Introduction

Interprofessional communication and collaboration

A healthcare team is a group of professionals contributing to the care and treatment of a patient. The team typically consists of professionals from interdisciplinary areas such as physicians, nurses, and technologists. Communication among members of a healthcare team is essential for quality patient care and effective team performance. Building cooperative and respectful team relationships assist in a patient’s perception of the care they are receiving. Critical patient information needs to be shared with members of healthcare teams to ensure a collaborative approach. Conversely, lack of communication creates opportunities for errors to occur, quality of care diminished, and can place patient safety at risk.

Interpersonal Dimensions of HealthCare Teams

Many components are involved in working effectively in a healthcare team. Communication channels bring the team together to enable patient-centered care. Therapeutic communication is an important tool that helps put the patient at ease and builds trust in the healthcare team. When managing patient care each member of the team will have their own interpretation of the information presented and how the information is acted upon can be dependent on each member’s uniqueness, expertise, and level of involvement within the team.

Interpersonal communication is the exchange of information between two or more people involving verbal and nonverbal methods. Developed interpersonal communication skills are vital to ensure collaboration with team members to support the best interest of patients. In most healthcare settings, teams are formed to support patient care and outcomes. A variety of teams are found in healthcare settings. They can be described as interprofessional care, collaborative care, shared care, or team care.

Common Types of HealthCare Teams

Primary care is the fundamental level of health services and contacts a patient has with the healthcare system. Primary healthcare teams are composed of healthcare providers who provide comprehensive healthcare within the community. As an example, a primary team could consist of a group of family physicians, nurse practitioners, practice managers, pharmacists, and healthcare administrators (HCAs) working to support the team. Primary care teams work to meet public and patient expectations, optimize health outcomes, and work to support and sustain the healthcare delivery systems.

Secondary care is concentrated health services. Secondary healthcare teams are composed of specialized healthcare providers who provide expert and specific care to patients who are often referred to them by a primary healthcare provider or team. Secondary healthcare teams are often found in a hospital setting. As an example, a patient is referred to a hospital outpatient clinic for care or inpatient emergency care. The team composition can include specialized physicians such as a cardiologist, technicians, nurses, dieticians, and HCAs.

Tertiary care is advanced and highly specialized health services. Tertiary healthcare teams are found in healthcare settings focusing on advanced treatments and extended procedures such as cancer treatment or neurosurgery. Patients are referred to tertiary healthcare teams by either the primary or secondary health team. Tertiary team composition typically, includes medical specialists, nurses, technicians, and HCAs.

Collaboration and Open Communication

Collaboration described in the context of the healthcare team involves professionals undertaking interdependent roles working together, investing in shared strategies, problem-solving, and decision-making to design care plans supporting patient outcomes. Inherently, effective teams who coordinate care successfully establish methods of communication, inclusive of data management systems, team meetings, and responses to rapidly evolving public health needs.

Interventions to support collaborative team dynamics include:

• remove the reliance on continuing the way things have always been done, try new approaches
• encourage change, look for opportunities to find solutions, and improve processes
• support transparency in all interactions
• recognize and celebrate collaboration within the team

Judgment and Decision-Making

Many thinking strategies are needed in a healthcare setting to ensure quality patient outcomes and accountability. Healthcare team members typically utilize and apply knowledge based on their scope of practice and role. Clinical reasoning is a process undertaken by healthcare professionals to understand a patient’s problem, analyze information, and implement interventions. Healthcare decision-making is also a process inclusive of definable steps in sequential order.

Technology and the Impact on HealthCare Team Communication

Technology has enhanced the accessibility of team communication in healthcare settings with the ability to communicate through the variety of devices and channels available. Connected healthcare spaces enable more agile treatment plans to develop within the team. Healthcare innovation allows the sharing and analyzing of patient data with team members to support decision-making capabilities. Technology can strengthen therapeutic communication via team relationships when used in a consistent manner to update team members and share information practices.

Navigating Challenging Conversations and Workplace Conflict

An integral part of being a member of the healthcare team involves navigating challenging or difficult conversations. These conversations may arise based on a number of contributing factors such as stress, fatigue, time of day, and a patient who is in pain, angry, or appears aggressive. We should attempt to approach these situations in a non-judgmental manner and avoid labeling someone as hostile or unpleasant. Practicing therapeutic communication techniques can help to de-escalate encounters.

Diversity and the HealthCare Team

Diversity in care teams involves members from multiple races, ages, genders, ethnicities, and orientations who present with various backgrounds and experiences. In 2019, around seven million people worked at general medical, surgical, or specialty hospitals; some two million at outpatient care centers, and about 1.8 million worked at nursing care facilities. There were 9.8 million workers employed as healthcare technicians and practitioners, including physicians, surgeons, and registered nurses. About two-thirds were non-Hispanic White. Another 5.3 million worked as nursing assistants, home health and personal care aides, and in other healthcare support occupations. One-quarter of healthcare support workers were Black. Women accounted for three-quarters of full-time, year-round healthcare workers (Laughlin et al., 2023). Healthcare teams composed of diverse members often have a wide range of decision-making and critical thinking abilities as they relate to healthcare decisions leading to more positive outcomes.

Health literacy

What is Health Literacy?

The definition of health literacy was updated in August 2020 with the release of the U.S. government’s Healthy People 2030 initiative. The update addresses personal health literacy and organizational health literacy and provides the following definitions:

• Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.
• Organizational health literacy is the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

These definitions are a change from the health literacy definition used in Healthy People 2010 and Healthy People 2020: “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

The new definitions:

• Emphasize people’s ability to use health information rather than just understand it
• Focus on the ability to make “well-informed” decisions rather than “appropriate” ones
• Acknowledge that organizations have a responsibility to address health literacy
• Incorporate a public health perspective

Why is Health Literacy Important?

Understanding Health Literacy

Health literacy is important for everyone because, at some point in our lives, we all need to be able to find, understand, and use health information and services.

Taking care of our health is part of everyday life, not just when we visit a doctor, clinic, or hospital. Health literacy can help us prevent health problems, protect our health, and better manage health problems when they arise.

Even people who read well and are comfortable using numbers can face health literacy issues when:

• They aren’t familiar with medical terms or how their bodies work.
• They have to interpret statistics and evaluate risks and benefits that affect their health and safety.
• They are diagnosed with a serious illness and are scared and confused.
• They have health conditions that require complicated self-care.
• They are voting on an issue affecting the community’s health and relying on unfamiliar technical information.

Why Do We Have a Health Literacy Problem?

When organizations or people create and give others health information that is too difficult for them to understand, we create a health literacy problem. When we expect them to figure out health services with many unfamiliar, confusing, or even conflicting steps, we also create a health literacy problem.

How Can Healthcare Professionals Help People Now?

We can help people use the health literacy skills they have. How? We can do the following:

• Create and provide information and services people can understand and use most effectively with the skills they have. See Develop and Test Materials.
• Work with educators and others to help people become more familiar with health information and services and build their health literacy skills over time. See Collaborate.
• Build our own skills as communicators of health information. See Find Training for free, online options.
• Work with trusted messengers to share your information.
• Build health-literate organizations. See the following:
  • • Attributes of a Health Literate Organization
    • Assess Health Literacy in Your Organization
    • Organizational Health Literacy: Quality Improvement Measures with Expert Consensus
• Consider the cultural and linguistic norms, environment, and history of your intended audience when developing your information and messages.
• Use certified translators and interpreters who can adapt to your intended audience’s language preferences, communication expectations, and health literacy skills.

Talking Points About Health Literacy

As a health literacy ambassador, it’s up to you to make sure your colleagues, staff, senior leadership, and community leaders understand the importance of using health literacy concepts. Use these talking points when making the case for building a health-literate organization. Add talking points relevant to your organization.

• Nearly nine out of 10 adults struggle to understand and use personal and public health information when it’s filled with unfamiliar or complex terms.
• Limited health literacy costs the healthcare system money and results in higher than necessary morbidity and mortality. Improving health literacy could prevent nearly 1 million hospital visits and save over $25 billion a year.
• We can improve health literacy if we practice clear communication strategies and techniques. Clear communication means presenting familiar concepts, words, numbers, and images in ways that make sense to the people who need the information.
• Testing information products with your intended audience and asking for feedback are the best ways to know if you’re communicating clearly. Test and ask for feedback before releasing information to the public.
• Clear communication builds trust with your audience. When your audience trusts you, they’re more likely to follow your recommendations.
• Choosing to use jargon is an act of exclusion. Using clear communication leads  to better access in healthcare.
• Clear communication streamlines the translation process. That means you can more quickly share your information with people who are non-native English speakers and readers.

Communication with Patients and Families

Defining Therapeutic Communication

Therapeutic, by its very definition, relates to curative treatments that benefit both the mind and the body (Merriam-Webster. n.d.). Effective therapeutic communication requires people to be compassionate. This may seem to be innate in people but that is not always true. In healthcare settings, effective therapeutic communication is used to care for people so that their healthcare needs can be met. Effective therapeutic communication skills can be learned through continuous self-reflection, empathy development, and practice.

Empathy

Empathy is helpful when therapeutically communicating with others because you feel what they are experiencing with the person, and that shared feeling leads to connection and trust with the patient. Empathy is an awareness of how someone is experiencing or feeling an emotional event because you have felt the same or similar emotion. For example, a patient shares with the healthcare provider that they are extremely sad after the death of their beloved cat Snips. The healthcare provider remembers the sadness she felt when her rabbit Hopper died and expresses to the patient, “This is a difficult time as pets are like family.” The patient then responds, “Yes, I was closer to Snips than I am to some of my family”. The healthcare provider responds with a caring glance and thanks the patient for sharing.

Sympathy

Sympathy is not considered helpful when therapeutically connecting with another person because the sympathetic person feels sorry for the other person and can only imagine how they might be feeling. Often, when sympathizing with someone, people try to solve the person’s problem to assist them in moving outside of their emotional state. For example, a patient shares with the healthcare provider that they are sad that they will have to quit their job to look after their mother who is in the early stages of dementia. The healthcare provider feels terrible that the patient’s mother is suffering from dementia and that the patient must now lose income to look after their mother. The healthcare provider responds by suggesting that the patient looks into some inexpensive adult daycare centers. The patient does not respond and leaves the encounter feeling confused because she interprets the healthcare provider’s response to mean that the healthcare provider doesn’t think that the patient can look after their own mother. The healthcare provider doesn’t understand how difficult it will be to have strangers care for their mother.

Governing Principles for Communicating with Patients with Limitations

An impairment may be new or temporary, such as an injury, surgery, or drug impairment. When the impairment is new, try different methods to address the patient’s needs. For example, if the person requires assistance in communication, treat them as you would any other person requiring assistance. The first principle is to ask the patient how to best communicate with them. Then listen to their response. The patient is the expert on their needs and what works for them. Do not insist that your way is the correct way; they have lived with their limitations daily (Harrington et al., 2020).

If a person asks for assistance, clarify how to help and what to do. For example, do they want you to take their arm? Ensure that you speak clearly and wait for responses and cues as to how they wish to proceed. Do not touch anything without asking first. For example, service animals or wheelchairs. A person’s assistive device (e.g. wheelchair, cane, walker) is considered a part of their personal space. Acknowledge the presence of an interpreter, attendant, or companion, but remember to address the person with a disability directly.

Electronic and non-verbal communication

Electronic Communication

Social media started as a means of enhancing people’s social lives, but it exceeded that purpose a long time ago. Virtually every business, healthcare service, and non-governmental organization has some sort of internet presence. These organizations use social media channels to communicate their brand or their values to the outside world. Even those few organizations that don’t run their own Twitter or Instagram account are sure to appear on other people’s review accounts or websites. Of course, our reliance on electronic communication doesn’t end there. Other channels of electronic communication–most notably email–are day-to-day facts of school, work, and personal life. This doesn’t mean that we can afford to take electronic communication for granted. Even the smallest text deserves the same kind of communication consideration that we give more formal, traditional kinds of writing and speaking.

Email

Most students are familiar with email, or as it was once known, electronic mail. Email is the most popular form of written communication in the history of human civilization. It is extremely flexible in what it can do. It can be used to send short routine messages or lengthy formal messages. It can be used to deliver other kinds of documents, such as letters, reports, and memos, and it can be used to facilitate the scheduling of face-to-face meetings and events. Email is also flexible in how it can be accessed: computers, tablets, smartphones, smartwatches, and other digital devices all allow you to send and receive messages. It is without question the most versatile communication channel in the workplace.

Because email is such a flexible and accessible technology, we must be mindful in how we use it. Professional emails should not look or sound like the texts we send our friends and family. As with more traditional forms of correspondence, our emails will be held to high standards for their vocabulary, organization, and appearance.

When a professional email is properly written, it gives the author credibility. The audience receiving it will be more likely to trust the information in the message and the person who sent it. When an email is overly casual or is filled with grammar mistakes, however, it distracts from the content of the message. It decreases the recipient’s respect for the person who wrote it and jeopardizes the integrity of the organization that the author represents. A well-written email makes a strong impression. A poorly written one could cost you a job, a contract, or your reputation.

Before hitting the Send button, put yourself in your reader’s position and assess whether you’ve achieved the purpose you set out to achieve in the first place. Evaluate also if you’ve struck the appropriate tone and formality. If you’re aware that your tone is too angry, for instance, cool down by focusing on other business for a while. After revising generally, always proofread an email. In any professional situation, but especially in important ones related to gaining and keeping employment, any typo or error related to spelling, grammar, or punctuation can cost you dearly. A poorly written email can come across as insulting because it effectively says to the recipient: “You weren’t important enough for me to take the time to ensure that this email was properly written.” Worse, poor writing can cause miscommunication if it places the burden of interpretation on the reader to figure out what the writer meant to say if that’s not clear. If the recipient acts on misinterpretations, and others base their actions on that action, you can soon find that even small errors can have damaging ripple effects that infuriate everyone involved.

Netiquette and Social Media

We create and curate personal profiles, post content and comments, and interact via social media as a regular part of both our personal and professional lives. How we conduct ourselves on the open internet can leave a lasting impression, one not so easily undone if it’s regrettable. The hilarious but compromising selfie you posted on Instagram five years ago is still there for your potential employer to find, judge for what it says about your professionalism, and speculate about what customers might think if they saw it too. That sarcastic reply to a public post on Facebook or Twitter in a heated moment a decade ago can come back to haunt you. We’re all learning as we go in this new media environment, but any mistakes we make along the way, no matter how much we’ve matured since, are still there for all to see and can have lasting impacts on our careers.

Legal Responsibilities

Your writing says something powerful about your personal credibility. It also says something about the credibility of any organization with which you’re affiliated. At work, what you write and how you write can be part of your company’s success, but it can also expose it to unintended consequences and legal responsibility. When you write, keep in mind that your words will keep on existing long after you have moved on to other projects. They can become an issue if they exaggerate, state false claims, or defame a person or legal entity such as a competing company. Another issue is plagiarism, or using someone else’s ideas or writing without giving credit to the source. Whether the material is taken from a printed book, a website, or a blog, plagiarism is a violation of copyright law and may also violate your school’s or your company’s policies. Industry standards often have legal aspects that must be respected and cannot be ignored.

Using Social Media Professionally

Review sites, blogs, tweets, and online community forums are some of the continually developing means of social media being harnessed by business and industry to reach customers and other stakeholders. People’s comfort in the online environment forces businesses to market and interact in this environment or risk a massive loss in sales and interest. Though most users learn how to use social media as an extension or facilitator of their social lives, using the same platforms for professional reasons requires some change in behavior.

Recognize that every modern business or organization should have a social media presence on the sites they expect their customer base to frequent, especially popular sites such as Twitter, Facebook, and Instagram. Messaging here must be consistent across the platforms when alerting the customer base of important information such as special events, deals, and other news.

Next, follow expert advice on how to properly take advantage of social media in detail to promote your operation and reach people. Large companies will dedicate personnel to running their social media presence, but small businesses can do much of it themselves if they follow some decent online advice. Also, know that social media is a constantly evolving environment. Stay on trend by continually searching out and implementing the latest advice similar to the above.

Finally, always consider how the sites you access and what you post represent you and your employer, even if you think others don’t know where you work or who you are. Internet service providers (ISPs) are required by law to archive information concerning the use and traffic of information that can become available under subpoena. Any move you make leaves digital footprints, so you will have to answer for any misstep that brings shame upon you or your company.

Non-verbal communication

Non-verbal communication strategies are ways you communicate without speaking, for example through facial expressions, hand gestures, eye contact, and body language.

In many situations, much of your communication occurs through non-verbal behaviors. Non-verbal communication can be a useful strategy for communicating emotions like empathy, compassion, and acceptance. It is often how healthcare providers respond, rather than what they say, that leaves a lasting impression on patients, so it is important to be aware of how you communicate using non-verbal behaviors.

Non-verbal behaviors must align with your verbal behaviors so that patients clearly understand what you are saying. For example, it would be confusing for the patient if you had a somber tone of voice, a distancing posture, and avoided eye contact while attempting to maintain a therapeutic relationship with the patient.

Try to ensure positioning where you are eye-to-eye with the patient and at a slight angle toward one another. This positioning conveys an open and non-confrontational and non-authoritative space. Whenever possible, avoid standing over the patient if they are sitting or lying in bed. It is better to sit down, which also conveys that you have time to listen to them.

Intercultural Communication

Cultural Considerations

Therapeutic communication with patients and families requires attention to a person’s culture. It is important to note that:

• People are cultural beings. At a basic level, culture includes a person’s beliefs and values. It refers to a person’s practices or their way of life. It includes a person’s ethnicity, spirituality, and religion, but it is much more than these components.
• Culture is deeply embedded in each person and everything they do, including how they communicate and what is meaningful to them. It is essential to understand because it shapes the way we think, feel, and behave. It can determine what is considered taboo, appropriate, and meaningful.

Cultural safety is an important component of therapeutic communication because culture is so dynamic and deeply embedded in a person’s way of being. In the context of therapeutic communication, cultural differences can affect the ways you communicate with patients. Cultural awareness is vital to providing safe care to patients (Curtis et al., 2019).

A relational approach can facilitate communication that embraces cultural safety because it relies on your dialogical engagement with the patient. In other words, healthcare providers should suspend what they assume they know about culture, and let patients direct healthcare providers with regard to how culture is meaningful to them. This approach encourages you to consider the relational interplay (Doane & Varcoe, 2015) of communication, the patient’s culture, and your own culture. Like everyone, healthcare providers are cultural beings – you will tend to view the world and your patient from your own cultural perspective. From a relational perspective, you must understand your own culture and your patient’s culture so that you are positioned to recognize and understand the patient’s culture. Part of a relational approach also involves positioning yourself as an inquirer who is in a “space of knowing/not knowing, being curious, looking for what seems significant” (Doane & Varcoe, 2015, p. 6). See Table 7.1 on how to develop yourself as an inquirer and understand the interplay of your culture and the patient’s culture.

Chapter 7 Test Yourself

References and attributions

Introduction

“Professional Communication” in Introduction to Communication in Nursing by Jennifer Lapum, Oona St-Amant, Michelle Hughes, and Joy Garmaise-Yee. Published by Toronto Metropolitan University Pressbooks under a CC BY-NC 4.0 license. Lightly edited for consistency with its new context.

Communication in the Clinic

“Health Care Teams and Communication” in Therapeutic Communication for Health Care Administrators by Kimberlee Carter, Marie Rutherford, and Connie Stevens. Published by Conestoga College under a CC BY-NC-SA 4.0 license. Lightly edited for brevity and to change to American spelling conventions.

Laughlin, L., Anderson, A., Martinez, A., & Gayfield, A. (2023). Who are our health care workers: 22 million employed in health care fight against COVID-19. United States Census Bureau. https://www.census.gov/library/stories/2021/04/who-are-our-health-care-workers.html

Health Literacy

“What is Health Literacy?” from the Centers for Disease Control and Prevention. Published under public domain.

“Dr. Rima Rudd” [YouTube video] by Centers for Disease Control and Prevention. All rights reserved.

“Understanding Health Literacy” from the Centers for Disease Control and Prevention. Published under public domain. Lightly edited for consistency with its new context.

“Talking Points About Health Literacy” from the Centers for Disease Control and Prevention. Published under public domain.

Communication with Patients and Families

Defining Therapeutic Communication

“Therapeutic Communication” in Therapeutic Communication for Health Care Administrators by Kimberlee Carter, Marie Rutherford, and Connie Stevens. Published by Conestoga College under a CC BY-NC-SA 4.0 license. Lightly edited for brevity, clarity, consistency with its new context, and to change to American spelling conventions.

Merriam-Webster. (n.d.). Therapeutic. In Merriam-Webster.com dictionary. Retrieved May 6, 2023, from https://www.merriam-webster.com/dictionary/therapeutic 

“Empathy: The Human Connection to Patient Care” [YouTube video} by Cleveland Clinic. All rights reserved.

“Communications with Clients of Differing Abilities” in Therapeutic Communication for Health Care Administrators by Kimberlee Carter, Marie Rutherford, and Connie Stevens. Published by Conestoga College under a CC BY-NC-SA 4.0 license.

Harrington, C. N., Koon, L. M., & Rogers, W. A. (2020). Design of health information and communication technologies for older adults. In A. Sethumadhavan & F. Sasangohar (Eds.), Design for Health: Applications for Human Factors (pp. 341-363). Academic Press. https://doi.org/10.1016/C2018-0-00043-2

Electronic and Non-Verbal Communication

“Electronic Communication“, “Email“, and “Netiquette and Social Media” in Essential Communication Skills: Mohawk College by John Corr, Grant Coleman, Betti Sheldrick, and Scott Bunyan. Published by eCampus Pressbooks under a CC BY-NC-SA 4.0 license. Edited for brevity and to change to American spelling conventions.

“Non-Verbal Communication Strategies” in Professional Communication in Health Professions by Jennifer Lapum, Oona St-Amant, Michelle Hughes, and Joy Garmaise-Yee (Eds.). Published by NSCC under a CC BY-NC 4.0 license. Lightly edited for brevity and consistency with its new context.

Intercultural Communication

Cultural Considerations

“Cultural Considerations” in Introduction to Communication in Nursing by Jennifer Lapum, Oona St-Amant, Michelle Hughes, and Joy Garmaise-Yee. Published by Toronto Metropolitan University Pressbooks under a CC BY-NC 4.0 license. Lightly edited for brevity and consistency with its new context.

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. International Journal for Equity in Health, 18(1). https://doi.org.10.1186/s12939-019-1082-3

Doane, G., & Varcoe, C. (2015). How to nurse: Relational inquiry with individuals and families in changing health and healthcare contexts. Wolters Kluwer.

Intercultural Communication

“Intercultural Communication” in Introduction to Communication in Nursing by Jennifer Lapum, Oona St-Amant, Michelle Hughes, and Joy Garmaise-Yee. Published by Toronto Metropolitan University Pressbooks under a CC BY-NC 4.0 license. Edited for brevity, flow, consistency with its new context, and to change to American spelling conventions.

Image Descriptions

Image 7.5: An image depicting several hands arranged around a globe as if the world was being cradled. [Return to Image 7.5.]