IMPROVING COMMUNICATION

In the UK, improving communication is a stated objective in the policy statement of every national, governmental, professional and academic body concerned with healthcare, particularly in respect of increasing the extent to which patients take part in their own healthcare and its management and reducing the wastage of resources from complaints and non-adherence to treatment.

Most UK institutions which offer undergraduate, postgraduate and continuing education diplomas to healthcare professionals now teach and examine the communication skills of the candidates.

The challenge to the professional bodies and to healthcare management equally is:
-to provide facilities, time, resources and trained personnel to develop and support good communication practice in every healthcare professional
-at the same time to motivate healthcare professionals in communication
-to provide patients with accurate accessible information
-to organize systematic regular feedback from patients and the community and respond to the evidence therefrom.
This requires consistent and persistent strategic initiative, money, an effective programme for change management, and the capacity to provide the individual coaching that is needed to change the performance of individuals. In this sort of strategy it is the peer pressure of senior and influential professionals which has the greatest influence.

Improving communication in individuals

There are certain basic factors which contribute to improving communication skills:
Having clear objectives about the work, the nature of communication and medical interviews and how the basic interview can be adapted to all others.
Teaching in small groups of learners who get to know each other, all of whom go through the same process. This allows each member to reveal difficulties and weaknesses and to discuss and improve them comfortably.
Experiential methods are needed; learning by doing it, not by reading the manual.
Role-play is one cornerstone of learning communication skill - role-play with experienced actors as simulated patients rather than amateur role-players selected from the group.
Discussion of each simulated consultation is carried out along pre-decided rules of feedback, designed to explore what has happened; working from the strengths of the learner towards weaknesses; among friendly, discreet and equally vulnerable colleagues. Learning from feedback can be enhanced by using a video-recording of the process.
A few hours' work can only raise awareness. A new skill needs to be practised at least three times and often more before it will stick. Improvement in performance requires coaching until the skill is established, and like any other human activity communication skills need to be exercised regularly.

Teaching the teachers

Widespread improvement in communication will require a lot more teachers and well-motivated learners. All teachers should be taught to teach and supported adequately.

Research

One reason that many clinicians do not know the results of research on communication is that the qualitative and meta-analytic methods used are unfamiliar and are dispersed in non-clinical literature.

Qualitative research seeks to ask broad questions concerning social phenomena in a natural rather than an experimental setting - questions about the meaning, the experience, the views and values of healthcare issues to all participants.

The methods used - observation, in-depth interviews, focus groups and detailed case studies - are complementary rather than antithetical to quantitative research. They are designed to answer the questions that quantitative research cannot reach. For example, while quantitative research demonstrates the dangers of smoking, qualitative research examines what makes people stop or continue doing it.

Research into the effect of communication on health is complicated because in the same patient at the same time, good or bad communication influences every one of the four categories of healthcare issues above. Separating the effects of these variables under research conditions requires meticulous techniques of qualitative care, achieved in certain studies hitherto, but only with great difficulty.