�鶹��ý

Overview

Communicating clearly helps your patients understand and act on health information. Using strategies to be clear in spoken communication also helps patients feel more involved in their healthcare and increases the likelihood of their following through on treatment plans. For guidance on improving written communication, go to Assess, Select, and Create Easy-to-Understand Materials: Tool #11.

Actions

Use strategies for communicating clearly.

• Get a qualified interpreter if a patient (or others participating in the visit) wants to use a language other than English. Do not try to "get by" with basic or intermediate foreign language skills or use unqualified interpreters such as family members or untrained staff. Go to Tool 9: Address Language Differences to learn more.
• Engage with your patients. 
  • Be respectful and caring. Welcome everyone warmly. Use body language and a caring tone to communicate that you want to hear about their concerns. Sit at the same level as your patient and make appropriate eye contact instead of concentrating on your computer. Go to Tool 10: Consider Culture to learn about being respectful of patients from different cultures.
  • Ask open-ended questions. Encourage patients and companions to engage in the conversation with open-ended questions. For example, say, "I'd like to hear—tell me, how are you doing?" Use nonverbal cues such as leaning in and nodding your head. Encourage them to voice their concerns. 
  • Listen actively and with curiosity. Give patients a chance to tell their story. Try not to interrupt. Pay attention, ask clarifying questions, and be responsive to the issues they raise and questions they ask. Use the Toolkit for Engaging Patients to Improve Diagnostic Safety to help clinicians to listen and patients to tell their story.
  • Encourage questions. Refer to Tool 14: Encourage Questions for guidance on how to let your patients and their companions know you want to hear their questions. 
  • Limit content and reinforce key points to avoid information overload. Prioritize with the patient what needs to be discussed. Limit information to one to three "need-to-know" or "need-to-do" points, and emphasize them more than once.

• Use plain, nonmedical language. Do not use medical or difficult words. 
  • Use the patient's words. Take note of what words the patient uses to describe their illness and use them in your conversation.
  • Use common words that you would use to explain health information to your friends or family who do not work in healthcare, such as tummy or belly instead of abdomen. Avoid acronyms. Find alternatives to medical terminology in the .
  • Use simple words instead of difficult ones (e.g., "helpful" instead of "beneficial," and "make worse" instead of “exacerbate”). Refer to the appendix Plain Language Words in for simple alternatives.
  • If you think it is important that a patient learn a medical term, ask whether the patient is familiar with it and if not, define it in a way that is easy to understand. For example, you can ask, "What do you know about a test called hemoglobin A1c?" and if necessary, explain, "It is a way to measure how much sugar is in your blood over the past 3 months. It tells us whether your diabetes is under control."
• Slow down. Speak at an unhurried pace and say the words clearly.
• Be specific and concrete. Do not use vague and subjective terms that can be interpreted in different ways. For example, say, "Two out of 10 people gain weight with this medicine," instead of "Few people get side effects." 
• Use pictures. Draw pictures, use illustrations, or demonstrate with 3-D models. All pictures and models should be simple, designed to demonstrate only the important concepts, without overly detailed anatomy.
• Show how it's done. Whether doing exercises or taking medicine, a demonstration of how to do something is clearer than a verbal explanation.
• Use teach-back. Confirm patients understand what they need to know and do by asking them to teach back important information. Refer to Tool 5: Use the Teach-Back Method for guidance on how to use the teach-back method.
• Practice. Use staff meetings to conduct role plays so everyone can practice their clear communication skills.

Help staff remember these strategies.

• Review these strategies during staff meetings and huddles. 
• Hang one of these Key Strategies for Clear Communication posters in non-patient areas (e.g., kitchen or conference room). Rotate posters regularly to keep reminders fresh.
• Ask clinicians and staff to use the Communication Self-Assessment with a few patients on a regular basis (e.g., every 4 to 6 months).

Track Your Progress

Before implementing this tool, ask all clinicians to complete the Communication Self-Assessment after a few patient encounters. Calculate the percentage who completed the self-assessment. One month after beginning implementation, complete another round of self-assessments and look for increases in the number of completions and changes in responses.

Before implementing this tool and 2, 6, and 12 months later, ask a respected individual to conduct observations of clinical interactions with patients. Use the Communication Observation Form to assess communication quality. Provide feedback. Repeat this process routinely. Calculate the percentage of clinicians who have been observed once, and the percentage who have been observed more than once.

Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. 

Select Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.