Improving healthcare communication to avoid harms: 3 Questions with Milisa Manojlovich

What are you thinking about?
I am thinking about how to improve communication between physicians and nurses, who represent the two largest provider groups in healthcare. Poor or ineffective communication between them contributes to ongoing and widespread barriers to patient safety, and is one of the top causes of adverse events, which can include anything from delays in care to increased length of stay in the hospital to premature death.

Effective communication occurs when there is shared understanding between communicators, which goes far deeper than just the exchange of information. Doctors and nurses can view the same clinical situation with the same patient from two totally different perspectives, with the result that they disagree about what information and knowledge is needed for patient care. This is why shared understanding – and out of that, effective communication - can be very challenging to achieve, and it’s why I’ve made this a central area of my work in trying to prevent healthcare-associated harm.

What role does technology play in provider communication?
We know that technology can be both a help and a hindrance when it comes to delivering quality care. The healthcare environment has become so complex in its array of communication modes, devices, and information technology platforms. We’ve been studying how all of this affects communication between nurses and doctors, and we’re finding that good relationships are far more important to communication than whatever technologies may be available. Translating this into practical advice for hospitals: to improve communication, don’t spend your money on the technology. Put your money into developing workshops to improve relationships. Put your money into supporting each group to learn how to talk to each other better.

What are the practical implications for healthcare?
Poor communication between physicians and nurses remains a pressing problem even after five decades of research focused on the issue. Twenty years into the patient safety movement in part launched by the seminal Institute of Medicine report, we’ve barely moved the needle in addressing medical errors and adverse events. The use of checklists and other popular approaches to improving communication in healthcare have had uneven success and have not led to significant, sustained progress. It’s time to rethink the way we address these problems in patient safety.

One way our team is trying to break through these barriers is by using a video-based feedback methodology that allows doctors and nurses to actually see how they’re communicating. Communication practices become habitual so we don’t even realize what we’re saying or doing, or how those practices might affect the people we’re trying to communicate with. By helping providers become more self-aware of their communication practices, this technique – known as video reflexive ethnography - has been effective in improving communication in a variety of healthcare settings around the world, and has great potential for improving patient safety.

I’m directing a new research center within the School of Nursing – the Pivot Hub – that’s using innovative methods like these to change the way we think about preventing patient harms and enhancing interprofessional communication.

For quality patient care, we need to include everyone’s perspective – from doctor to nurse to pharmacist, nutritionist, physical therapist, social worker, and, most importantly, the patient – that’s when the best outcomes occur. How we achieve understanding between all of these perspectives is where some of the biggest opportunities remain.