Running head: ENHANCING PATIENT-PHYSICIAN COMMUNICATION

Enhancing Patient-Physician Communication

Malgorzata Borowy
Olivet Nazarene University
Leadership and Management in Nursing
NRSG 463
Meaghan Gerhardstein
December 8, 2014

ENHANCING PATIENT-PHYSICIAN COMMUNICATION

Enhancing Patient-Physician Communication

Introduction
The core of the health care system is the patient, who is the consumer of its services. This
identity requires the health care provider to deliver those health care services. These two
completely independent entities require an effective patient-physician communication
component to serve each other. Patient-physician communication has the potential to promote
patient-centered care and favorable health outcomes (Van Dulmen, 2011). Effective patientphysician communication is linked analytically to outcomes of care including patients
satisfaction, health status, recall of information, and adherence (Haskard Zolnierek & DiMatteo,
2009, p. 826). However, there are barriers to which there is correlation of poor patient-physician
communication to poor health outcomes. These can include ineffective decision skills, lack of
attention and time, lack of trust, poor literacy and language skills. Such actions, or even patients
perception, can cause conflicts between the patient and physician relationship. This correlation
addresses the need for a strategic plan that undertakes such a problem and plans for a solution for
an effective patient-physician communication.
Strengths, weaknesses, opportunities, and threats
The benefits of an effective model for patient-physician communication can be seen in
multiple areas of healthcare. Ultimately it is the patient who is at the center of this dilemma.
Patient satisfaction is an important component to the health care system business model, and
patient satisfaction scores are being tied directly to reimbursement. Therefor organizations are
paying more attention towards building and developing physicians public relation skills and
improving communication skills (Robinson & Watters, 2010). Such elements of the patientphysician relationship include verbal and nonverbal communication, effective questioning and

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transmission of information, expressions of empathy and concern, and partnership and

participatory decision-making (Haskard Zolnierek & DiMatteo, 2009, p. 826). These skills
value acknowledgement and incorporation of patients values, beliefs, and culture; they cater to
planning and delivering care with respect and dignity of the individual (Bujak & Bartholomew,
2011). Poor physician communication with their patients, as seen by the patient, contributed to
greater than 19 percent of individuals attributing that to their fault of non-adherence of their
medical regimen (Hospital Consumer Assessment of Healthcare Providers and Systems
[HCAHPS], 2013). Studies have shown that good patient-physician relationship can yield better
health outcomes, including improved daily functioning and increased adherence to medial
regimen, along with a decreased length of hospital stay, improved mental health and enhanced
psychological adjustments (HCAHPS, 2013).
Internal and external stakeholders
A strategic plan for a healthcare system involves the stakeholders of the organization.
These individuals need to be understood and appreciated as the committed to the improvement
workings of the organization and the individuals who this change will impact. Yoder-Wise
(2011) explains that the key to achieving a successful strategic plan is to understand the nature or
needs of the stakeholders. The stakeholders are classified into two categories: internal and
external. Internal stakeholders are people who are directly vested in the success or failure of the
organization by serving and participating in the coordination, funding, and building of the
policies and structures. In turn, the external stakeholders are individuals who also have an impact
on the workings of the organization but indirectly, as they do not work for the organization
directly (Yoder-Wise, 2011). Internal stakeholders include board members, staff, volunteers, and
donors; external stakeholders include clients, community partners, and others.

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The internal stakeholders of this organization who impact the outcomes include the
facilitys administration including the Chief Executive Director, managers including nursing
managers, nursing staff, and ancillary departments such as social work and case management.
External stakeholders would also have an impact on the success of this strategic plan. These
individuals include the foremost the patient who is the consumer, insurance providers, federal
and state providers, community providers, and employers. The needs of these two groups would
have to be met by consistent and conscientious coordination and evaluations. The involvement of
these stakeholders would allow this author to reduce cost of care, increase productive leadership,
and improve quality of care.
Goals, objectives, and plans
The main goals of patient-physician communication include an improved methodology of
facilitating exchange of information between patient and disciplines, establishment of an
exceptional therapeutic relationship, and empowering patients to make informed decisions. The
relationship between a patient and his or her health care provider is the important link between
adherence to medical plans and thereby favorable to good patient health outcomes (Haskard
Zolnierek & DiMatteo, 2009). Patients, as consumers, have the right to individualize their care;
the right to be informed, the right to maintain and uphold their values and beliefs, and the right to
participate in their care, are just as important as the right to making an informed decision, which
is all based on communication and understanding between the patient and their health care
provider (Yoder-Wise, 2011).
The plan for improved patient-physician communication involves the quality
improvement process (QIP) (Yoder-Wise, 2011). The QIP is a multi-stop process that will
facilitate the strategic plan of dealing with the first step addressing the need: to develop adequate

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patient and physician communication, with a focus on patient safety and superior care. The
second step is the development of the supporting team. The supporting team is the members
previously included as the stakeholders of the organization. These stakeholders have directly
vested interest in the success of the plan. The third step involves the collection of data
surrounding the problem. Within the boundaries of this issue, the important data set includes
patient satisfaction scores derived by HCAHPS. These scores and trends are to be evaluated and
analyzed to show correlation among actions and perceptions to directly identify the problem and
solution. Utilizing nursing staff to obtain more information can also be utilized. Administration
and nursing management can follow up with patients post discharge to further gain information
regarding patients perceptions. The forth step involves developing measurable outcomes and
quality indicators (Yoder-Wise, 2011). These outcomes are how the organization would depict
whether the goals have been accomplished. In this plan, it would involve the HCAHPS patient
satisfaction scores and net promoter scores.
Implementation and evaluation
The quality improvement processs fifth step involves the development and
implementation of the plan, in this strategic plan it is the improvement of communication
between physicians and patients. Communication contributes to patients understanding illness
and the risks and benefits of treatment. Support, empathy, and understanding, collaborative
partnerships, and patient-centered interviewing, require effective communication and enhance
adherence (Haskard Zolnierek & DiMatteo, 2009, p. 827). Other skills of active listening,
providing information according to the patients understanding level, effective feedback,
questioning skills and empowering the patient to make decision are also necessary for a
meaningful patient-physician relationship (Gregory, Peters, & Slovic, 2011). The National

ENHANCING PATIENT-PHYSICIAN COMMUNICATION

Asthma Education and Prevention Program Expert Panel Report 3 (EPR3) addresses the
importance of developing physician communication skills to engage patients in discussions that
can alter perceptions and improve treatment adherence. The EPR3 recommends that physicians
participate in programs designed to increase communication skills and cultural sensitivity and
work to develop a partnership with a patient and family that includes a willingness to negotiate
the treatment plan (Bender, 2009). The collaborative communication between the patient and
physician is also impacted by the patients health beliefs and values. The physician who
addresses and identifies how the patients values and beliefs will impact the outcomes such as
adherence. Mir & Sheikh (2010) found that outcomes are usually positive when a physician
acknowledges, addresses and respects the patients believes. Such skill facilitates patients
feelings of empowerment and autonomy with a collaborative communication and decisionmaking (Mir & Sheikh, 2010).
The evaluation of this plan is the final step of the QIP. The collection of data and analysis
of the measurable outcomes developed in the earlier step of the QIP will show the results of the
implemented actions. At this step and evaluation is also made to create adjustments in the
strategic plan for patient-physician communication improvement.
Summary
Ineffective communication is the leading cause of preventable patient injuries and death
(Fernandez, Tran, Johnson, & Jones, 2010). In patient-centered care, the physician works to
establish trust through communication, including listening and exploring concerns. Effective
communication is necessary to ensure that the physicians goal for treatment is the same as that
of the patient (Bender, 2009). The strategic plan set forward includes action planning and

ENHANCING PATIENT-PHYSICIAN COMMUNICATION

methods used to improve patient health outcomes and their satisfaction thereby directly the
medical facilitys achievement.

ENHANCING PATIENT-PHYSICIAN COMMUNICATION

References
Bender, B. (2009). Physician-patient communication as a tool that can change adherence. Annals
of Allergy, Asthma & Immunology, 103(7), 1-2.
Bujak, J., & Bartholomew, K. (2011). Transforming physician-nurse communication:
Deteriorating relationships must be reversed for the benefit of patients, staff and the
organization. Healthcare Executive, 26(4), 56.
Fernandez, R., Tran, D., Johnson, M., & Jones, S. (2010). Interdisciplinary communication in
general medical and surgical wards using two different models of nursing care delivery.
Journal of Nursing Management, 18, 265-274.
Gregory, R., Peters, E., & Slovic, P. (2011). Making decisions about prescription drugs: A study
of doctor-patient communication. Health, Risk & Society, 13(4), 347-371.
Haskard Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician Communication and Patient
Adherence to Treatment. Medical Care, 47, 826-834.
Hospital Consumer Assessment of Healthcare Providers and Systems. (2013). HCAHPS Fact
Sheet, August 2013. Retrieved from hcahpsonline.org/facts
Mir, G., & Sheikh, A. (2010). Fasting and prayer dont concern the doctors ... they dont even
know what it is: Communication, decision-making and perceived social relations of
Pakistani Muslim patients with long-term illnesses. Ethnicity & Health, 15(4), 327-342.
Robinson, K. L., & Watters, S. (2010). Bridging the communication gap through implementation
of a patient navigator program. Pennsylvania Nurse, 65(2), 19-21.
Van Dulmen, D. (2011). The value of tailored communication for person-centered outcomes.
Journal of Evaluation in Clinical Practice, 17(2), 381-383.
Yoder-Wise, P. (2011). Leading and managing in nursing (5th ed.). St. Louis: Mosby.