We all know that communication is a very important skill, although it seems that many times in the healthcare industry it is lacking. Last year the Wall Street Journal reported a study of the lack of communication in operating rooms. It stated that nurses and technicians were often afraid to speak up if they saw something going wrong because in that setting the physician is the primary communicator (speaker). Hospitals are trying many techniques to use communication to improve outcomes, such as having a patient repeat his or her name before being given a medication. Much of this effort comes about because of directives from accrediting bodies, such as JCAHO. However, there is a long way to go; employees and patients need to be HEARD.
In the best selling business book "The Seven Habits of Highly Effective People" Stephen Covey lists the fifth habit as Seek First to Understand, Then to Be Understood. He states that there are basically four ways to communicate: reading, writing, speaking and listening. Very few, he goes on to say, really practice the art of listening well. It is an underdeveloped talent that is extremely important. Without it, many efforts in healthcare will produce unsatisfactory results or worse and will generate much ill will.
Let me give you an example of listening that proved effective. It is an encounter that I had with an insurance company. I wanted to have the insurance company to be involved in a study that I was organizing to see if screening by primary care physicians for alcohol and other drug misuse and abuse could have improved locally. I am involved with a local group which has this as one of their goals. A local behavioral health specialist, an expert in alcoholism from Grand Valley State University, and a diabetes center had already agreed to be involved in the study. I wanted the insurance company on board so that they could use their physician contacts to let them know that screening would save doctors time and money and improve patient health.
There were two representatives from the insurance company at the meeting – Ms. S and Ms. A. I had already met Ms. S previously; she had said then that the company was having trouble getting doctors to screen for alcohol misuse. I could have gone into the meeting, I guess, saying that I had a solution for them. Instead, I decided to try and understand better what seemed to be the problem with getting doctors on board. I first got to know Ms. A; she worked in the clinical area at the insurance company. Both she and Ms. S were involved in a study group at the company trying to get doctors to screen. They had given some physicians educational material and laminated cards with the CAGE screening questions. Still, they had not achieved the success that they wanted. I asked what the challenges seemed to be. They claimed that the stigma of the abuse of and addiction to alcohol kept the doctors from bringing the subject up with patients. The insurance company had not been able to overcome this barrier.
I asked if they thought they could get doctors involved if they could demonstrate with local data that screening for misuse and abuse would save time and money for them. They agreed the chances of success would be greatly improved. I then told them of the experiment that I was arranging and that I thought it would be of benefit to them to be involved as I would be sure to measure time and money saved within patient health measures if the company were involved in the study. They were very interested. They stated that they would contact the manager in charge of diabetic studies at the company and explain what I had told them. He would then contact me.
The main point of this illustration is that I could not be sure of whether they might be open to my invitation to be a part of the study without I first understand their efforts and challenges up to that point. I had to listen. Having found that out, I offered my offer and they were ready to move on to the next step.
I have seen or been involved in many instances where listening and understanding first helped solve many difficult problems. Of course, I do not claim to already have succeeded at always using this strategy in problem solving with others. I do however keep running towards the goal that Covey illustrated so well in his text. I encourage you too to adopt this strategy. In fact, please get a copy of the book and at least read about this habit, if not the complete book. It will be very useful to you in problem solving at your site.