Research from the University of Michigan Health System Is Helping Improve Nurse and Physician Communication
Lack of communication, miscommunication, and the absence of viable communication channels in healthcare settings can result in significant impacts on patients. Nurses, physicians, and other providers must be able to communicate quickly and effectively to ensure a patient’s continuum of care is on track and that they are gradually progressing toward a desired health outcome.
There are many common challenges associated with a lack of communication in healthcare settings. These include language barriers, logistical problems, lack of collaboration and openness, frustration with a lack of professional respect, and overall preparedness.
Thankfully, plenty of clinics, hospitals, and healthcare organizations have taken steps to address this challenge, and the University of Michigan Health System is an excellent example.
Here, we’ll explore the University of Michigan Health System’s years of communication research as well as the results it has yielded for patients and healthcare providers.
An Initial Investment and a Communication Study
In the mid-2010s, the University of Michigan identified a link between healthcare challenges and poor communication between nurses and physicians. This was despite an abundance of communication technology implemented in clinical settings.
According to a quote by Milisa Manojlovich, Ph.D., RN, CCRN, a University of Michigan School of Nursing (UMSN) associate professor and member of U-M’s Institute for Healthcare Policy and Innovation, "Communication technology can increase or reduce adverse effects for patients depending on how nurses and physicians are using it. Unfortunately, communication failures are one of the most common causes of adverse events for hospitalized patients, so it is very important to understand how communication technology is being used and how it can be improved.”
In 2014, Manojlovich would become the primary investigator on a $1.6 million grant from the federal Agency for Healthcare Research and Quality (AHRQ). Those funds would help Manojlovich and her colleagues "use a sequential mixed methods design including surveys, telephone interviews, observations, shadowing, and focus groups at hospitals across the country to learn how communication technologies, communication practices, and work relationships affect communication.”
At the time, Manojlovich said, "The work environment and policies are often not [conducive] to effective communication. For example, in a previous study, we observed physicians place a STAT order, meaning immediately, in the computer. However, they would not notify the nurse in any other way.”
The hospital’s policy was for nurses to be required to check the computer for orders every two hours. That meant a STAT order sometimes went almost two hours before it was acknowledged and acted upon.
An Ongoing Challenge
Since the original launch of the grant, the university has conducted studies and reviews across the country to identify the sources of communication problems between doctors and physicians.
In one 2018 study, university researchers reviewed recorded interactions between physicians and nurses to identify problems. As a result, "Several themes emerged to help explain the poor communication, and both nurses and physicians improved their communication styles,” said Milisa Manojlovich, U-M professor of nursing.
One of the biggest barriers to good communication noted in the study was "that the hospital hierarchy puts nurses at a power disadvantage, and many are afraid to speak the truth to doctors.” Nurses didn’t directly request what they needed and often communicated indirectly. This confused physicians and they often ignored nurses’ requests rather than ask for clarification.
One interaction in particular showcased nurses’ and physicians' different approaches to patient care:
"A patient with mouth pain, caused by a fungal infection called thrush, couldn’t swallow the pills she needed to get better. The physician wanted to prescribe more medication to treat the thrush, but the nurse––who knew the patient well––wanted to treat the patient with strong painkillers, as well.
‘The physician realized that the pain was inhibiting the treatment, and treating the pain, as well as the condition, would solve the problem,’ Manojlovich said.”
In other examples, physicians recognized that they didn’t give nurses enough time or bandwidth to voice their opinions. Researchers found that having nurses and physicians watch videos of themselves communicating helped them to identify issues and rectify them, thus revealing a promising new teaching method.
A Combination of Trust and Technology
Manojlovich also published a report in PubMed in 2021 with another author outlining how nurses and physicians could advance patient safety through a framework focused on communication. The conceptual framework outlined by the researchers encompassed eight traditions, namely rhetorical, phenomenological, semiotic, cybernetic, sociopsychological, sociocultural, critical, and pragmatic.
The researchers concluded that their framework "suggests ways to build relationships and trust, addresses hierarchical differences between communicators, and illuminates the role of technology in communication. It also importantly expands the definition of the value of communication beyond simple information exchange to include creation of new knowledge during communication through the development of shared understanding.”
In a separate report, Manojlovich and colleagues identified a need for both parties (doctors and nurses) to work on the problem of communication collaboratively.
"How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups,” said the report.
Some of the factors that contribute to miscommunication, as well as effective communication, include "the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response.”
Other factors that lead to delays in responsiveness to patient needs include trust and interpersonal relationships between physicians and nurses, as well as their different perspectives on the same clinical issue.
Closing the Communication Gap
The lesson from U-M’s extensive research is that effective communication in healthcare settings depends on a variety of factors, especially when that communication is between nurses and physicians. Technology plays an important role in facilitating effective communication, but each party must be aligned on what channels and programs to use, how to use them, and how often to look at them to stay updated about the health statuses of patients.
More importantly, establishing trust, erasing hierarchal barriers in the healthcare setting, and communicating with clarity and urgency could lead to better health outcomes for patients. As healthcare providers move forward, they would do well to integrate these suggestions into their day-to-day workflows.
To learn more about improving communication in healthcare through practice and technology, don’t miss NGPX 2023. It’s happening from November 28 - 29 at the Westin Rancho Mirage in Palm Springs, California.
Download the agenda and register for the event today.