Beverley H. Johnson. An Interview on Communication CONVERSATIONS

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2 Beverley H. Johnson Beverley H. Johnson serves as President and Chief Executive Officer of the Institute for Patient- and Family- Centered Care. She has over 25 years of experience in organizational development and management and has provided technical assistance and consultation to over 250 hospitals across the United States and Canada. She has published widely on patient- and family-centered issues and strategies and has been the recipient of many awards for her leadership in the field. Patient/provider communication efforts can pose many challenges and opportunities. How can provider communication enhance favorable patient outcomes on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores? When providers have a clear understanding of how to effectively talk with patients and their families, patients will feel more satisfied overall with their care. But to get to this outcome, we have to provide a lot of professional education to help clinicians learn how best to communicate with patients and their families and how to use these opportunities to promote health and wellness. I don t think these skills have been taught significantly in the hospital or clinical setting to most residents, fellows, and clinicians, but this type of training needs to happen across all disciplines in order to ensure best outcomes. A big part of the problem hampering patient/provider relationships is the fact that in most hospitals today, rounds are conducted in the hallway and not in the patient room with the patient and family. This means that it s only physicians talking to physicians, trainees, residents, and medical students, and not having an interdisciplinary conversation with the person who truly matters. That s a major component of our current system that really needs to change. The good news, though, is that we are already making progress in this area. In fact, exciting work is now underway in various academic medical centers around the country, where rounds are finally being conducted in the room with the patient and family. And it s not just getting the geography right that s so crucial here it s having a conversation in a respectful way with the patient and family and including them as essential members of the healthcare team. The more we train medical students on working directly with patients and families toward common goals, the more this will begin to be an accepted part of how we do business moving forward. 2 Copyright 2015 The Center for Health Design. All Rights Reserved.

3 The research shows that the lack of privacy in a shared room discourages patients from disclosing personal information to the clinician. What are other barriers to good communication in the doctorpatient relationship? There are a number of huge barriers inherent in our current system that hampers doctor-patient relations. For instance, nurses, like physicians, are also weak in communication skills when it comes to patients. But this barrier is beginning to lessen. In the past, the nurse change-of-shift used to happen on a tape recorder or at the nurses station. However, more organizations are now insisting that nurses go into the room and do their report with the patient and family. This is an important step that more hospitals need to adopt. It s a huge culture change for nurses but it s also an important one, since it increases safety. Another big barrier to communication is the lack of single rooms in some facilities. The research shows that the lack of privacy in a shared room discourages patients from disclosing personal information to the clinician. If you think about it, it really makes sense. I wouldn t go to a hotel when I am healthy and stay with a stranger. Why, when I am sick, would I want to be in a room at my most vulnerable time with someone I don t know and why would I share health details in front of this stranger? There is clear data around that issue, and we are addressing it now as we design new facilities. Another huge barrier is that many of our hospitals still have restricted visiting hours, and they also limit the amount of time that families can visit intensive care units. We need to allow families to stay according to the patient s preference so that the patient is supported and the family is encouraged to be part of the care process. This is important so that when the patient goes home, the family will know how to provide proper care to help the patient avoid rehospitalization. Our feeling is that you will reduce chances of harm and readmission if you keep whomever the patient defines as family in the loop and informed. What tools and resources are available to healthcare providers trying to improve patient communication? We started an international campaign called Better Together: Partnering With Families. It can be accessed from our website. 3 Copyright 2015 The Center for Health Design. All Rights Reserved.

4 You ve got to help patients and families feel that they can manage the space in your facility. From the moment they step through the front door, there should be a sense of arrival, and there should be visible clues that tell them where to go. This should carry through on every floor. The campaign offers free resources, including videos, models, action steps, and media tools all of which are available to staff and leaders to promote this change in eliminating restrictive visiting policies in the hospital. There are also a few pamphlets for families about their role and how they can partner in the patient s care. What are the potential opportunities for designers? How can the physical space support the work processes of the organization? There are a number of concrete things designers can do to help a facility s physical space support the work that happens inside its walls. For instance, in the hospital setting, we need to continue the movement to all single rooms because we know communication is better in that setup and it reduces exposure to germs. Designers also need to plan for spaces that support family presence and participation. It s very hard to sleep in a stand-up hard chair. We need to provide a comfortable space for a family member to spend the night, and we need to better apply all of the elements that help them feel welcomed and encouraged to be part of the care process. Other ways designers can help include making sure signage and artwork are reflective of the population you serve. We also want to prevent hospitals from looking like clinical spaces designed only for the people who work in them. A well-designed space should have elements that communicate that the patient is welcome and valued there. What other issues or challenges have you seen related to this topic? I think some facilities forget that their visual space, and not just their clinical staff, needs to communicate with patients. In fact, it s essential that the surroundings speak the patients own language, so they will feel right at home in the setting and have a sense of trust there. To give you an example, years ago I visited a fancy Boston hospital, and they asked what I thought about their new lobby. I said, Do you really want to know? I felt it was intimidating for the patient to have a big space that was all marble and hard surfaces. It wasn t at all like a living room concept. It s harder when you have a huge place and have to deal with matters of scale, but you ve got to help patients and families feel that they can manage the space in your facility. From the moment they step through the front door, there should be a 4 Copyright 2015 The Center for Health Design. All Rights Reserved.

5 sense of arrival, and there should be visible clues that tell them where to go. This should carry through on every floor. If you re going to build a new healthcare facility, the people it will serve should be included as an integral part of the design team right from the very first planning meeting. From my personal perspective, I get lost easily. If I am going to visit with a clinician and have to go to the fifth floor, I get lost and end up wandering around on my way there. By the time I see that physician, I am so anxious that I m really not at my best to be a partner in my healthcare. If you have people positioned as greeters, or if the signage is clear, this can help a lot to orient people so they don t feel lost and out of control. That flow is very important in a hospital. Can you share an example of how a hospital can effectively tackle communication challenges? An Emergency Room nurse in Tennessee and Mississippi told me that in her facility, patients seemed to feel isolated from the staff. To address the issue, she removed the sliding glass window that separated patients and families from the staff working in the reception area. This helped to foster a stronger sense of community between patients and workers and made them feel more like they were on the same team. Since security is always a concern, of course, the staff was prepared for any safety issues that could arise. But in the meantime, they were also able to interact more positively with the patients and make them feel more comfortable. As a result of this change, I believe that patients will experience less stress, and there will be a much more positive dynamic in the ER overall. What is the next step for designers? How can they play a proactive role to facilitate communication? The bottom line is that patients and families should be included on design teams so they can work side-by-side with designers, architects, and engineers. If you re going to build a new healthcare facility, the people it will serve should be included as an integral part of the design team right from the very first planning meeting. They can learn right along with staff members as you move through the process. When patients and families are involved in the process from the beginning, they can bring a valuable perspective and insights that help people to think in different ways. We ve worked with a lot of healthcare organizations in the United States and Canada on making that happen. In our process, patients are part of the visioning exercise for the new facility, and they help sort out 5 Copyright 2015 The Center for Health Design. All Rights Reserved.

6 what the priorities are. If you do a good job at articulating the goals, objectives, and functional outcomes of a new facility or major renovation of an existing facility the patients and families involved can help you make the best decisions as you go through the design process. The Center for Health Design advances best practices and empowers healthcare leaders with quality research that demonstrates the value of design to improve health outcomes, patient experience of care, and provider/staff satisfaction and performance. Learn more at Copyright 2015 The Center for Health Design. All Rights Reserved. 6 While The Copyright Center believes 2015 that The the Center information Health in this Design. interview All Rights is valid, Reserved. it has not fact-checked the information or tested any findings. The Center disclaims any warranties, expressed or implied, regarding this content.