What considerations are present when communicating with other health professionals?

Patient education allows patients to play a bigger role in their own care. It also aligns with patient- and family-centered care.

To be effective, patient education needs to be more than instructions and information. Teachers and health care providers need to be able to assess patient needs and communicate clearly.

The success of patient education depends largely on how well you assess your patient's:

• Needs
• Concerns
• Readiness to learn
• Preferences
• Support
• Barriers and limitations (such as physical and mental capacity, and low health literacy or numeracy)

Often, the first step is to find out what the patient already knows. Use these guidelines to do a thorough assessment before starting patient education:

• Gather clues. Talk to the health care team members and observe the patient. Be careful not to make assumptions. Patient teaching based on incorrect assumptions may not be very effective and may take more time. Find out what the patient wants to know or take away from your meeting.
• Get to know your patient. Introduce yourself and explain your role in your patient's care. Review their medical record and ask basic get-to-know-you questions.
• Establish a rapport. Make eye contact when appropriate and help your patient feel comfortable with you. Pay attention to the patient's concerns. Sit down near the patient.
• Gain trust. Show respect and treat each patient with compassion and without judgment.
• Determine your patient's readiness to learn. Ask your patients about their outlooks, attitudes, and motivations.
• Learn the patient's perspective. Talk to the patient about worries, fears, and possible misconceptions. The information you receive can help guide your patient teaching.
• Ask the right questions. Ask if the patient has concerns, not just questions. Use open-ended questions that require the patient to reveal more details. Listen carefully. The patient's answers will help you learn the person's core beliefs. This will help you understand the patient's motivation and let you plan the best ways to teach.
• Learn about the patient's skills. Find out what your patient already knows. You may want to use the teach-back method (also called the show-me method or closing the loop) to figure out what the patient may have learned from other providers. The teach-back method is a way to confirm that you have explained the information in a way that the patient they understand by asking them to act as if teaching it to you. Also, find out what skills the patient may still need to develop.
• Involve others. Ask if the patient wants other people involved with the care process. It is possible that the person who volunteers to be involved in your patient's care may not be the person your patient prefers to be involved with. Learn about the support available to your patient.
• Identify barriers and limitations. You may perceive barriers to education, and the patient may confirm them. Some factors, such as low health literacy or numeracy may be more subtle and harder to recognize.
• Take time to establish rapport. Do a comprehensive assessment. It is worth it because your patient education efforts will be more effective.

Bowman D, Cushing A. Ethical practice and clinical communication. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clarke's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 5.

Bukstein DA. Patient adherence and effective communication. Ann Allergy Asthma Immunol. 2016;117(6):613-619. PMID: 27979018 pubmed.ncbi.nlm.nih.gov/27979018/.

Gilligan T, Coyle N, Frankel RM, et al. Patient-clinician communication: American Society Of Clinical Oncology consensus guideline. J Clin Oncol. 2017;35(31):3618-3632. PMID: 28892432 pubmed.ncbi.nlm.nih.gov/28892432/.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

As clinicians we communicate with other clinicians in person, in the patient record, in handover documentation and in other charts. We also have discussions during ward rounds, in meetings with treating team members, at handovers, and in informal conversations. All of these tasks require skilful clinical communication1.

Teamwork impacts on patient wellbeing

A supportive health service team culture has been associated with higher functional wellbeing for patients post discharge2.

Communication is a critical element in effective teamwork. A well-functioning team fosters an environment where we can ask questions and be ‘respectfully assertive’ with other team members, no matter the role or position, whenever a patient appears at risk3, 4. Good team member communication processes support clinicians, translating into better individual interactions.5

Effective teamwork does not just happen; it requires skill development, practice and a supportive environment. Excellent individual skills do not guarantee effective team performance in delivering care4, 6.

Team meetings

Team meetings can be used effectively to organise and learn6. Even brief one to five minute team meetings at handovers (and within shifts if required) to assess and organise are important4.

Items to address in team meetings to improve patient care include:

• identifying team members and leaders
• establishing or re-establishing situational awareness
• assigning or re-assigning responsibilities and tasks
• making team decisions
• discussing problems
• reviewing lessons we have learned.4, 6

Teamwork actions

Individual teamwork actions are the most common teamwork activities. Failures in four individual teamwork actions have been most implicated in medical errors4. The following are the four clinical teamwork skills that most reduce medical errors:

1. Know what protocol or plan is being used. This should be clear to everyone on your team.
2. Advocate for your patients. Assert your opinion or a correction to team members if you believe a patient is at risk. Leaders have a responsibility to create an environment where this is possible.
3. Understand the care plan and prioritise tasks for your patients accordingly.
4. Cross-monitor the actions of team members for simple errors and act to correct if required. Leaders should create an environment where this is an acceptable practice.

Documentation

Documentation helps us monitor interventions to minimise functional decline in our patients and communicate with the team.

In addition to following local documentation policy and procedures, consider the following actions to provide the information needed by the team7.

Record observations and actions accurately; clearly state the facts, what you saw, heard, smelt, felt and did.

• Record enough information so that another clinician can continue care, include what preceded an event or change in care if that information is relevant to continuing care (for example, if a code grey is called for an older person with dementia, the events preceding the code grey are important for other clinicians to know how to deliver safe and effective person-centred care).
• Document information about medications completely. Write medication names in full.
• Document every assessment while the older person is in your care. This establishes a baseline, a record and a timeline of the person’s health.
• Document as soon as possible to ensure important details are recorded and facts are not lost or shaded by subsequent events. Timely documentation also aids in treatment.

1. Australian Commission on Safety and Quality in Health Care, National Statement on Health Literacy, 2014, [Accessed 17 February 2015].

2. Shortell, S.M., Jones, R.H., Rademaker, A.W., Gillies, R.R., Dranove, D.S., Hughes, E.F.X., Budetti, P.P., Reynolds, K.S.E., Huang, C-F. Assessing the Impact of Total Quality Management and Organizational Culture on Multiple Outcomes of Care for Coronary Artery Bypass Graft Surgery Patients', Med Care, 2000. 38: 207-17.

3. Clinical Communique [electronic resource]: Department of Forensic Medicine Monash University Victorian Institute of Forensic Medicine, 2 (2015).

4. Risser, D. T., M. M. Rice, M. L. Salisbury, R. Simon, G. D. Jay, and S. D. Berns, The Potential for Improved Teamwork to Reduce Medical Errors in the Emergency Department, Annals of Emergency Medicine, 1999. 34: 373-83.

5. Safran, D. G., W. Miller, and H. Beckman, Organizational Dimensions of Relationship-Centered Care: Theory, Evidence, and Practice, Journal of General Internal Medicine, 2006. 21: S9-15.

6. WHO Guidelines for Safe Surgery: 2009: Safe Surgery Saves Lives, 2009.

7. Hunter, S., M. Bauer, D. Fetherstonhaugh, M. Winbolt, and R. Nay, Module 2: Communication of Assessment - Professional Issues, (Melbourne: La Trobe University).

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