Could it be that the key to good, quality healthcare is good, quality communication? Deborah Bosley, PhD, who describes her passion as making written communications simple and useful, thinks so.
"It is very clear that poor communication . . . adds to a problem of [achieving] quality healthcare," said Bosley, who is an associate professor of English at the University of North Carolina in Charlotte, and a principle in The Plain Language Group. Many of these examples of good communication can be seen in most healthcare settings every day.
To approach better quality communications, Bosley breaks it down by the three E's: effectiveness, efficiency, and economy.
Effectiveness. Many times providers may believe they are communicating effectively by giving their patients lots of oral information during a consultation—but actually they are not. A number of studies have shown that between 40% and 80% of information is almost immediately forgotten, Bosley said.
The reasons why patients fail to retain much data can vary. For instance, some patients just may not understand English that well. Others may not have good memories. Or others may get lost on some of the medical jargon used by the provider (for instance, doctors who say "myocardial infarction" instead of heart attack).
While writing down the information can help, this is not always the preferred route either. "Sometimes that information is really written so that the bureaucracy can speak to each other or that the doctor and the lab can understand it—but the patient can't understand," Bosley said.
"One of the most important things is to create information in plain language that your audience can understand and use," Bosley said. This can include taking some tips from the National Institutes of Health’s initiative on plain language that focuses on how to convey healthcare messages without speaking down to a patient.
Other times it could mean getting feedback from patients or others on written communications aimed at those patients. For instance, a flyer in a physician's office on how to dress your bandages can be made to communicate its message better by testing it out on about half a dozen people. "With 'usability testing,' you only have to test a document out on five to eight people to uncover 85% to 90% of the problems," she said.
Efficiency. "Efficiency is a problem with people having to contact a [medical] staff or physician multiple times in order to try to get clarity with the information that they've been given," Bosley said.
This has become a prime issue in discharge planning from a hospital, for example, where a patient is released from a hospital with vague or unclear healthcare data—only to return a few days later.
And in physician offices, calls from patients unclear about data or directions can eat up hours of unbillable hours of care by staff on the phones. "The lack of the use of plain language increases the inefficiency," she said.
Economy. While the most important objective in healthcare is keeping the individual alive, "the second most important thing is decreasing the costs," Bosley said. And while poor communication can negatively influence a patient's quality of life and treatment decisions, it can also impact outcomes—and possible cases of malpractice.
"If physicians and hospitals improve communications with patients, they create an environment in which patients do not want to sue their doctors," Bosley said. "If the patient trusts that the doctor has explained the diagnosis and has explained the comprehensive care that they are receiving—in a language they can understand—they are much likely less to sue," she said.