Globalization of Healthcare and the Advent of private participation in Healthcare has given much imputes to the sector. Due to different factors like affordable cost, zero or less waiting time availability of advanced technology interventions, highly skilled healthcare professionals etc., are the main cause for overseas patients coming to India. These main objectives are not sufficient to satisfy an overseas patient. An important aspect of patient satisfaction is communication. Communication reflects in all the spheres of healthcare right from the patient leaves from their home country till they reach back to home country. Loose Communication, Bad Communication, no communication, irresponsible Communication, Inattentive Communication are some of the factors that will dissatisfy a patient in their sojourn in a destination country, when they want to have procedural/intervention for their ailment/discomfort. Communication plays an important role in healthcare and it may be verbal communication, written communication, by signs or in any form of electronic device to transfer an information/message /problem to a group and vice versa.

What is Communication

Healthcare sector is a human group constituted for certain specific objectives and to achieve these objectives it depends upon the fact that human efforts are properly coordinated and integrated through communication. To maintain these relationships it is only possible through communication for exchange of information/ideas/messages and instructions.

Definition of Communication

Communication is a process of conveying meaning from one person to another in the broadest sense it refers to the whole process of man’s life in relation to the group.

In healthcare facilities communication plays an important role, whether it is vertical/horizontal or cris cross, from top to bottom or from bottom to top. At every stage, makes the patient more satisfied if he gets a positive communication. Improper, ill-advised, poor communication make the patient more disturbed and dissatisfied than no communication. Hence the healthcare professionals should be more cautious careful in communicating with the patient and their accomplice.

For the success of a management, especially in healthcare, good and effective communication is the foundation. Managerial functions such as planning, organizing, directing and controlling depends upon good communication. Whatever may be the good the planning and management, if the communication is not upto the mark you may not get your objectives realized. For planning to be realistic it is essential that it should be based on sound information and this information is not possible without a good system of communication existing in particular in healthcare sector [2].

It is necessary that in any organization leadership is exercised and that decisions are taken, efforts are coordinated, staff are motivated and functions are controlled, for effective functioning and in all these aspects being interaction between patient and accomplice and healthcare professionals, paramedical staff, administrative staff etc., are necessary in healthcare organization. This attitude coupled with respect can go a long way in creating meaningful interactions and a positive patient experience in healthcare. Every single action of communication by the healthcare professionals will have a direct impact on the patient’s satisfaction. These healthcare professionals as caregivers want their patients to have the best overall experience but if the communication is not upto the desired level and patient’s satisfaction level take a back seat. A fully satisfied patient is a mouth piece of healthcare facility where he has undergone procedure/intervention for his/her ailment/discomfort Dale Cornige, a noted Public Speaking Expert in his book [3],

“How to make friends and influence people”, [1], He mentions that

“the sweetest thing for everybody his or her is the name”

Hence if healthcare professionals when they meet the patient and addresses with his/her name makes lot of difference. In addition before examining the patient, the healthcare professional/paramedical staff or any person connected with the healthcare sector when they meet the patient first, they should enquire about their personal things, family etc. and how they are feeling in this new environment. This will cause immense happiness among the patient and they feel that these people are like family members and very courteous. This creates an environment of mutual trust and confidence especially in the mind’s of patient and their accomplice [4]. 

Many a researchers documented that the body language is very important in healthcare profession. When healthcare professional deals with the patient, should keep in mind “open body posture” and face the patient but do not turn away without seeing him/her. They should always be actively listening to the patient by nodding, agreeing and using occasional repetitions and questions to show that the caregiver is actively engaged in the conversation. This gesture of an health caregiver goes a long way in building confidence and trust among the patient and the accomplice. The healthcare professional or the paramedical staff should put questions to the patient or their accomplice in such a way that there should be a positive reaction and feeling of courtesy and respect. Many researchers admitted that it is always necessary to put “open ended questions” to the patients like, “Tell me how can I help” instead of asking “Do you need any help?” likewise instead of asking “Do you have help at home” instead of “Tell me about the help you have at home” makes a lot of difference. This kind of communication will have a positive result and the healthcare professional will get more information which is helpful to come to a conclusion of the patient’s ailment/discomfort.

Epstein a professor of medicine a Rochester University and a practicing physician is a leader of mindfulness movement in medicine, drawing from his own “ground breaking paper”, the professor explains, “how mindful self reflection and self regulation” are key master clinical care, enabling health professionals to listen attentively, making good judgments and act compassionately [2].

Break Down in Communication at Different Levels

There are many barriers/obstacles to effective communication between healthcare professionals and patients according to [5], Prof. Ofri. Healthcare professionals normally very busy during working hours attending patients listening to them, giving replies, it so happen many a times they are distracted by such things when they listen to the patients. This will cause embarrassment to the patient and their accomplice and they will form an opinion that healthcare professionals is not attentive. Sometimes patients do not know the problems/discomfort they are having or what to reveal and what not to reveal and which is important and which is not to the healthcare professional. In such situation if the healthcare professional is attentive, can have better results with the patient’s conversation in a polite and observative manner. According to some researchers the implicit bias of healthcare professional with some patients cannot give that much care that they give to others [3]. 

When there is less Doctor – Patient dialogue, patients are not only more likely to leave the healthcare facility (hospital), frustrated but they are also a great risk of being mis diagnosed.

Effective Communication

• What is the importance of effective communication 

• Let us identify and discuss the barriers of effective communication in an healthcare organizational environment

• Any healthcare facility is an human tool constituted for certain specific objectives. The achievement of these objectives largely depends upon the fact that all human efforts are properly coordinated and integrated through communication in which exchange of information with one another is possible

• Communication is a process of conveying meaning from one person to another in the broadest sense that it refers to the whole process of person’s life in relation to group

• Good and effective communication is a foundation for sound management the managerial functions of planning, organizing, directing, coordinating and controlling depends upon effective communication in healthcare facilities (Hospitals)

• For any planning to be realistic it is essential that it should be based on sound and effective information and is possible only with a good and effective system of communication

• It is necessary that leadership is exercised decisions are taken, efforts are coordinated and staff are motivated and all the functions are controlled in a manner that will yield better results. The main function of a good health organization is to have effective and pleasant interaction between the patient and the healthcare professionals

• Shift changes by the paramedical staff including nurses improper exchange of instruction by the health professionals leads to discomfort, pain to the patient and at times if the misdeed is irreparable it leads to loss of life

• Ineffective and negligent communication between any person attending the patient will have serious repercussions on the health of patient 

• Hence, it is obligatory on every person who is involved in the patient’s healthcare should have effective and communicative skills

Causes of Breakdown in Communication

• What we understand when someone speaks to us is largely shaped by our own experience and background, instead of hearing what people tell us

• It is natural that every person will have preconceived notions of what people mean and what we intend to identify it with our past experience is incorrect. 

• It is always customary that any conflicting information which is conflicting with what person believe will be rejected by that person; it is human nature that everybody thinks that he is correct and the other’s are wrong

• Prof. Epstein says [2],

“Medicine and Meditation, etimologically, come from the same root; to consider, advice, reflect, to take appropriate measures”

He also mentions that,

“Suggesting that the two are closely related this explains why Doctor should consider using mindfulness in the medical practice.”

Prof. Epstein explores how the mindlfulness skills of attention, curiosity, beginner’s mind and presence of mind that caregivers should observe [2]. 

How to Minimize Breakdown in Communication

Attention

Healthcare professionals feel that they have everything in their mind, may not be fully attentive in the examination of the patient. Normally healthcare professionals relay on automatic, fast thinking when they are interacting with the patients. On the other hand practicing mindful attention can help them, slowdown enough, to use deliberate, more conscious thinking when patient’s present situation of something seriousness.

Curiosity

Developing a sense of curiosity can help and inspire healthcare professionals to ask more questions and go deeper with the patient as well as foster empathy and understanding for patient’s unique needs, values, feelings and circumstances. It helps healthcare professionals recognize when something is off with a patient so they can then, tune in Prof. Epstein mentions that while genetics partly contributes curiosity, supportive environments can also foster it – particularly those that allow patients to feel comfortable, freely sharing their doubts, discoveries and misshapes [2].

Beginner’s Mind

Inspired by a book by SHUNDRY SUZUKI, Epstein advices, healthcare professionals, to "hold expertise lightly" and be aware that their understanding of a patient’s care while based on expertise, may be provisional and incomplete. He wants that self confidence can "get in the way of good care", if healthcare professionals do not recognize that there are things they may not fully know. Luckily, beginners' mind can be taught; at one randomized controlled study found that, practicing mindfulness, mediation, helped people to, not to be, "blinded by experience" from novel or obvious solutions to problems.

Presence

It is important for caregivers to listen patiently without pre judgment, interruption and pre conceive notions, can help patient feel understand and acknowledge that they are listening to their problems with respect.

According to Prof. Epstein, support from colleagues and paramedical staff in healthcare are most important. To improve communication the healthcare professionals should spend more time listening effectively when an appointment is given to the patient. One study shows that, in attentive listening can distract the speaker and makes him feel discomfort. It is important for healthcare professionals to help patients to communicate their problems better and feel more understood by acknowledging that what they are saying and encouraging them to continue so that the patients can have a sigh of relief. The first visit of the patient to the healthcare facility if the healthcare professional can give attention subsequent visits will be very easy. Clear communication between healthcare professionals and the patients will have more healing effect and better communication can leads to less litigation. Patients should not feel that the healthcare professionals are indifferent towards medical errors and also the points raised by the patients. If an healthcare professional is willing to admit error, show concern and apologize can help prevent patient’s from seeking retribution through loss hoods.

Communication between Nurses and Patient

It is quite customary that nurses have tremendous amount of healthcare knowledge, experience and expertise in attending patient’s conditions, but their greatest challenge is communication. Since the admission, till the patient is discharged, Nurses will have close contact with the patient as such nurses must communicate well to provide comprehensive care.

A research paper in 2014 mentioned [3],

“Communication in nursing practice found that nurses who display courteous, kindness and security to their patients – through both their actions and words – are generally more successive in establishing good rapport. The paper suggested that nurses must go beyond simple demonstrating is niceties, they need to approach every patient interaction with the intent to understand the patient’s concern and experiences and they should demonstrate that they are open to truly hearing patient’s input.”

Good Communication Between Health Professionals and Patients

It is always benefits the caregivers, patients if good communication prevails between them. The benefits are: 

• It greatly contributes to the ability to provide patient’s with individual care

• Greater focus on addressing the patient’s concerns by the nurses in a polite manner will have better patient outcome

• Once the patient feel that the healthcare professional is very attentive during interaction,, the patient is likely to disclose better

• Inter Personal Communication can satisfy the needs of the patient, has outlined in MASLO’s “hierarchy of needs”, these needs include the feeling of safety, love and confidence, are important during patient’s procedure

• Many researchers admitted that, communication in healthcare profession, benefits all the stake holders

Learning to Communicate

It is not necessary that every one need not be a natural communicator but by additional training and insight, even the best communicator can be benefited. With the introduction of electronic health records (EHR) malpractice loss hood and insurance denials it has become increasingly important for healthcare professionals to fully document patient encounter and treatment plans and they should avoid unnecessary details. Nurses act as the hub of communication, relying and interpreting information between caregivers and patient. Effective communication in nursing is important in providing best care to the patient.

Facilitators

If a patient goes to any destination country for healthcare procedures/interventions through a facilitator the communication between the facilitator, the patient and the accomplice are very much important for the satisfaction of the patient. 

Healthcare Travel Arrangements are different because people (patient) travel to other than their own, to receive healthcare procedure/intervention for their ailment/discomfort. In this regard healthcare facilitators provide travel arrangements to the healthcare travelers because their requirements are different from ordinary travelers and it is case specific . These facilitators offer different packages for different ailments and international patients has to choose according to their ailment/discomfort. In this regard unless there is better communication and understanding between the communicator (facilitator) and the patient it will create bad situation; because healthcare facilitators function as intermediaries or liazon between patients and healthcare providers. It is the responsibility of the facilitator to look after the want needs of the patient and their accomplice from the date of leaving their home country till they reach their home country after health procedure /intervention fully recovered and satisfied. Unless the healthcare facilitator is not a good communicator and communicate properly with all the stake holders to their satisfaction things will go wrong.

Interpreters and Translators

The problem arises when an international patient comes to a destination country where the language is not their own there must be a communicator between the patient and other healthcare stake holders. In this regard healthcare interpreters and healthcare translators play an important role as communicators between the patient and others connected with healthcare. An interpreter has to be very familiar with medical terminology in the language of the patient as well as in the language of the healthcare professional and others. Any mis/wrong interpretation leads to fatal at times.

On the other hand translators are also equal important because the patients health history may not be in the language of the healthcare professionals who have to attend. These translators in addition interpreting the material (health information) into the patient’s language also translate healthcare documents that are in patient’s language into healthcare professionals language.

Healthcare profession is quite different from other professions because healthcare professionals are dealing with human beings. Any lapse on either of the party will have long lasting effects. Hence good communication is always a good foundation for sound management. Good communication is always necessary to implement the managerial functions of planning, organizing and controlling in healthcare facilities. It is not sufficient that to have a good planning and management but it is also equally necessary to have better communication skills and better communicators. In healthcare facility a patient will come with an ailment/discomfort coupled with anxiety, stress, feeling and much disturbed. In these circumstances all the stake holders of an healthcare facility such as healthcare professionals, paramedical staff and the administrative staff should be in a position to show compassion, courtesy and kindness not only by their acts but with better communication skills. A better communication will relieve the patient half of their discomfort and the patient will feel that they have chosen a right place and right people. All the stake holders in an healthcare sector whether they are connected with procedural/non procedural should learn the art of communication and be a good communicator.

1. Carnegie, Dale. How to Win Friends and Influence People. Simon and Schuster, 1936.

2. Epstein, Ronald M. Attending: Medicine, Mindfulness and Humanity. Scribner, 2017.

3. Kourkouta, Lambrini and Ioanna V.Papathanasiou. “Communication in Nursing Practice.” Mater Sociomedica, vol. 26, no. 1, 2014, pp. 65–67. https://doi.org/10.5455/msm.2014.26.65-67.

4. Maslow, Abraham H. A Theory of Human Motivation. Psychological Review, vol. 50, no. 4, 1943, pp. 370–396.

5. Ofri, Danielle. “Breakdown in Communication.” The New York Times, 1 Feb. 2014.