Clear Communication with Medical Staff Means Better Results

May 6, 2012

Giving practice staff context for a task or policy enables them to perform reliably, and it increases both their productivity and yours.

Taking the time to explain to your medical practice staff why you are giving a particular instruction or edict is one of the biggest favors you can do for your patients, your staff and yourself.

Some of the problems with making a request or statement and walking away include:

Staff can only use the data you have given them. The analogy is to a computer application, which has no context. It will do only what it is explicitly told to do. If your input is incomplete, there are at least four possible outcomes and only one produces your desired results: Staff will become aware that something is missing, and guess right in filling in the blanks. Far more likely, staff will be unaware anything is missing: They will guess about the missing information and be wrong, or they will interrupt you to get what they need.

Staff has no basis to make informed exceptions. Back to the computer analogy, staff has no way to correctly differentiate between the non-negotiable and an acceptable modification. They will make a guess, sometimes conferring with others to produce a group guess, or they will come back to you. Reporting to you and asking for amended instructions is essential in some cases and a waste of your time in others. For reasons I have yet to discover, the selected action is likely to be the wrong one. Without understanding, staff will come back to ask you to state the obvious or guess at a resolution in risky situations.

Staff will make more mistakes. Both experience and research inform us that it is difficult to remember items in an apparently disjointed list.

Conscientious staff will work more slowly. Since they know only the activities and not the purpose, staff is forced to treat all elements as of equal importance. If you were watching, you would see them checking and double checking everything. The exercise is confined to pattern matching, which is sometimes necessary but is always tedious and error-prone.

Staff will infer the purpose. Human beings have a great need to understand. In the absence of explanation, they will construct a purpose. There is no malice in the motive, but the results can cause problems. An example is the medical assistant who tells a patient that you will not prescribe antibiotics without an office visit, because you only get paid for actually seeing the patient.

Here are some of the benefits of ensuring your staff understands why:

• They will find their jobs more satisfying. Explaining why invites staff to be junior partners instead of drones. It cuts down on both your aggravation and staff turnover.

•They will have the same understanding of the purpose as you. Staff will be consistently working with you toward a common objective. You will have encouraged them to think and take ownership.

They will be able to accurately state the purpose to patients. A patient is generally compliant when told that an office visit is required to initiate treatment because you have an obligation to confirm her diagnosis.

They know what information should be included in the instructions and make sure they get it from you with the initial request. Not only does this save you and staff the time required by a second interaction, it also gets the task completed more quickly.

They can deal with unexpected circumstances. Staff will know when they can proceed and report the change to you at a later time, as well as when everything needs to stop until you are informed and give other instructions.

They will make fewer mistakes. Any person finds it far easier to remember and correctly and consistently execute the steps in a process if they are contained within a logical framework. The SOAP note is a good example.

Yes, it takes more time to explain and to confirm understanding. If, however, it is likely that the same situation will occur again, the extra time is an investment and not an expense. You spend the extra time once (or twice) and then save time with each subsequent successful execution.

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