Communication With Hospital Administration

Effective communication with hospital administration requires an understanding of the key stakeholders with whom emergency department (ED) staff and leadership might interact. This chapter will outline typical governance structures for hospitals and identify other key hospital leaders with whom ED leadership should maintain relationships and lines of communication. The chapter will also suggest effective internal communication strategies such that communication with hospital leadership is most effective. Finally, through the use of relevant case studies, the chapter will demonstrate how effective communication can lead to solutions to improve patient care. Throughout practical tips to improve effective communication will be emphasized.

Patient Communication

Good communication with patients has now been recognized as critical to their care. Although there are many potential barriers to communication in the patient care setting, health care workers understand that breaking them down to communicate in a healthy, positive fashion helps to provide patients with better care, improves staff morale, and decreases medical errors. Skilled practitioners recognize these challenges and come equipped with a toolbox designed to communicate well with patients, as they know good communication skills denote good patient care.

Keys to Effective Communication in All Circumstances

Emergency departments (EDs), with their high degree of interruption, evolving and often incoherent patient stories, and multiple patient needs, strain practitioner cognitive processing over time, forcing a reliance on default communication approaches and pattern recognition. This shift to scripted, routinized, and default approaches to interaction in the ED reduces situational awareness, impacting providers’ ability to respond appropriately to the person and story in front of them and their clinical decision making. However, being able to rapidly and effectively adapt to circumstances is essential for high-functioning providers in emergency department settings. Although solid, learned fundamental communication checklists can suffice in straightforward, low-stakes, or routine individual and team encounters, complicated, high-stakes, or unusual circumstances or situations require effective communicators to move beyond habituated communication practices to those that enable providers to appropriately interpret and adapt to circumstances while respecting self, others, and context.

The Art of Communication in Meetings

Communication, when it’s effective, it’s nearly invisible. When it’s ineffective, it’s a roadblock that quickly becomes impassable. This chapter describes barriers to good communication, including ever-changing contexts, overcomplicating the message, and lack of clarity and consistency. It also discusses the importance of building a cohesive team, establishing a few basic ground rules for effective communication, determining a team’s conflict comfort scale (there are “red zones” and “blue zones,” and this chapter discusses the characteristics of both), avoiding the muddied minefield of “meeting stew,” and identifying meetings by type (among them, administrative, operational, and strategic), and offers specific tips for conducting successful virtual meetings. When is it time to bring in a subject matter expert? Should one attend a virtual meeting in pajamas? How does one engage the people attending one’s meeting and ensure they are ready to act on decisions? Leaders and administrators will benefit from the clear guidelines, relevant strategies, and conversational tone of this discussion.

Communication in Medical Resuscitation and the Post-Code Debrief

During high-stakes situations, such as resuscitations, effective communication among providers is of utmost importance to ensuring the best potential patient outcomes. Families can be present in resuscitations, adding an additional complexity and another point of communication focus. After resuscitations, a debriefing session is important to provide an opportunity for reflection and for future improvements. This chapter will focus on principles for improved communication during resuscitations.

Communication With Minors in Emergency Settings

This chapter provides an overview and description of the challenges health care workers face when encountering pediatric patients in emergency settings. Children make up a substantial portion of annual visits to US emergency departments, though most children are seen in settings where adults make up the majority of the patient volume, meaning there is often a lack of comfort in communicating with children. Special attention is paid in this chapter to the importance of the “triadic” nature of the visit (provider-child-parent), introductions and body language, pediatric developmental stages, issues of consent and confidentiality, and decision-making capacity. The chapter uses case examples of commonly encountered clinical scenarios to provide tips and tricks for engaging with pediatric patients in these stressful situations. Case examples include the reticent child, the painful procedure, delivering bad news, the angry parent, and the overtalkative parent.

Communication With Family

This chapter addresses key elements of effective communication and common communication challenges encountered in the emergency department setting with families and concerned persons. It discusses the principles of effective communication, including AIDET and ask-tell-ask styles; demonstrates language that acknowledges and respects diversity; and provides methods to enhance staff training in these areas. Additionally, the chapter provides models for sharing difficult news, including notification of death, and pertinent legal and ethical principles to guide disclosure of patient information. Specific communication methods are shared to manage common challenges such as conflict, disagreement, and unrealistic patient or family expectations. These situations are commonly encountered in emergency settings and are linked to provider burnout. The chapter includes a primer on “therapeutic language,” including the use of suggestions for patient and family comfort during procedures to lessen anxiety and discomfort.

Conflict Management

Conflict is ubiquitous in relationships. It can be productive if managed constructively, resulting in diversity of thought and better solutions. Often, however, it is counterproductive, resulting in stress, frustration, and decreased effectiveness. Assessing one’s conflict tolerance helps to identify one’s conflict management style and minimize and mitigate situations of counterproductive conflict. On a team level conflict can be managed in part by deliberately establishing goals, roles, processes, and a framework for interactions. In the midst of conflict, an approach of pausing, acknowledging, empathizing, redirecting, and delayed readdressing is frequently the best initial response.

Email and Social Media

Social media is a prevalent part of today’s society. Its main use is for communication. Social media has become ingrained in the daily lives of digital natives. As educators continue to engage their learners, social media has become a tool for education. This chapter examines social media’s role in daily life and how educators are harnessing the power of social media to build connections, enhance education, and further their career. Additionally, this chapter provides information on how to use a wide variety of social media platforms and provides best practices to avoiding violating HIPAA when posting medical content online. Electronic communication between physicians and patients is also explored.

Feedback and Communication With Learners in an Emergency Department

Feedback and communication are essential components of learner clinical education, important for learner growth and development. The emergency department presents a unique environment for communication that can impact how learners receive feedback. The fast, chaotic environment means common tools often need to be modified to give learners the ability to close the gap between the learner’s actual practice and aspired practice. Formal and informal feedback needs to be employed in an effective and timely fashion while taking into account the varied level of learners, from medical student to resident and fellow. Effective and timely communication and feedback can transform the learning environment from chaos to learned deliberate practice and empower the learner to become the clinician he or she aspires to be.