Effective communication and holistic patient care induce better health care facility

In the recent times, health care facilities and treatments have undergone sea changes. The changes implied that better communication with the patients was the need of the hour. Thus health care professionals need to have effective communication that is accurately timed, unambiguous, complete and comprehensible to the patients and their family. This will help in reducing mistakes resulting in improved healthcare facilities.

Promoting effective communications with the patient and his family

1. It is essential for the healthcare professionals to follow the rules of communication as described in the policy of the hospital or the healthcare organization.
2. The policy states that the professionals should use different modalities such as verbal, electronic as well as written documents to communicate and explain a certain situation to the patient and his family using the available facilities of the organization.
3. The hospital or the medical organization must communicate with the patient’s family once in a day to explain the patient’s current condition as well as the treatment that is being administered. The healthcare professionals must also notify the family about any change in the patient’s condition or any change in the treatment procedure.
4. The policy also states that only those communicative languages should be used that the patient’s family understands. If required, the organization must use an interpreter in order to explain the patient’s condition.

Special situations that require improved communicative skills


The organizations have identified certain essential situations where an improved communicative skill is compulsory. These situations include:

  • Explaining a bad news to the patients family
  • While managing an undesirable situation
  • While controlling an aggressive or a violent patient or his family
  • While intervening into a complex situation
  • Being gentle while talking to the family of a deceased patient
  • While explaining the complete procedure of an organ transplant to the patient’s family
  • Explaining the possibilities of a treatment to a patient going in for clinical research

The Process of Effective Communication Explained


A. Explaining a bad news to the patient’s family


In cases of breaking a bad news to the patient and his family, the organization must explain the process of diagnosis of the patient as well as their decision, if a treatment is required. Usually cases like cancer detection, heart failure, renal failure or any other terminal illness needs special attention. The chief consultant must counsel the patient and his family gently and with sensitivity. The counselling session can be recorded and duly signed by the patient’s family.

B. While managing an undesirable situation


In events such as complication in the process of anaesthesia, medications, sentinel events or adverse complications during a surgery, the organization must go for a detailed analysis and investigation and then take actions as required.
These situations should be communicated immediately to the chief consultant who may involve other professionals for further communications with the patient’s family, if he may require. These communications should be explicit in making the patient’s family understand the cause of such situation and the actions that has been taken. These communications should be documented and kept securely by the organization.

C. While controlling an aggressive or a violent patient or his family


When the patient is aggressive due to certain clinical condition then the chief consultant must communicate the situation as well as the consequences to the patient’s family. The consultant must also explain the necessary actions such as restraints to the family which should also be documented clearly in the restraint order form with the family’s consent. If any aggression arises from a nonclinical issue then the organization should use the code help in order to manage the situation.
The manager on-duty along with other professionals, as required, should communicate and counsel the patient and his family about the consequences of such aggression. The organization shall take required steps in protecting the healthcare professionals while managing the situation. The incidents must be documents in the incident report form.

D. While intervening into a complex situation


Complex clinical situation may arise and the medical consultant must communicate essential information such as the risk involved in the treatment process and the desired outcome along with factors like expenditure and expected time of recovery. The consultant must also explain the benefits of such treatment procedure so that the patient’s family can make informed decision which should be documented in the consent form duly signed by the patient party.

E. Being gentle while talking to the family of a deceased patient


The consultant must explain the following points to the patient’s family

1. The chief consultant should inform the patient’s family about the demise of the patient when it occurs.
2. According to the general rule the chief consultant must confirm the demise and document it in the patient’s medical record. A summary of death has to be prepared. Apart from this, if the death is due to an MLC(Medico Legal Case) then the organization must inform the police as per rule.
3. If the body requires a post mortem, then the healthcare professionals must cover all tubes, lines, devices or equipments, if any, from the deceased’s body in order to prevent any leakage. Otherwise, if there is no need for a post mortem then these devices and tubes should be removed from the body.
4. Jewellery, if any, should be removed in the presence of a nurse along with a family member. The same must be handed over to the family after removal. If there is no family then the articles must be handed over to the police against an acknowledgement receipt with valid photo ID proof. If a valid ID proof of the deceased is not available then the whole thing should be done in front of a camera or CCTV and it should be documented as per rule.
5. The body should then be prepared to be shifted to the mortuary and handed over as per the HIC protocol. A record should be taken in regards to any jewellery that could not be removed or any other object that is still left in the body. The family members can accompany and witness the procedure of shifting.
6. While handing over the body to the family or the police (in case of MLC), the healthcare workers should explain the precautions that need to be taken until the body’s funeral.

F. While explaining the complete procedure of an organ transplant to the patient’s family.


Donors who are brain dead:


1. The transplantation of organs can only be initiated in accordance to the will of the deceased or as per the documented consent of the family members.
2. The transplant coordinator of the organization will take the responsibility to counsel and explain the procedure of organ transplantation to the relatives of the deceased.
3. After the satisfactory completion of the documents regarding the consent of the relatives and legal requirements, the organization should proceed for the transplantation of organs.
4. The process and other issues of transplant should be satisfactorily explained to the relatives in the languages that they understand.
All these procedures should be explained to the relatives and documented in the consent form duly signed by the relatives.

Live donors:


1. The transplant coordinator of the hospital will be responsible for explaining and counseling the donor, the recipient and his relatives on the procedures of the transplant.
2. After receiving the consent from the donor and the recipient and completing the legal requirements, the organization shall proceed with the transplantation of organs.
3. Everything related to the donation and transplantation of the organs should be explained to the donor and the recipient in the languages that they understand.
It is mandatory and essential to explain all these above procedures to the donor and the recipient and their respective family clearly. The same should be recorded and duly signed in the consent forms by both the parties. The hospital shall also organize for a video recording of the process of consent.

G. Explaining the possibilities of a treatment to a patient going in for clinical research


In cases of clinical research patient, all communications should be done by the chief investigator in accordance to the protocols laid down by the clinical research department. Before the initiation of the research, the organization must obtain the consent in written from the research patient. Moreover, the chief investigator must explain the benefits, risks and alternatives of the research to the research patient in a language that he or she understands.

Communications that is totally unacceptable


The organizations have laid down certain rules regarding unacceptable communicative behaviour and they also need to train and sensitize the healthcare workers about such misconduct. The communicative behaviours that are unacceptable include:
1. Abusing the patient in any way
2. The staffs should not hurt any religious or cultural aspects of the patient
3. They must not communicate with the patient disrespectfully
4. They must also not disclose or discuss the condition of the patient to anyone else

Monitoring of the research patient


The hospital or the organization abides by the system of monitoring and reviewing the accomplishment of effective communications of their staffs with the help of patient’s feedback from time to time.

Training procedures


The healthcare staffs are sufficiently trained on how to communicate with the patient and the clinical research patient. The hospitals also conduct periodic training programs for the staffs in order to impart training on how to manage special or complex situations. The staffs also learn the good practices of communication in the healthcare industry. The hospitals usually have methods to identify the requirement of trainings to improve communication skills of the staffs. These methods are patient feedback system, staffs feedback system, incident reports and appraisal.

Managing an aggressive communication


In a situation, where the patient or his family is behaving aggressively or violently and which is going out of control of the management staffs, nurses and unit staffs, then the organization must use a dedicated emergency alert in order to generate a prompt response.

Published By:- Sudip Dey

MHA, PGDOM, Six Sigma Green Belt
NABH internal Assessor
Environment & Social Governance(ESG) expert
Life Member of CAHO(Consortium of Accredited Hospitals)
Member of Quality Council of India

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