The majority of American healthcare organizations have profit margins so slim it would take a scalpel to dissect and understand what’s happening. Forbes recently surveyed America’s most profitable hospitals and discovered the reasons some hospitals operating at higher profit margins were performing so well. One thing that did not surprise me was seeing once again that patient satisfaction scores from Medicare’s Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) survey correlate with profitability. Communication is a comparatively dominant facet of the H-CAHPS survey, and given that results are reported publicly, no institution can afford to leave patient-doctor interactions to chance.
Lisa Goldstein, Senior Vice President with Moody’s Investors Service, further underscores the relationship between quality and profitability. “A strategy aimed at quality can result in improved market share and volumes, better ability to recruit and retain staff, lower nursing vacancy/turnover rates, improved financial performance and better credit position,” Ms. Goldstein wrote in an recent Moody’s report.
Communication in Healthcare and Clinical Outcomes
A Studer Group study reported the following: Patient perceptions of physician communication and empathy result in positive outcomes that include:
Patient assessment of physician communication associated with Improved patient medication adherence
Reduced incidence of malpractice claims
The fact that healthcare organizations score high in communication and clinical outcomes is no coincidence. The interpersonal aspects of the patient-doctor relationship affect how information is gathered, the accuracy of diagnoses, and the extent to which patients understand their care.
Empathy: a Taught Skill
Almost all of America’s most profitable hospitals offer continuing education programs teaching their healthcare providers communication and empathy skills. The Mayo Clinic was one of 10 non-profits to make the Forbes list, and Mayo’s understanding of the importance of doctor-patient communication is among the most evolved in the country. As published in the Patient Experience Journal (PXJ), the patient experience is described as a process made up of critical interactions or “touch points”. The PXJ article highlights frequently discovered barriers to effective provider-patient communication:
Mismatched expectations of care
Healthcare providers tend to be altruistic and compassionate, so these are generally not character traits that need teaching, per se’. However, the ability to demonstrate those interpersonal skills may be less common, and one that can be taught through mentorship, coaching, and facilitated courses.
An excerpt from the Washington Post: “In the 1980s, when I trained, the emphasis was on medical knowledge and technical skills,” said Debra Weinstein, Vice President for Graduate Medical Education at Partners HealthCare, the largest provider of medical services in Massachusetts. But in the past decade, “the profession has been more attuned to patient satisfaction and the connection between satisfaction and outcomes and incentives.”
The Devolution of Empathy
“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.” (The Ochsner Journal, Doctor-Patient Communication: A Review”). Healthcare organizations offering communication training have experienced a pleasant, and encouraging result – a restoration of passion for many of their healthcare providers, a critical result given how difficult it is to manage compassion fatigue in today’s bustling healthcare environment. “It has been observed that communication skills tend to decline as medical students progress through their medical education, and over time doctors in training tend to lose their focus on holistic patient care.” Medical training is brutal enough to suppress the empathy required to communicate with patients well. Doctors sometimes avoid talking to patients about the emotional aspects of their illness.
Complaint Management and Service Recovery
Fortunately, some basic communication skills are pretty straight forward and easy enough to teach. Coaching managers, nurses, and other healthcare professionals to respond to patient complaints in an empathetic way is enough to improve patient satisfaction scores. Something as simple as eye contact is an important, learned skill.
Other aptitudes require more from directors. Healthcare providers need a blame-free environment if a culture of transparency is to be fostered. Communication in healthcare cannot exist without staff morale.
Healthcare organizations are usually managed in a way that assumes compassionate caregivers – ‘assuming’ anything, as you and I know -- is not wise. When healthcare professionals are willing to engage patients (customers) in an emphatic way, healthcare improves for all constituents; patients, physicians, administrators -- we all benefit.