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Communication Breakdowns at Your Medical Practice


Are docs and staff just not on the same page? Here's how to fix it.

About a decade ago, family physician Randall Rickard separated from a larger healthcare system in Murfreesboro, Tenn., to form Family Practice Partners, an independent four-physician, two-site practice. Unfortunately, breaking away from the larger healthcare system led to major communication breakdowns between staff members at the new practice, says Rickard.

"We formed this group and we didn't have much effort put into working together," he says, noting that faulty communication arose within each practice site and between the two locations. Employees were failing to discuss their daily schedules and responsibilities with one another, and as a result, coordination and efficiency suffered. "To build teams you have to build communication," says Rickard.

To combat these types of breakdowns, Rickard and his colleagues began "huddling" with small groups of employees each morning to briefly discuss the day's schedule and identify what each individual could do to keep things running smoothly. They also initiated full-staff meetings regularly to relay goals, policies, and upcoming changes to employees. That way, Rickard says, "We could all work toward the same point as opposed to just randomly establishing schedules without communicating with each other."

Today, Family Practice Partners is thriving. So much so that it's even added a third practice site to its group. "We did a much better job once we started communicating," Rickard says. "…In order to innovate we had to communicate a lot."

Chain reactions

Often practices underestimate the importance of communication, says Barbara Stahura, a practice management consultant at PYA GatesMoore in Atlanta.

"A lot of times people see communication as a 'soft skill,'" she says, noting that it's not as "in the news" as say, coding changes, and it might not seem as measurable as accounts receivable.

But, done poorly, it is very measurable in terms of the problems it creates, she says.

As Rickard learned, the poor interchange of ideas can cause inefficiencies and disorganization. Worse, it can hinder quality of care, says Sherry Migliore, director of consulting at PMSCO Healthcare Consulting in Harrisburg, Pa. "If you have inherent issues in terms of how staff communicates with each other, you are going to have communication issues with patients as well," she says.

Of course, when quality of care is hindered by poor expression of information, both the patients and providers suffer negative results, says Miranda Felde, assistant vice president of patient safety at The Doctors Company, a nationwide malpractice insurer in Napa, Calif. "If there is a patient harmed and the patient decides to pursue litigation or file suit against the physician provider, the physician has to endure that," she says, noting that 85 percent of medical malpractice cases result from communication failures.

Making clear communication a top priority is the first step to improving it at any practice. If staff members don't understand its importance, they don't take the time to ensure they are articulating their ideas properly, says Migliore.

Stahura says implementing formal communication policies is key. Leaders should "define their expectations" regarding verbal, written, and nonverbal communication skills and policies. But leaders also need to show staff members that they too are working to fulfill those expectations, she says. "You can't expect your staff to communicate well and treat patients well if they're not seeing it modeled at the top."

The critical tool

Meetings provide an ideal opportunity for leadership to prioritize and address communication issues, says Migliore. Meetings can also (as Rickard learned) ensure your staff is working together to reach shared goals.

• Staff meetings. Meryl Luallin, a healthcare marketing consultant with SullivanLuallin Healthcare Consulting in San Diego, advises weekly staff meetings to keep employees updated and connected. Meetings minimize confusion that might later lead to communication breakdowns, and they reinforce a constant flow of discourse between staff members. Migliore recommends making communication an agenda item at such meetings. This helps relay its importance, and it also provides an opportunity for staff members to continually discuss problems and identify ways to solve them.

• Department meetings. For large medical practices, Stahura suggests short weekly meetings within each office area to discuss issues and keep staff informed.

• One-on-ones. When employees continually communicate poorly with one another, a manager should step in to help facilitate a discussion and resolve the issues, says Migliore.

Though meetings are "critical" to keeping communication flowing, Stahura says the frequency and type of meetings should vary depending on your practice's size and current challenges faced. "You have to feel out what works based on the practice," she says.

The vital activity

As Migliore points out, medical practices are now more "hectic" than ever. Often staff members have less time to do the same, or more, amount of work. This leads to major communication breakdowns.

"When you are rushing from one thing to the next and you don't have a lot of time you don't communicate very well," she says.

Daily huddles can ensure your staff is prepared and ready to take on each day despite busy schedules, says Luallin. Each morning, small teams of staff members, for example, a doctor, nurse, and receptionist, should huddle briefly to discuss the day's schedule, identify challenges that might crop up, and allocate tasks and responsibilities.

Huddles can also solve communication breakdowns between departments, says Stahura. For instance, if your practice is encountering accounts receivable problems, the billing office and the front office should huddle each morning to review the schedule and determine what needs to be collected from patients, she says. "I think it's a great way to understand what each other does, what your role is, and how they play into each other but also get the job done."

Further complications

Often breakdowns are more prevalent at large multi-specialty practices and multi-site practices. One reason is it's more difficult for staff members to become personally acquainted with each other, says Luallin. "You have to know who it is you are communicating with." Leadership at these practices should foster social interaction by holding weekly or monthly staff gatherings, such as lunches or dinners.

Quarterly "town hall" meetings can also ease breakdowns, says Luallin. The entire practice staff should meet in one location to discuss goals, responsibilities, policy changes, etc. "It builds camaraderie," she says. "That also improves communication."

Stahura suggests using Skype to hold remote practice-wide meetings when multi-site practices are separated by larger distances. She also says implementing practice-wide newsletters can help keep staff updated and connected. "The goal is to make everyone feel like we're one practice as opposed to only identifying with the site."

Honing skills

One of the most common sources of breakdowns is when staff members and physicians simply lack proper communication skills. Here are a few noteworthy one-on-one tips:

• Respect. When providing feedback to others, never "crush" them, urges Luallin. And when criticized, don't immediately become defensive.

• Follow through. When discussing a new policy or responsibility, don't assume colleagues immediately understand what you are saying. Check back in with them, says Migliore.

• Repeat back. When giving instructions to a colleague, ask him to repeat back his understanding of your directive, says Felde. That creates a "constant communication flow to and from so there isn't any kind of misunderstanding - the communication is clear."

• Tone appropriately. When rushing to complete a task, watch your tone, says Migliore. It's easy to come across as curt or rude. "How you say it is just as important as what you say."

If one-one-one communication problems are causing serious breakdowns at your practice, invest in skills training for staff and leadership, says Stahura. Though the initial price tag might be off-putting, she points out that not investing is likely costing you money. "Over and over again when we go into a practice we hear that communication is a problem," she says. "…Training is well worth a practice's time and expense."

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the April 2012 issue of Physicians Practice.

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