Quality Improvement is Impeded By Poor Communication 

Quality Improvement is Impeded By Poor Communication 

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Quality improvement is a strategic priority of almost every healthcare organization.  Regardless of what your quality scores and metrics show, competitiveness and financial strength are directly tied to the quality of your services.  This is becoming even more important in the move to outcomes and value-based care., This is why organizations have been gathering data, (re) assessing processes and procedures, and even implementing technology to enhance their performance. Yet many organizations have found they’ve reached a peak in quality, even if scores are subpar.  

So what could still be missing to improve quality, outcomes, and efficiency? It could be as simple as better  ‘Communication’.

Inefficient or lacking communication not only among the caregivers within and outside the organization but also with patients and family is often the root cause of quality gaps. Numerous peer-reviewed research studies have shown that communication failures lead to errors, can cost precious lives, reduce quality-of-life scores, and negatively impact the bottom line.  In fact, various studies have indicated that more than 35% of errors can be attributed to breakdowns in nurse-nurse or nurse-provider communications.  And it gets even worse when we consider communication with the patients. According to the Agency for Research and Healthcare Quality, “Communication between the patient, family, and clinicians is a critical component of high-quality, safe care and the foundation of partnerships between the patient, family, and clinicians.”  It’s important that establishing efficient processes and procedures to do so is a key part of the NAHQ’s strategy to improve quality.

While many organizations have invested in improving communications, the focus tends to be on what is being communicated (e.g. appointment reminders) and the language used in those communications (to address literacy and language barriers). They’ve overlooked how the communication is happening: is it via the EHR’s internal messaging, phone, email, text, or a message sitting in a portal?  There’s no question that refining what’s being communicated is crucial and the language being used to convey it, but if the information is not sent in an effective way to be received and acknowledged in an effective way, all is for naught.

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This challenge is even more difficult to address outside of acute care where the majority of caregivers are in one location, one EHR (or EMR), and typically controlling all of the care.  As we move to ambulatory and post-acute care, the ‘care team’ becomes far more diverse, dynamic, and distributed.  

For example, a patient discharged from the hospital back to the skilled nursing facility after surgery is supported by staff at the SNF, the surgeon, on-call medical staff from an affiliated provider group and its nurse practitioners, an external physio-therapist, and perhaps a phlebotomist from the local private lab to collect blood and urine samples, plus the family that is coming by with the patient’s favorite snacks. Each of these different caregivers works for a separate organization, with a separate IT infrastructure.

Let’s imagine the patient is complaining of difficulty breathing at 2:00 am.  The SNF’s nursing staff needs to communicate with the on-call physician, so they call the central phone # and await a callback.  When that call comes in, the physician needs a complete summary of the patient’s case before offering a course of action.  In the delay the patient’s condition worsens, and the on-call physician eventually prescribes intubation. 

At 7:00 am the family arrives with donuts, and is horrified to find their loved one “on death’s door.”  At 7:20 am the physio-therapist arrives for the initial consultation, only to find it won’t be happening today.  At 8:00 am the surgeon walks in the door after sitting in traffic for 35 minutes to round on her patient, and is similarly surprised to see the patient’s condition has degraded since discharge, and the trip may not have been necessary.  You get the idea… the issue was not a lack of process or data, but a lack of efficient communication across this entire group of people all with an interest in supporting the patient.   

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All the information regarding the patient’s status was in the SNF’s EHR. So what happened?  Do you think all this could be prevented if there was a shared communication platform that was patient-centered rather than organizationally centered, and each of these independent caregivers – including the family and friends- could communicate securely?  Even with perfect data, communication that is rooted in a hierarchical mindset fosters silo’d thinking, and results in delayed care, redundant work, and increased workload.  This contributes to burnout, and decreased job dissatisfaction, ultimately impacting staff retention. Advanced care delivery models such as ACO, value-based care, and state-run CMS programs require advanced approaches to communication, not just data integration and sharing.  

Still not convinced? Studies show:

Faster response times:

A 2023 study by HIMSS Analytics found hospitals with strong communication practices experienced 20% faster response times to critical events.

Reduced readmissions:

A 2022 Journal of Nursing Care Quality study demonstrated a 15% reduction in readmissions when care teams effectively collaborate through secure platforms.

Improved patient satisfaction:

A 2021 Commonwealth Fund study revealed a 30% increase in patient satisfaction scores when healthcare providers prioritize clear and timely communication.

Now some readers may be thinking “Yeah, we know.  That’s why we use text or WhatsApp.”  Or they may simply have informed staff to “do whatever it takes to communicate” which leads back to the myriad communication tools that expose the organization to greater inefficiencies and potential privacy risks as many tools are not HIPAA compliant.  So what should organizations look for in a unified communication platform to address these challenges?  

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Connect Diverse Teams:

Empower seamless collaboration across internal and external care providers, regardless of their location or employment affiliation. Include family & friends, and the patient themselves.

Prioritize Patient-Centricity:

Don’t just dump messages into a single continual string such as for a physical location, but make it patient-centric.  Enable communication with the specific team members to support each specific patient.  This will enable contextually relevant information delivery with clarity and action-ability, fostering better and faster-informed decision-making.

Contextualize Data Insights:

Clearly communicate what needs immediate attention versus what’s shared as an “FYI” or on an as-needed basis equipping all involved parties with the right information at the right time.

Ensure Secure Information Sharing:

Commit to HIPAA compliance which again, requires patient-centricity.  Just because one team member is at a location doesn’t mean they should have visibility into all patient’s care at that facility.  Solutions that embed ‘Privacy by Design” in their architecture not only strengthen each team member’s position concerning privacy and security but, also build trust and ensure adherence to regulations.

At the core of good healthcare is quality care.  And good quality care is dependent on effective communication, not just data and metrics.  As we move beyond the 4-walls of the hospital or outside the health system the care continuum is dynamic and diverse. So are the teams of individuals supporting patients, particularly in post-acute and ambulatory care.  As outcomes- and value-based care expands so too will the demands for more efficient communication across these diverse and dynamic teams.  With well-considered and intentionally designed communication strategies, organizations can meet these challenges with purpose-built communication tools.   

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