On Call Magazine, March/April 2006

In Other Words…Speaking With Colleagues

By Helen Osborne, M.Ed., OTR/L,
President of Health Literacy Consulting

While healthcare providers need to communicate clearly with patients and their family, it’s equally important that colleagues understand one another. Miscommunication with administrators, co-workers, professionals in other departments or institutions, and even students and interns can have dire effects. Often the result of failing to consider differences in levels of experience or frames of reference, misunderstandings can occur whether you are talking, sending an email, or otherwise exchanging information.

Consider, for example, how language issues follow a healthcare worker throughout his or her career. By the time they are ready to graduate, students have spent several years studying a new language with complicated terminology, multiple acronyms and abbreviations, and a unique syntax. As interns and trainees, they need to be proficient in this language and use it with confidence during their clinical rotations. New graduates need to quickly learn how individuals within their organization communicate as members of teams, inside departments, and across the entire facility. Eventually, as seasoned professionals, healthcare providers often become student supervisors or department managers who mentor and train others. When they do, they will need to remember what a daunting task it was not just to learn the language, but to understand how it changes in sometimes very subtle ways from place to place and situation to situation.

Marianne Weiler, RTT, and Courtney Hallinan, RTT, know firsthand the importance of communicating well with colleagues. Weiler has been working as a therapist for three years and Hallinan is a recent college graduate. They are both radiation- therapist technologists in the department of radiation oncology at the Dana-Farber Cancer Institute in Boston. They work in a fast-paced environment that gives daily radiation treatments to approximately 50 patients a day, with appointments 15 minutes apart. The work is technical and exacting, with no room for variation or error. “We work together and rely on each other,” Weiler says. “We need to be on the same page [when we communicate].”

I recently spoke with Weiler and Hallinan about their experiences communicating with other professionals. While I am now a consultant who speaks nationwide about health literacy and related communication topics, I worked for many years as an occupational therapist, student supervisor, and department manager. I found that the three of us share many of the same perspectives on colleague-to-colleague communication.

Classroom Issues. Students in all health professions must learn technical terms, disease-specific words, and communication “short cuts” that make use of jargon and acronyms. Beyond simply memorizing how to spell and say these words, they need opportunities to practice using them in their daily routines. Such things as reading journal articles and textbooks, meeting and interacting with practicing professionals, working with other students in study groups, and writing reports will help prepare them to communicate professionally when they go on clinical rotations. Students should be encouraged to take advantage of as many opportunities as they can to use the language their colleagues will be using when they graduate.

Transitioning From Student to Professional. New graduates are confronted almost immediately with differences in the way the language they’ve learned is used from site to site. Hallinan knows what a challenge this can be — she went to school in one state, trained in another, and now works in a third. One of the challenges Hallinan faced was that each facility had its own mode of communication, including differences in the way abbreviations were used. For instance, colleagues at one facility talked about “focus to skin distance” (an important number in radiation treatments) ,while those elsewhere referred to this same concept as “FSD.”

Mentor relationships (either formal or informal) with more seasoned staff can help newcomers make this transition. As a mentor, Weiler knows how important it is to confirm understanding. When students or new therapists look confused or have questions, Weiler may ask them to repeat back or demonstrate what was just discussed. This is an excellent way to confirm that what was communicated was correctly understood.

The Language of Teamwork. While being a member of a team makes it faster, easier, and less stressful to handle the multiple responsibilities of a healthcare workplace, teamwork is possible only when team members know how to communicate effectively with one another. Here are some of the techniques that Weiler, Hallinan, and their team members use to facilitate communication with each other

• Dry erase board. A dry erase board placed where everyone on the staff will see it can be easily updated on a daily basis. That way, staff can be regularly informed of what lies ahead. For instance, the board might be used to list new treatments scheduled for that day or to announce the time and place of upcoming meetings.
• Daily record sheet. At Dana-Farber, radiation therapists routinely communicate with each other using a three-page daily record sheet. This sheet has information about patient set-up, technical settings, and a record of each day’s treatment. The sheet is easy to complete and to read. Therapists only need to fill in blanks with standardized responses, which helps eliminate the possibility of misunderstanding that can accompany narrative reporting.
• Email. Therapists use email to communicate with doctors about nonurgent questions regarding patient care. Weiler and Hallinan agree that staff need to understand that while messages may be informal, keeping them concise and polite will make communication easier. Providing guidelines for staff on email etiquette and when to use it, including when to respond, will help ensure that messages do what they need to do and aren’t ignored.
• Paging. A page should be reserved for situations that need an immediate response. While it takes experience for new employees to be able to gauge the urgency of a question, mentors and trainers can help new employees understand how to use this technique.
• Objects and models. When teaching colleagues, Weiler sometimes uses patients’ radiation films to help explain procedures or point out what the technique is accomplishing. She might also use a pillow or other pretend model to demonstrate a technique. For example, she might mark tattoos on a pillow (letting therapists know where to aim radiation) so others can practice a procedure.

Communicating Outside Departments. I am often in situations requiring me to communicate with nonclinicians or health professionals in another discipline. This happened a lot when I chaired my hospital’s Patient and Family Education Committee and occurs much of the time now in my consulting work. Here are some techniques I use:

• Put new concepts into a familiar context. To help healthcare professionals better understand the concept of health literacy, I often present cases in which patients have trouble understanding information. I find that putting concepts into context helps “set the stage” for a fuller discussion about ways to improve health communication.  
• Use stories and examples, not just statistics. Facts and figures add credibility and let others know the scope of what you are talking about. But by themselves, statistics may not get the message across. To show why they’re important, I often support statistics with real-life examples.
• Repeat yourself. Whether talking one-on-one or in front of a large audience, I find that repetition helps people understand new information. For example, when I give a health- literacy presentation I first mention the topics I will be talking about. As I teach, I refer to these topics with the exact same wording each time. At the end, I summarize by repeating the topics we just discussed. This way students, colleagues, and outsiders have multiple opportunities to learn why clear communication matters.      

Ways to learn more

Helen Osborne, M.Ed., OTR/L is a health literacy consultant. More information about effective communication can be found online at the Health Literacy Consulting Web site at www.healthliteracy.com.