The Importance of Communication in Healthcare
Megan Ivey
ID: 43958283
University of Queensland
PSYC3062
Words:1934
Communication Training in Healthcare
Training is an important task in human factors research regarding healthcare and aviation. The effects of training accurately have been widely studied in many human factors journals. Healthcare training styles involving adapting programs that are relevant for specialists working together in high-risk environments (Kolbe & Grote, 2011). Healthcare in the past ten years has seen an increase in human factors techniques in many domains (Hignett, Carayon, Buckle, & Catchpole, 2013). The Clinical Skills Development Service (CSDS) opened in 2004 and is located in the Royal Brisbane Woman’s Hospital in Brisbane. The centre is committed to the improvement of healthcare through training, collaboration, and innovation. They provide simulation courses (online or in-person) to postgraduate students all over Queensland. By using simulations, immersive scenarios and augmented reality, the CSDS aim to assess all the technical skills required in health care. Unfortunately, attendance of these courses is optional and CSDS hosts usually only see people once. The CSDS also host external communication courses, however, they are not compulsory and may only be organised by dedicated departments/hospitals. Communication training is vital in the healthcare system, as communication errors are the more common cause of errors in the hospital (Walker, Reshamwalla, & Wilson, 2012) (Liaw, Zhou, Lau, Siau, & Chan, 2014)
Importance of Training
Healthcare and aviation are very similar in terms of their training methods, structural similarities, high-stress environment, and specialist team work. Though, the biggest difference is the accidents that occur in each occupation. Aircraft accidents are highly visible, infrequent and involve a massive loss of life. Following accidents, the airline and pilots are extensively investigation and scrutinised publicly until the human factors issue has been remedied (Brindley & Reynolds, 2011) (Kapur, Parand, Soukup, Reader, & Sevdalis, 2016) (Omura, Maguire, Levett-Jones, & Stone, 2017). In comparison, healthcare accidents happen to individual patients and rarely hit the news headlines. There is no standardised method of investigation or documentation for errors in the medical system, thus many incidents are swept under the rug. The US Institute of Medicine estimates that between 44, 000 – 98, 000 people die each year due to medical errors. (Helmreich, 2000). That averages out to 375 mass causality aircraft crashes each year!
Skill development is vital in healthcare. For many years training in anaesthesia and surgery has focused on technical skills and the innovation of technology (Walker, Reshamwalla, & Wilson, 2012). It has been argued that training and technical skills are required for teams to function successfully (Borrill, et al., 2002). (Hackman, 1990). This team training complements individuals own technical and medical skills and knowledge (Poulton & West, 1993) (Poulton & West, 1994) (Poulton & West, A failure of function: teamwork in primary health care, 1997)
Crisis Resource Management (CRM) training is now common in medical training after being adapted from aviation simulations (Kolbe & Grote, 2011). CRM training was introduced in 1989 for UK airline crews, and since then there has not been a single death on a British aircraft (Higham & Baxendale, 2017). The sophisticated simulators allow full medical teams to practise errors in healthcare without consequences. Students also receive technical feedback on their individual and team efforts (Helmreich, 2000). CRM training combines didactic training in the characteristics of healthcare systems and processes with experimental training for different personnel in highly realistic simulators. (Helmreich, 2000). This intervention has found to enhance teamwork and patient outcomes (Kolbe & Grote, 2011). In the medical department, CRM is now used as a way to try and manage training and communication errors, by focusing on training teamwork skills that will (1) reduce errors, (2) promote early detection of errors and (3) minimize consequences resulting from medical errors. (Salas, Burke, Bowers, & Wilson, 2001). A study conducted in 2004 introduced an anaesthesia Crisis Resource Management course for the Harvard Medical School. The objectives of the course were to understand and improve the student’s ability in CRM skills and learn communication methods following critical events. The results of the course found that the students self-reported CRM behaviours indicated an improvement in performance for critical events (Blum, et al., 2004). Training in healthcare is vital to keep medical errors at a low and to ensure all professionals are prepared for adverse and routine events that occur in the workplace. An important layer in training is communication skills, which are often overlooked in the training process, despite being a common cause of medical errors.
Importance of Communication
Communication skills are vital in any workplace. They involve many elements; from what is being spoken, medical handovers, eye-contact and breaking the critical news to family members. Unfortunately, in many workplaces, especially highly intensive medical situations, communication is often the first element to break down in a crisis. Studying medicine at university often involves the traditional, clinical method; mostly focusing on the master-disciple relationship with little attention paid to communicative skills (Verhaak, Bensing, & van Dulmen, 1998). Coiera and Tombs’ (1998) discovered that communication in hospitals is often driven by adverse events; this poor communicative method often interrupts tasks, consultations and are often regarded as inefficient (Gosbee, 1998) (Coiera & Tombs, 1998).
Communication errors are the most common cause of medical events in healthcare. The patterns of inter-professional communication follow complex hierarchies, which often don’t reach the right person, are inaccurate, or the ‘minor’ issues remain unresolved until they become critical (Walker, Reshamwalla, & Wilson, 2012). In the operating theatre, this can lead to wasted equipment, mistakes, delays, frustration and poor morale (Walker, Reshamwalla, & Wilson, 2012). West and Slater (1996) reported that much of the potential collaboration in medical teams were not recognised, with only one in four healthcare teams building effective communication and team working skills (Borrill, et al., 2002). Communication integration in regular healthcare meetings has found to be associated with higher levels of effectiveness and innovation. However, in the daily life of medical staff, many medical teams fail to set aside time for regular meetings to define these objectives, clarify roles, encourage participation and handle changes in the team (Borrill, et al., 2002). Another major reason for the communication breakdown in healthcare is due to the differences in status, power, the assertiveness of the individual and the assumption of the hierarchy in the medical team (Borrill, et al., 2002). Communication is vital as it provides information on current activities, updating team members with shared knowledge and having a mutual awareness among medical teams (Rognin & Blanquart, 1999). A study conducted in 2014 assessed medical and nursing students on their communicative skills when caring for a deteriorating patient. They used a full-scale simulation and taught them accurate communication skills based on “Team Strategies and Tool to Enhance Performance and Patient Safety (TeamSTEPPS)”. The results of this intervention demonstrated that both medical and nursing groups significantly improved their self-confidence, communication and perception scores following the training. (Liaw, Zhou, Lau, Siau, & Chan, 2014) (Lane & Rollnick, 2007) (Omura, Maguire, Levett-Jones, & Stone, 2017). There has been a number of advantages to using simulated patients for communication skills training. The simulations enable students to try and experiment with new skills learning. These scenarios can be adjusted and re-played as needed, and there is the opportunity for standardisation and customisation for scenes, and the opportunity to provide a safe environment for difficult issues (Lane & Rollnick, 2007).
Communication at CSDS
Communication at CSDS is not included as one of their courses held in the simulation rooms. However, third-party groups are able to hire the space to run their own communicative courses. During their normal simulation courses, facilitators observe the participants and how they interact and communicate with their team members during immersive scenarios. They use formative assessment monitor the students learning to provide them with feedback following the simulation. These facilitators use their personal knowledge, skills, and experience as well as a modified non-technical skills assessment tool to give feedback. A loophole in this method is that different facilitators may have different thoughts as to how communication should be displaying in critical instances. The students are not given a summative assessment of their communication skills in the workplace. Studies have shown that inappropriate communication training could result in worsening communicative performance rather than better skills (Hsu, Chang, & Hsieh, 2015). In comparison, some studies have found that despite simulation-based training being prominent in healthcare training the actions or behaviours displaying in simulated environments may differ from those in a real clinical context (Ryall, Judd, & Gordon, 2016). This can be due to the lack of perceived responsibility and the sense of urgency that may be present in a simulated environment (Omura, Maguire, Levett-Jones, & Stone, 2017). Yet the technological advances evident at the CSDS aim to also display hi-fidelity environments in any simulation system. Successful reduction of communication breakdown can significantly improve patient safety and reduce errors. (Greenberg, et al., 2007). Therefore it is vital to improving the communication courses at the CSDS to prevent unwanted events.
Recommendations
After visiting the CSDS and discussing with the management, it is clear there is a need to optimise and implement communication training into their course. The dependability of many complex systems and procedures relies on human operators, both through human reliability and human ability to effectively manage these unexpected events (Rognin & Blanquart, 1999). Good communication skills for nurses and doctors are not innate and can be learned and enhanced through effective training (Hsu, Chang, & Hsieh, 2015), (Maguire & Pitceathly, 2002)
Traditionally healthcare centres were built on the ‘doctor-knows-best’ philosophy, as the profession is changing the rise of doctor-nurse communicative relationships are becoming more common in the workplace (Holden, et al., 2012).
CSDS has already taken steps forward by introducing simulation training into the Queensland Health Care System. As well as QLD, other students response to the use of simulated patients in teaching communication skills has been positive (Lane & Rollnick, 2007)). The WHO Surgical Safety Checklist was published in 2008 and involves routinely checking common safety issues by providing better team communication and dynamics. Implements the WHO checklist meant that perioperative morbidity and mortality could be improved. (Walker, Reshamwalla, & Wilson, 2012). Introducing the checklist into simulation scenarios can contribute to the team’s communication and their increased situational awareness (Walker, Reshamwalla, & Wilson, 2012)
A second recommendation is introducing the Simulation-Based Inter-professional Education Program (Sim-IPE), using the presage-process-product (3P) model, to improve medical students communication skills. This intervention was adapted from the TeamSTEPPS model. Previous research has found this intervention to be successful in improving students communication skills in the workplace (Liaw, Zhou, Lau, Siau, & Chan, 2014). The Sim-IPE is the overlap of simulation training and interprofessional education, to provide a collaborative approach for the development and mastery of interprofessional practices (INACSL Standards Committee, 2016). By providing these recommendations to the CSDS their simulation training programs will be able to adequately assess the communication skills that occur in their courses.
Conclusion
In conclusion; training, especially simulation based, is vital for teaching post-graduate medical students about routine and adverse procedures that occur in the medical system. The Clinical Skills Development Service in Queensland has paved a new training method for medical staff in QLD, by aiming to improve patient care, connect with other professionals and push the boundaries for real-world solutions. Continuing forward, the CSDS should begin to implement their own courses for communication training based on the WHO CHECKLIST. Communication errors are extremely common in healthcare (Kolbe, et al., 2012) and medical staff has been successfully trained in effective communication (Hsu, Chang, & Hsieh, 2015). Once these compulsory courses have been implemented it the Queensland training system, then the CSDS will truly become a great pioneer in the Australian Healthcare System.
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