes will happen regardless of skills, Gregory explains.
Thankfully, the industry has seen a shift over the past 10 or 15 years as healthcare systems start to recognize their outcomes shouldn’t hinge on superstars. “We need to focus on standards of professionalism,” says Gregory.
The Great Resignation has highlighted the need for more respectful workplaces as more and more surveys show that staff are walking away from disrespectful or uncomfortable work environments. A recent study by MIT’s Sloan Management Review found that while 63% of resignations were due to compensation, 57% cited toxic work environments.
Unfortunately, the COVID-19 pandemic has put a damper on the forward momentum of interpersonal skill training, Gregory notes. Many medical schools and healthcare organizations have had to put their training initiatives on hold while the industry navigates the ongoing crisis—and the numbers have reflected this stall. “We’ve seen a dramatic drop in the same scores that had risen before” regarding interpersonal communication, adds Gregory.
With COVID-19 still a factor and hospitals still working to get through each week, it’s easy for investments in communication improvement to fall to the wayside, especially if staff or leadership don’t think there’s time in the day to accommodate such training.
But that training remains vital. People often naïvely hope that people will just figure out the tenets of good communication and improve their behavior on their own. That strategy won’t work, says Gregory. “While sometimes you can tell someone they’re being disrespectful and they’ll change, for the most part, it does pay to invest in those skills. They can be trained and people can get better.”
Eliminating poor interpersonal communication will also improve a healthcare facility’s standing in the eyes of accrediting bodies, professional bodies, and other organizations—all of whom are keeping an eye on the future and looking for ways to improve healthcare work environments.
“Ingrained and habitual behaviors take time and effort to change,” says Gregory. “And you have to do so in a sustained way, and that takes effort.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at email@example.com.