Improving Communication: Pay Attention to the Basics


What do you notice about this bowl of M&Ms?

It’s colorful, yes.

Lots of primary colors, yes.

Someone’s been eating some of them, yes.

What’s the significance of this bowl of M&Ms to physician communication and patient experience?

Believe it or not, notorious 80’s rock band Van Halen really did have a contract rider demanding a bowl of M&Ms backstage—with all of the brown M&Ms removed. Contrary to popular belief at the time, it wasn’t because they were divas; they were operations masters. The “M&M clause”, buried in the middle of critical technical specifications of their contract, was their “canary in the coal mine.” The presence or absence of brown M&Ms was a way to quickly assess if people were paying attention to every word of their contract. The idea was that if this small, less significant detail was missed, what larger safety detail may have also been missed. This was a big deal when they were going into different markets with more elaborate setup and shows than had been done quite that way before.

The reason that I bring this up is that I honestly believe, after all of my work in the area of physician communications, there is a similar phenomenon in the connection between courtesy and respect, listening carefully and explaining things in a way that can be understood.

Say Something Human

In coaching and working with physicians, I discovered that empathy in provider communication is really more about genuine, supportive comments than long, drawn-out conversations. That was reinforced by an experience I had as a patient.

I was sick with a respiratory thing, so I made an appointment at my clinic, not with my provider, but for the first available time so it wouldn’t interrupt my day. I came in with my 2-year-old son, and we got roomed pretty quickly. But that’s when things slowed to a crawl. I rifled through my purse and found some Goldfish snacks. We “read” every automotive magazine that they had.

By the time the physician came in, I had spent a total of 63 minutes waiting in a room with a 2-year-old boy! If you know anything about a longer-than-expected wait with a toddler, you know what kind of stress I was dealing with. I thought I had done a really good job, so I was just looking for some acknowledgement of the wait.

When the physician walked in, he didn’t even acknowledge it. It wasn’t just the lack of an apology for being late, but he offered no pleasantries of any kind! There were a lot of even not-so-direct ways that this physician could have let me know that he appreciated what I had been through. But he exhibited not one bit of empathy.

Here’s the link back to the basics and the brown M&M’s… The physician I saw, who showed no empathy for my hour-long wait with a toddler didn’t show me any courtesy or respect. Consequently, as I shared why I was there and what I was concerned about, I didn’t feel like he listened carefully to me. Later, I realized that I forgot to ask about something at the appointment, and I realized that we hadn’t been communicating at all. I didn’t feel like I was being heard, and I certainly didn’t feel like he could explain things in a way that I could try to understand.

Communication Counts

When I was a social worker taking classes in empathy and active listening, I never imagined that I would be putting those skills into practice with physicians. Yet here I am, coaching physicians on ways they can make a real difference in the lives of their patients by empathizing and listening.

With an issue as big as communication, improvement goals may seem insurmountable. But I see it as a universal opportunity to engage people on many different levels, and that ignites a passion for the work.

Communication—and specifically provider communication—encompasses our physicians, our staff and all of the care team interactions. It even includes the exchanges that occur when we’re not face to face with one another.

With resources constrained by economic realities, we are all challenged to do more with less. The good news is that there’s much that can be accomplished by building on existing strengths and instilling new confidence. In that spirit, we can make the most of the resources and the time that we have.

Strategies and tactics for communication across the continuum apply directly to the CAHPS Clinician & Group Surveys (CG-CAHPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). There is a progression to how the aspects relate: When we feel like people are treating us with common courtesy, then we can actually hear each other better and we can ultimately better understand what is being explained to us.

In the next few blog posts, I will provide some thoughts on key strategies, keys to success, the puke and shoot continuum, and the path to performance for improving physician communication through coaching.

Janiece Gray

I began my career as a social worker and later, with my Master of Health Administration (MHA), directed operations at Allina Health in Minnesota. I later directed patient experience at Allina. My background and experience give me strengths in approaching healthcare opportunities and challenges through a systems lens – with unique strengths, challenges and activation points. My experience is also informed by leadership roles leading performance improvement in patient-centered care and patient experience departments. Working in the client role with healthcare consulting firms inspired me to address some unmet needs in the industry, and to co-found DTA Healthcare Solutions. I have a Lean Six Sigma Black Belt, and find that the discipline of practice translates to healthcare work very well.

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