Culture, Communication & Centered Care

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2012 is bringing new changes for hospitals across the U.S. thanks to the Joint Commission. With the implementation of new communication standards, many hospitals are scrambling to pull together the pieces of a complex puzzle that will soon affect accreditation scores and perhaps even their reputation.  

With the implementation of a pilot program in 2011, the Joint Commission began assessing how hospitals are communicating with patients and how well patients are comprehending what is presented to them - and everything from admission paperwork to lab results and discharge teaching are on the line.

The last several months have been a practice run, allowing facilities to implement their own programs. The results have had no impact on scores. However, starting as soon as January 1, 2012 this could change as Joint Commission's suggestions for better communication become a pivotal part of how well facilities may fair upon inspection.

Know Your Community
Before you can create a communication style that works for your population, you must first know those in your community. Consider any minority or ethnic groups, the most common languages spoken, and average educational level of those you serve. Serving large numbers of patients who speak a language other than English may mean that you create translated materials - and then ensure that these materials are easily accessible by patient care staff when needed.

Research has proven that educational background has no bearing on a patients' ability to comprehend medical information therefore each and every patient must be evaluated for special needs that may arise. Train intake or registration staff to ask about hearing aids, language barriers, vision problems, or learning disabilities that might make simply reading materials difficult to utilize and have backup information delivery methods available.

Staff should create a sense of helpfulness to reduce fear asking for assistance. Because literacy issues affect about 40 percent of all Americans, those who need help filling out forms should be made welcome and offered an intake setting that is free from embarrassment or judgment from others who might overhear. Staff members should be prepared to sit one-on-one with patients to complete any paperwork, and extra staff should be available during peak traffic times to assist without slowing the intake of other patients.

Recognizing these problems early in a patient's admission process and streamlining written materials, having translators available, or video programs to meet needs should become second-nature for staff.

"A hospital must embed effective communication, cultural competence, and patient- and family-centered care practices into the core activities of its system of care delivery-not considering them stand-alone initiatives-to truly meet the needs of the patients, families, and communities served." JCAHO's Roadmap for Hospitals

Stress the Importance of a Support Person
Often visiting a patient's bedside for only moments, healthcare providers may not always have time or make time to ensure that patients understand what's happening while they are in the hospital. With the added challenge of illness, stress and side effects from medications, many patients have difficulty remembering what their doctor has said. For this reason it is especially important to encourage the use of support people who can sit quietly and listen to what is said by both the patient and physician. The support person can then repeat information back to the patient at a pace and level that they will understand.

A support person can be a family member, trusted friend or partner. There is no requirement that they be a healthcare designee or surrogate for the patient. Support people should be available to the patient at all times as long as their presence is not contraindicated for safety or treatment reasons.

Encourage patients to choose a support person who can be involved in decision-making, assist with comprehension of educational and discharge instructions, and provide emotional support that is necessary for proper healing.

Create a Kit
Perhaps the most essential part of any kit for teaching and communication purposes is to first understand and properly evaluate the specific needs of the patient. Facilities must fine-tune assessment skills from the first interaction to determine hearing, visual or comprehension deficits, which could impact literacy during their stay.

For the hearing-impaired, simply handing out lengthy materials to read may be counter-productive. Instead, ensure that trained interpreters who are confident signing medical information are available. Relying on family members to sign may not be the most reliable resource because there is no way to verify accuracy. Providing patients with erasable white boards for communicating is a temporary way to aid the transfer of information if there is not a translator available.  

Visually impaired patients in your facility should be provided with Braille materials, or offered materials in an audio form. A support person should also be emphasized for additional emotional support and assistance with unfamiliar surroundings.

Clearly translated printed materials, simply designed charts and personal assistance should all be foundational materials in health literacy kits. For those who speak English as a second language, the translator should also be considered as al part of this foundation.

"Successful communication takes place only when providers understand and integrate the information gleaned from patients, and when patients comprehend accurate, timely, complete, and unambiguous messages from providers in a way that enables them to participate responsibly in their care." JCAHO's Roadmap for Hospitals

Health Literacy Equals Hospital Safety
Safe, high-quality healthcare is a mainstay for every hospital in this country. No facility wants to be recognized for its dangers - and you strive to make sure that is never the case. Every day, hospital staff follows facility protocol to ensure that spills are mopped before visitors slip, nursing personnel round regularly on patients to prevent falls and meet personal care needs, and advanced medication safety technology, electronic charting and record-keeping are all in place - and it's all in the name of safety.

Are you ready for the changes Joint Commission will be looking for in the future? Have you started the process of evaluating how your hospital communicates with its patients, and how the patients communicate in return? Does everyone understand each other as well as they could? It can be a daunting task to tackle - but transforming every piece of medical information and teaching tool into data that patients can comprehend is essential for upcoming compliance.