Strategies to Improve Nurse Physician Communication

nurse physician communication

Communication is the key to  collaborative and efficient workflow in any industry. Collaboration is a critical task in healthcare since a single patient is cared for by multiple people including technicians, nurses, physicians, and doctors. Clear, efficient communication is imperative in healthcare because a single error can lead to serious consequences for the patient.

Physician Communication

Nurse and Physician Communication

Communication between a nurse and a physician is an extremely important link in the chain of patient care. However, there are still many challenges in this era of technological advancement. The dilemma is aptly summarized by Cassandra Lee Flicek in MEDSURG Nursing:

“The lack of co-educational experiences involving the two professions possibly leads to a lack of understanding of what each profession contributes to the interdisciplinary team, and complicates communication between nurses and physicians.”

Common Challenges in Nurse-Physician Communication

Several factors affect nurse-physical communication. A study by Dr. Jennifer Tjia et al in the Journal of Patient Safety found that the most common impediments to communication between nurses and physicians are:

  • Language barriers
  • Nurse preparedness
  • Logistical problems
  • Frustration with a lack of professional respect
  • Lack of collaboration and openness

 

Learn more about improving communication using hucu.ai

Language Barriers

Nurses reported difficulty in understanding physicians due to language difficulties or accents. Jargon is also an issue. These problems prevent effective communication.

Nurse Preparedness

Some nurses felt uncomfortable in deciding what to report to the physician and almost 1/3rd of respondents said they were afraid of bothering the physician with their observations. Since nurses spend a lot of time with the patients, their observations are critical to patient care and should be communicated.

Logistical Problems

Finding a quiet place to communicate without distractions has been proven difficult for 1/3rd of the respondents of the study. Nurses also claimed to not having time to communicate. 1/5th of the respondents claimed they were not able to get in touch with the physician when they needed to.

Lack of Professional Respect

In the study, around 17% of nurse respondents and their answers indicated a perceived lack of respect from physicians. 16% also reported being interrupted before they finish imparting information. Both physicians and nurses are important links in patient care and a breakdown of respect between these two can cause a breakdown of trust which adversely affects patient care.

Lack of Collaboration and Openness

In Dr. Tija’s study, the communication problem that nurses most frequently report was feeling hurried by the physicians or feel unheard by the physician when he/she tried to convey information. Such perceptions indicate that information is not being given or received effectively and that nurses feel active discouragement about their views, assessments, and opinion in patient care. This can drastically lower the chances of critical observations and information being voiced out.

Impact of Nurse-Physician Communication on Patient Outcomes

The impact of poor communication on organizations around the world is well documented. This study found out that poor communication is one of the main reasons why a project fails one-third of the time and has a major negative impact on project success more than 50% of the time. In a business environment this can be devastating for the profits. In a medical environment, it can cost precious lives. According to a study in The Online Journal of Issues in Nursing both safety and quality of care patients receive depend upon the quality of the practice environment where care is provided. The study also found that 55% of nurses surveyed indicated that physician behavior impacted patient care decisions and that less experienced nurses were affected more than the more experienced ones.

If nurse-physician communication is improved, it can have several benefits. Patient satisfaction also improved as patients see medical staff being competent and professional. This impacts the quality of the patient care. Medical team satisfaction also improves leading to job satisfaction which reduces turnover. All of these factors have an impact on patient care.

Lack of Collaboration and Openness

Improving communication between nurses and physicians has lots of obvious benefits but implementing this change is difficult. According to Patient Safety & Quality Healthcare (PSQH) there are three important tools for improving communication. These are:

  • Culture Change
  • Structured Communication Tools
  • Supportive Technology

Culture Change

PSQH calls this factor as the most fundamental intervention for improving nurse-physician communication. Culture change begins from the top: leaders need to create an environment of open communication by displaying approachable behaviors, setting expectations, and investing in support systems in the organizational structure. If patient families and nurses are both included in bedside rounds, it emphasizes that physicians and nurses are a team and fosters an environment of mutual respect that goes a long way to create a culture of open communication.

Structured Communication Tools

Using a structured communication tool like SBAR can remove any doubt of guesswork from nurse-physician communication. SBAR stands for Situation, Background, Assessment, and Recommendation. It gives a framework that facilitates the easy organization and giving of information between nurses and physicians. By following an established procedure that everyone needs to follow and respect, expectations can be set for communication. Nurses can quickly and effectively prepare for an impromptu conversation with physicians and will be able to communicate important information in an organized method. A structured communication tool can also aid in overcoming some language barriers, when it comes to medical jargon.

Supported Technology

Secure communication technology like electronic health records (EHRs) and telehealth can facilitate efficient, quick, and effective communication. Writing a nurse-physician communication can eliminate accent based and linguistic barriers while also easing time constraints by making communication asynchronous. EHRs are important communication tools as these ensure all parties have updated information about patients. It creates a shared foundation of knowledge for effective communication.

Telehealth provides multiple channels to improve nurse-physician communication. Hucu is a free texting application that is HIPAA compliant. It can work wonders to ease communication among the medical staff and impact patient care positively. Nurses and physicians can update each other in real-time about any important incident or share health records instantly. They can also communicate about the next steps in critical situations instantly which can save a life. Different channels can be created for different patients for updating their health information and this can save time for both the nurse and the physician. Hucu is an excellent choice of telehealth technology for eliminating communication challenges in a healthcare organization.

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The Dramatic Impact of Increased Telemedicine in the Covid 19 Era: WHAT’S NEXT

As the world was hit by COVID-19 which seems here to stay without a vaccine, there has been one question reverberating throughout the healthcare industry: what is the future for the temporary healthcare expansion in Medicare once the coronavirus public health emergency is over? 

This is also the same question discussed in the Senate Committee hearing a few weeks ago, “Telehealth: Lessons from the COVID-19 Pandemic.” The Health, Education, Labor and Pensions (HELP) Committee Members listened to four candidates on this topic including Karen Rheuban, M.D From University of Virginia, Joseph Kvedar, M.D from the American Telemedicine Association, Sanjeev Arora, M.D from the University of New Mexico Health Sciences Center and Andrea Willis, M.D. from the BlueCross BlueShield of Tennessee. 

These experts had a great deal to say about how telehealth is so important throughout the pandemic and has the ability to truly deliver healthcare in an effective and efficient way before and after the public health emergency. Discussion also touched on how patients showed acceptance of virtual visits and remote patient monitoring. The witnesses also warned how patients are at a risk of losing access to healthcare if the telehealth expansions are not made permanent in future. 

Since the PHE was declared, there have been more than 30 temporary federal policy changes that took place related to telehealth. The Center of Connected Health Policy (CCHP) prepared a chart detailing temporary actions taken in reaction to COVID-19, basis of those actions, expiration date and what action could be taken to preserve such policy change after the public health emergency (PHE) is over. 

The Senate hearing witnessed  great interest in favor of making the telehealth expansion permanent forthe originating sites and to include all locations, including the patient’s house.  It was also discussed whether it is a good idea to allow a healthcare provider that’s eligible to bill Medicare for their professional services to maintain that eligibility for telehealth reimbursement – and most people agree. Right now, certain statutes restrict eligible telehealth distant site providers to set list of 8 different providers – physicians, nurse practitioners, psychologists and others.  

But since there is a digital divide and lack of technology coupled with digital literacy and access to high speed internet in some low-income communities and areas, concerns were shared and discussed in relation to the possibility of making audio-only telephone reimbursement permanent.  BlueCross BlueShield of Tennessee fielded questions about their permanent expansion of parity pay for telehealth delivered primary, specialty and behavioral health care services for all in-network providers. 

This hearing was a great start to answer questions and discuss telehealth’s future as many policymakers try to grapple with whether they should approve several telehealth bills that are being presented to congress and are asking to make the current telehealth reimbursement policies permanent in Medicare or in private insurance plans. You can check out the complete list of proposed telehealth bills here including these highlights:

  • S 3988 – Amends the Public Health Service Act with respect to telehealth enhancements for emergency response.
  • HR 7187 – Provides for permanent payments for telehealth services furnished by federally qualified health centers and rural health clinics under the Medicare program.
  • HR 7078 – A study to determine the effects of changes to telehealth under the Medicare and Medicaid programs during the COVID-19 emergency.
  • S 3792 – Requires parity in the coverage of mental health and substance use disorder services provided to enrollees in private insurance plans, whether such services are provided in-person or through telehealth.
  • HR 6792/S 3998 – Simplifies payments for telehealth services furnished by federally qualified health centers or rural health clinics under the Medicare program, and for other purposes.
  • HR 7233 – Directs the Secretary of Health and Human Services and the Controller General of the United States to conduct studies and prepare a report to Congress on actions taken to expand access to telehealth services under the Medicare, Medicaid, and Children’s Health Insurance programs during the COVID-19 emergency.
  • HR 3741:  Requires ERISA plans to cover telehealth services at parity for the duration of the PHE.

What’s Next?

It cannot be denied that the world has seen a dramatic impact of increased telemedicine because of the Pandemic. Whether or not we can channel that impact to positively change the outlook of healthcare is still a question. Telehealth is a world in its own right and if the pandemic has taught us anything, we know for sure that everything is connected.

Everything is Connected

It is known that people who live in densely populated cities are exposed to air pollution and have a negative impact on their health in the longer run. Covid-19 also alleviated environmental stressors. We know that a healthy environment makes for healthier people. This also illustrated an important aspect of healthcare which is not acknowledged: it does not exist in a bubble. Just as healthcare represents an essential set of services that exist as part of a larger ecosystem, telehealth also represents one type of service that is part of a connectivity ecosystem known as Smart Cities.

Smart Cities use connected devices, lights, sensors, and meters to collect and analyze data that is used to improve infrastructure, essentials services, and public utilities. A report from the McKinsey Global Institute found that smart city technologies can improve key quality-of-life indicators by 30%.

healthcare communication app

Doctors, Patients and Families Can Stay Connected Remotely and Securely With Hucu

For example, many senior citizens say they would prefer to live the rest of their lives at home rather than move into residential care according to Harvard Joint Center for Housing Studies. But there are gaps in technology right now which makes aging in place riskier. However, imagine an elderly person who lives alone but is being monitored remotely by a wearable sensor that sends out automated data to the healthcare team and alerts them about irregularities that could indicate an underlying condition. Moreover, the patient can use telehealth applications like Hucu to stay connected to his doctor and regularly check-in via video conferencing. In case of an emergency, the sensors can detect if the person falls or is not able to call for help. The device could contact emergency services to send an ambulance. After EMTs determine the patient has to be transported to a healthcare facility, Smart City infrastructure can manage the stoplights on the way to the hospital, give a fast and unimpeded drive to the closest ER with the shortest wait time, and availability of staff to handle the person’s medical needs.

The reality is that today’s telehealth services have only begun to scratch the surface of what is possible in terms of connectivity and healthcare. It is very exciting and has a lot of potential. Though the scenario is fabricated, it is possible that in the near future, we would see something like this being facilitated by telehealth connectivity.

Connectivity Is Everything

To move forward with a true Smart City ecosystem, we need to consider the underlying infrastructure it will take to support it. The biggest factor which can damage the establishment of Smart Cities is a lack of connectivity as discussed in the senate hearing. Without a strong connection between devices, Smart Cities technologies would not be possible to implement.

 

Smart Cities will be most impactful when they operate across sectors to connect healthcare, public safety, human services, and the environment. Technology can reinvent healthcare as we know it. The pandemic may have been the catalyst for change but hopefully, telehealth’s benefits will inspire more lasting transformation.



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Seven Ways Healthcare Leaders Can Reduce the Cost of Physician Burnout

The fourth pillar of the Quadruple Aim of healthcare is provider satisfaction for an important reason. Nearly all physicians that participated in a 2019 survey about physician dissatisfaction by Geneia LLC agreed that curbing physician burnout is critical and without improved physician work satisfaction there will be a decrease in the quality of the workforce and consequently both the quality and cost of healthcare.

With the trend towards physician group employment increasing, levels of physician burnout among employees is outpacing independent doctors. The Geneia survey was designed to identify workplace solutions to improve physician satisfaction.

The result from the survey of 401 employed physicians indicated that solutions need to address priorities for physicians’ time. Physicians want to get control of how their time is used, improve the amount of quality of time with patients, and to create a workplace that allows them time for basic needs like eating, bathroom breaks, and administrative duties. Overall, there are serious concerns about the way administrative burdens like EHR prior authorization, quality metrics, and health insurance approvals have overwhelmed schedules and reduced the time/care they can offer to patients. All of this is resulting in Physician burnout. Other notable  results from the survey:

  • 84% of physicians said the quality time doctors can spend with patients has reduced in the past 10 years.
  • More than 77% know a physician who is likely to quit practicing medicine in the next 5 years due to burnout.
  • Almost 74% of physicians said the challenges of practicing medicine in today’s hectic environment have caused them to reconsider career options.
  • 83% said they are personally at risk for burnout at some point in their medical career

7 Ways Employers Can Reduce Healthcare Staff Burnout

In addition to improving the efficiency and effectiveness of EHR tasks, here are seven ways for healthcare organizations that employ physicians to help address the growing problem of physician burnout and lower stress in healthcare.

Listen!!!

The employed physicians surveyed agreed there is benefit in adding more purpose, intention, and clarity in physician engagement surveys in the workplace.  Even more important, employers must offer concrete examples how survey results have or will impact change to demonstrate hearing physician perspectives.

Offer Professional Development Opportunities.

90% of physicians want employers to offer professional opportunities for physicians. They believe offering a robust professional development program is a meaningful way for employers to show they care about the professional advancements and satisfaction of their staff members. Note: Physicians do not consider EHR training professional development!

Empower Burnout Action Teams

Employers can empower clinician-staff committees to identify and attack burnout contributors and make operational recommendations to administrators so that those changes can be implemented effectively.

Schedule Breaks

Employers can pay attention to the basic needs of physicians that work long hours. Carving out time for bathroom breaks and making healthy food available near physicians’ offices can be great ways to increase satisfaction. It will help lower healthcare staff stress

Invest in Non Physician Supports

Employers can invest in physician time-savers like scribes – which is a top solution for relieving stress in the workplace – pre-visit planning and pre-visit lab testing, and care team huddles. All of these investments will allow physicians to have more time with patients and let them know that employers truly prioritize clinical time.

Prioritize Patient Facing Time

Employers can consider ways to allow physicians to have more time with patients with complex healthcare needs. While physicians would like more time with all patients, the intensity of feeling to do this is stronger for patients with complex healthcare needs. 97% of surveyed physicians said that it is important for employers to increase the current allocation of time per patient. 

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Encourage Physician Collegiality

It is important for employers to build team unity to help lower provider stress at the workplace. Anecdotal evidence suggests physicians miss the doctor lounge and informal opportunity it created for collegiality.

Physician Burnout Can be Costly

Why do employers need to consider these solutions to address physician burnout? Because it can cost their practice dearly otherwise. Several studies have shown that physician burnout is costly to doctors, patients, hospitals, and healthcare organizations.

  • Economic Costs: a study published in the Annals of Internal Medicine concluded that physician burnout costs the industry between $2.6 billion and $6.3 billion annually with a baseline of around $4.6 billion due to turnover and reduced clinical hours. In simpler words, each employed physician leads to about $7600 in annual burnout costs for their organizations.
  • Patient Safety: Research shows that physician burnout can double the odds of a patient safety incident. Physician burnout is related to a higher risk of patient safety incidents, poorer care, and lower patient satisfaction.
  • Patient Outcomes: with physicians who had higher depersonalization and burnout scores, their patients took much longer time to recover even after the severity of illness and other demographic factors were adjusted according to one study.Patient Satisfaction: In a 2018 Geneia survey, 96% of physicians reported that they have personally experienced or witnessed negative impacts as a result of physician burnout such as cynicism, dissatisfied patients, extreme stress, and lowered empathy for patients.
  • Patient Shortage: physician dissatisfaction is likely to worsen the projected physician shortage. A study by the Association of American Medical Colleges predicts a shortage of nearly 122,000 physicians by 2032. Burned out physicians are more likely to leave clinical practice in advance of retirement.

At the organizational level, strategies such as the ones addressed in this blog can acknowledge the problem and lower stress in healthcare. There is a need to develop targeted interventions, cultivate community at work, and provide resources to promote resilience and self-care. Healthcare systems can also deploy healthcare applications like Hucu.ai that can free up time spent by physicians, doctors and nurses in coordinating care for patients.

HUCU helps Reduce Physicians’ Stress

Hucu is a HIPAA compliant free text messaging application that organizes team members, patients and families in one application to provide care.  Here is how Hucu.ai helps clinicians, physicians and healthcare team members get more done. With Hucu:

  • Organize Providers’ Days by automatically generating real-time prioritized patients’ hot lists.
  • Prioritized Patients’ Hot Lists are further organized by each facility.
  • Streamline Communication Between Providers & Facility Staff by allowing them to communicate in context within each Patient-Channel, with each other in 1-1 Direct Messages & within internal and/or external Groups through Collaboration Channels
  • Timely, Yet Distinctive Notifications when providers and facility staff tag each other, or when the entire Group is tagged, or when no one is tagged.
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