By the Numbers

Eight guidelines for better practice-wide communication

Medical workers have a profoundly complex environment to keep aligned.

“The single biggest problem in communication is the illusion that it has taken place.”
– George Bernard Shaw

“Words are singularly the most powerful force available to humanity. We can choose to use this force constructively with words of encouragement, or destructively using words of despair.”
– Yehuda Berg

Practices in trouble, like patients in distress, always have a chief complaint. And the most common core complaint of doctors and staff alike centers on communication:

  • “Nobody knows what’s going on here.”
  • “Are we still accepting new Medicaid patients?”
  • “I couldn’t possibly talk to him about that.”
  • “If my patients could only be compliant and follow my directions.”
  • “I have no idea what these financial reports mean.”

Much inhibits great communication in the typical practice. It can be scary for lay staff to tell an owner about a problem in their business or in their behavior. Managers and doctors are time poor. Staff turnover is on the rise, so relationships fall short of their potential intimacy and mutual understanding. Few practices get around to writing down protocols and use verbal directions when written communication would be more effective.

Here are eight guidelines for better communication at all levels in your practice.

1. Be nice. As a surgeon, your training, skills and time poverty condition you to talk mostly downward. You issue one-way directives to staff, patients and vendors. Sometimes your frustration shows, and your orders come across with a side of sarcasm or impatience. Try to put yourself in the head of your 20-something tech with an AA degree and an infant in day care who has only worked for you for 3 months. When you gruffly ask for forceps and she has to hunt for the correct drawer, you are working against your own interests. It is just as easy to say, “Could you please hand me the forceps from the top-right drawer?” And the odds will rise that your tech will still be your employee in 3 years.

2. Listen more. As the saying goes, “Your mother gave you two ears and one mouth. Use them in that proportion.” Try it today with a patient (although it works equally well with staff and peers). Take a brief pause from thinking up what you are going to say next. Look at the patient directly — eye to eye. Absorb their question or concern. And then speak. Doing so will provide two chief benefits. First, if you clearly understand a patient’s question, you will provide a satisfying answer and reduce follow-up time-burning questions. And second, by slowing just briefly, and for just this phase of the encounter, your patient will perceive that the encounter was longer and that the doctor was more caring. I have seen this play out thousands of time when shadowing a client in clinic. The doctor who pauses, reflects and delivers a just-right answer the first time sees more patients and makes them happier.

3. Be clear. What you say sets things in motion all around you. Patients take their medicine or sign up for surgery. Your administrator cancels a contract. Staff commence a new testing protocol. If what you say is unclear, this will frustratingly resonate throughout your practice. Here is an easy self-check. Use the voice memo app on your phone to privately record a few conversations. These can be with patients or a couple of staff interactions. How clear was your side of the discussion? If you were on the receiving end of what you said, would you know what to do next? (Obviously delete such test recordings immediately, and avoid recording any interchange that is inappropriate.)

4. Confirm understanding. Here is a crisp example you would hear on a naval vessel:

Captain: “Come right to 270.”

Helmsman: “Aye sir, come right to 270” (at which point the new course is sought).

Helmsman: “Steady on course, sir” (when the new course is achieved).

Captain: “Very well.”

How does that compare with communication in your practice? For complicated instructions, you should ask to have your instructions repeated back to affirm they were heard correctly. And when the instructions are especially critical, it may be appropriate to ask your assistant, “When you get an answer from Mike, could you please let me know, hopefully by the end of the day?”

5. Involve everyone necessary. Here is a common example. You feel your clinic is backing up because the appointment template is outdated for your growing patient volumes. Your instinct might be to just complain to the front desk supervisor or, worse, ask her to make specific changes on the fly. Not so fast. Almost everyone in your practice “owns” that template: your administrator, the front desk, your techs and you. For something as important as this, call together everyone who touches this matter. Review the facts together. Achieve consensus about what should be done and how and by when. Make sure someone in the meeting is the singular person responsible for supervising the agreed action.

6. Use the right channel. Do not use email and texts as a substitute for face-to-face communication, particularly when you are working through a conflict. Avoid writing long emails with multiple topics and points. Make each email have its own topic and subject line. Recipients will get your point faster and better that way.

7. Use multiple channels. Depending on what you are communicating, it may be appropriate to move beyond a verbal exchange. Indeed, one of the common gaps in practices is to have a purely verbal culture rather than putting things in writing. Here are some examples of going beyond the verbal:

  • You and your head tech have a brief hallway conversation about a new OCT that staff will have to get trained on. Time does not allow you to go into much detail, so at the end of the conversation you say, “Amanda, could you please drop me an email by the end of the week giving me your training plan and a draft of the new protocol?”
  • You and your landlord are discussing new signage for your office. Later in the day, you follow up with an email reviewing what was agreed and attaching a picture of a sign from another business in town that you would like to emulate.
  • You and your administrator have a conversation about staffing levels in the billing department, which appears to be falling behind. You both agree there is both a people problem and a process problem, but so far, the discussion is subjective rather than objective. You have recently read an article about billing department benchmarks. You hand your administrator the article and say, “Could you please read this, work up the same set of benchmarks for our practice and come to the next partner’s meeting with your recommendations? Happy to work with you on this before the meeting if you like.”

8. Do not expect miracles. Be patient. Be a guardian of better communication. Humans are slippery, fault-prone and backsliding. Although surgeons are probably the smartest, craftiest humans in your company, they are famously oblique. Even with the best of intentions, great, logical communication is clouded by emotion and never endures for long. Ask often: “Are we being clear with each other here?”

Communication aligns and soothes us. Medical workers — from techs to clerks to managers and up to the boardroom — have a profoundly complex environment to keep aligned and happy. Patients have to be heard and helped. New staffers have to find their way in your distinct business culture. Priorities have to be worked out. There are ethical, legal, strategic, financial and myriad other domains where disagreements can crop up. Better communication is at the heart of it all.

“The single biggest problem in communication is the illusion that it has taken place.”
– George Bernard Shaw

“Words are singularly the most powerful force available to humanity. We can choose to use this force constructively with words of encouragement, or destructively using words of despair.”
– Yehuda Berg

Practices in trouble, like patients in distress, always have a chief complaint. And the most common core complaint of doctors and staff alike centers on communication:

  • “Nobody knows what’s going on here.”
  • “Are we still accepting new Medicaid patients?”
  • “I couldn’t possibly talk to him about that.”
  • “If my patients could only be compliant and follow my directions.”
  • “I have no idea what these financial reports mean.”

Much inhibits great communication in the typical practice. It can be scary for lay staff to tell an owner about a problem in their business or in their behavior. Managers and doctors are time poor. Staff turnover is on the rise, so relationships fall short of their potential intimacy and mutual understanding. Few practices get around to writing down protocols and use verbal directions when written communication would be more effective.

Here are eight guidelines for better communication at all levels in your practice.

1. Be nice. As a surgeon, your training, skills and time poverty condition you to talk mostly downward. You issue one-way directives to staff, patients and vendors. Sometimes your frustration shows, and your orders come across with a side of sarcasm or impatience. Try to put yourself in the head of your 20-something tech with an AA degree and an infant in day care who has only worked for you for 3 months. When you gruffly ask for forceps and she has to hunt for the correct drawer, you are working against your own interests. It is just as easy to say, “Could you please hand me the forceps from the top-right drawer?” And the odds will rise that your tech will still be your employee in 3 years.

2. Listen more. As the saying goes, “Your mother gave you two ears and one mouth. Use them in that proportion.” Try it today with a patient (although it works equally well with staff and peers). Take a brief pause from thinking up what you are going to say next. Look at the patient directly — eye to eye. Absorb their question or concern. And then speak. Doing so will provide two chief benefits. First, if you clearly understand a patient’s question, you will provide a satisfying answer and reduce follow-up time-burning questions. And second, by slowing just briefly, and for just this phase of the encounter, your patient will perceive that the encounter was longer and that the doctor was more caring. I have seen this play out thousands of time when shadowing a client in clinic. The doctor who pauses, reflects and delivers a just-right answer the first time sees more patients and makes them happier.

PAGE BREAK

3. Be clear. What you say sets things in motion all around you. Patients take their medicine or sign up for surgery. Your administrator cancels a contract. Staff commence a new testing protocol. If what you say is unclear, this will frustratingly resonate throughout your practice. Here is an easy self-check. Use the voice memo app on your phone to privately record a few conversations. These can be with patients or a couple of staff interactions. How clear was your side of the discussion? If you were on the receiving end of what you said, would you know what to do next? (Obviously delete such test recordings immediately, and avoid recording any interchange that is inappropriate.)

4. Confirm understanding. Here is a crisp example you would hear on a naval vessel:

Captain: “Come right to 270.”

Helmsman: “Aye sir, come right to 270” (at which point the new course is sought).

Helmsman: “Steady on course, sir” (when the new course is achieved).

Captain: “Very well.”

How does that compare with communication in your practice? For complicated instructions, you should ask to have your instructions repeated back to affirm they were heard correctly. And when the instructions are especially critical, it may be appropriate to ask your assistant, “When you get an answer from Mike, could you please let me know, hopefully by the end of the day?”

5. Involve everyone necessary. Here is a common example. You feel your clinic is backing up because the appointment template is outdated for your growing patient volumes. Your instinct might be to just complain to the front desk supervisor or, worse, ask her to make specific changes on the fly. Not so fast. Almost everyone in your practice “owns” that template: your administrator, the front desk, your techs and you. For something as important as this, call together everyone who touches this matter. Review the facts together. Achieve consensus about what should be done and how and by when. Make sure someone in the meeting is the singular person responsible for supervising the agreed action.

6. Use the right channel. Do not use email and texts as a substitute for face-to-face communication, particularly when you are working through a conflict. Avoid writing long emails with multiple topics and points. Make each email have its own topic and subject line. Recipients will get your point faster and better that way.

7. Use multiple channels. Depending on what you are communicating, it may be appropriate to move beyond a verbal exchange. Indeed, one of the common gaps in practices is to have a purely verbal culture rather than putting things in writing. Here are some examples of going beyond the verbal:

PAGE BREAK
  • You and your head tech have a brief hallway conversation about a new OCT that staff will have to get trained on. Time does not allow you to go into much detail, so at the end of the conversation you say, “Amanda, could you please drop me an email by the end of the week giving me your training plan and a draft of the new protocol?”
  • You and your landlord are discussing new signage for your office. Later in the day, you follow up with an email reviewing what was agreed and attaching a picture of a sign from another business in town that you would like to emulate.
  • You and your administrator have a conversation about staffing levels in the billing department, which appears to be falling behind. You both agree there is both a people problem and a process problem, but so far, the discussion is subjective rather than objective. You have recently read an article about billing department benchmarks. You hand your administrator the article and say, “Could you please read this, work up the same set of benchmarks for our practice and come to the next partner’s meeting with your recommendations? Happy to work with you on this before the meeting if you like.”

8. Do not expect miracles. Be patient. Be a guardian of better communication. Humans are slippery, fault-prone and backsliding. Although surgeons are probably the smartest, craftiest humans in your company, they are famously oblique. Even with the best of intentions, great, logical communication is clouded by emotion and never endures for long. Ask often: “Are we being clear with each other here?”

Communication aligns and soothes us. Medical workers — from techs to clerks to managers and up to the boardroom — have a profoundly complex environment to keep aligned and happy. Patients have to be heard and helped. New staffers have to find their way in your distinct business culture. Priorities have to be worked out. There are ethical, legal, strategic, financial and myriad other domains where disagreements can crop up. Better communication is at the heart of it all.