Health Care Roles in Communication, Essay Example

Introduction

This is a study of a fictional health care situation in which poor communication skills between the individuals, professionals and organizations played a major role in the negative outcome.  This study is to examine how poor communication can effect the treatment and overall experience of a patient in a health care setting.  Communication plays a vital role in the treatment of a patient, however faces multiple challenges in the health care industry.  First and foremost, patients are often under great duress during their time in a health care facility.  They may be facing serious medical, emotional, psychological and family issues and therefore, may react more intensely to giving verbal and non-verbal cues.  Secondly, the health care professional is also under stress, having to care for the needs of multiple patients, react to an ever-changing environment and avoid any mistakes that could be costly, both financially, legally and mortally.  Third, there is the administrative aspect of the health care industry, in which a number of different agencies, organizations and companies have to interact in an environment that is stressful, time dependent and inherently unstable.  Insurance companies, equipment and technology suppliers, government and hospital management all must interact multiple times a day for each and every patient, which can result in mistakes, miscalculations, denials of claims and care, technological and equipment malfunctions and legal issues.  Sometimes this vast interaction of the administrative bodies in health care can leave the patient feeling powerless because each aspect is dependent on the other and the patient is not able to act as a player in their interactions. “Responding effectively to the rapid change and complexity in the healthcare environment requires fundamental shifts in thinking to find effective solutions to new challenges (Zubialde & Aspy, 2001).”

A positive patient experience at a health care facility is crucial to the well-being of the patient, regardless of diagnosis, and is also essential to the survival of the facility and the employees/employers therein.  Very often the patient is facing an illness or malady that is beyond their area of expertise and understanding, it is the job of the healthcare professional to be able to properly communicate the patient’s situation to them properly and be able to work with them to reach a favorable outcome.

Description of Patient Scenario

The fictional patient scenario is as such: “Office billing receives notes written by the doctors and translates them into codes for billing health insurance. Routinely, Dr. Chan and Dr. Idea send in illegible notes that result in both Medicare and private insurance denying patient claims. As a result, the office bills the patients directly. This seems to be happening quite often, and irate patients are calling the billing office to complain. Mr. and Mrs. Johnson have called three times because they continue to be billed incorrectly, so they decide to meet with someone face-to-face to get results. The first person they come in contact with is Rose, a medical assistant tending to the front desk. Rose is aware of their problem, and in an attempt to explain the situation to the Johnsons, she tells them that it’s hard for billing to read the doctors’ handwriting, and when questioned about an illegible note, the doctors act as though they are “above” everyone else and disregard any inquiries. Rose also assures the Johnsons that this problem was brought up to the medical director, who is also unsupportive. Rose apologizes and assures the Johnsons that she will do everything she can to fix their billing issue. A few days later, the Johnsons request that their medical records be transferred to a different medical facility.”

This scenario offers a good cross section of the major components of any healthcare communication situation.  All levels of the healthcare industry are in play; the patient, the professionals and administration and all are having to interact in an imperfect environment, made even more imperfect by the lack of effective means of communication.  Some of the major components of communication are lacking in this situation.

First, there are the key players in the matter. This interaction between the Johnsons and Rose actually incorporates many more key players and aspects of healthcare communication.  Besides, Rose and the Johnsons, Dr. Idea and Dr. Chan, Medicare and private insurance companies, the medical director and the environment of the facility itself are all major players in the scenario.  Naturally, the Johnson’s are directly effected by the mistakes made on behalf of the Dr.’s, healthcare facility and Insurance companies, however Rose is not verbalizing competence on behalf of the healthcare facility.  By indicating that this has been an on-going issue that has not been addressed and remedied for some-time, Rose is actually telling the Johnsons’ that the facility is unfit to administer care through their inability to rectify and rather simple problem. Dr. Chan and Dr. Idea also face issues of competency, accuracy, understandability and reliability in their communications through their handwriting.  The insurance companies are experiencing a failure to interpret the handwriting and are subsequently denying the claims but without trying to reach the Dr. and determine the accuracy of the bill.  The healthcare facility’s billing office, in response to the numerous complaints, should have communicated to its staff that the denials may not be appropriate so that subsequent action could be taken.

Thus, the major players are experiencing difficulty in communicating competence, accuracy, understandability and reliability on all levels of the healthcare spectrum from the patient to the administrative level.  In order to understand the complexities of the communication failure, each individual player must be looked at in depth.

The Johnsons

The patient is the central figure in any healthcare situation.  It is ultimately the goal of all parties involved to see that their needs are met, and while this can be difficult and confusing at times, it is ultimately an altruistic goal shared by the providers on all levels.  The difficulty lies in the communication of this goal and this altruism to the patient so that they feel safe, cared for, and most of all heard and understood.  This being said, healthcare is also a business, which relies on patients to meet their financial needs and goals.  In this sense, customer service is important to maintain a clientele that can sustain the facilities and employees.  In the given fictional sample, this is where the problem lies, customer service.  While the Johnsons’ medical needs may have been met, their needs as customers were not.  The Johnsons rightly expect a level of competence in their healthcare provider to carry out the agreements set forth in their contractual obligations.  The Johnsons have both a verbal and written contract with both the facility and their insurance, which is being violated and the Johnsons are being unduly inconvenienced and disturbed by that violation.  The Johnsons feel helpless when faced against an administrative system that is too large and complex for them to navigate.  Also, they are probably quite irritated because they shouldn’t have to navigate this system.  They have a contractual agreement with the healthcare facility the insurance company precisely so they don’t have to navigate the complex administrative level.  Also, they have a reasonable customer expectation that they will be billed properly for services rendered.  In this case neither contractual obligation nor customer obligation was met by the healthcare facility and therefore the Johnsons have more than enough reason to be upset.

Rose

Rose represents the healthcare facility and is the Johnsons’ contact on behalf of the facility, therefore her role is crucial to the Johnsons’ perceptions of events and the resolution of their problem.  As a personal representative of the healthcare facility, Rose assumes responsibility for the incident that has occurred and exists in a capacity to ease the worries of the customer. However, Rose shirks her role as representative of the facility in favor of representing herself.  Rose is trying to deflect the Johnsons’ anger away from herself and instead blame it on the facility to avoid any personal stake in the matter.  While this may be easier for Rose, it is not easier for the Johnsons or for the facility.  By deflecting responsibility away from herself, the representative of the facility, and placing it on the doctors and supervisors, Rose undermines the Johnsons’ confidence in the facility.  Rather than trying to maintain a positive, competent image of the facility, Rose reveals inner, interpersonal conflicts of the facility, which reveals a company at odds with itself and unable to work competently to solve a problem.  Rose expresses frustration that this problem can’t seemingly be solved.  This violates the parameters of Rose’s job and she under- represents the facility. The workforces of hospitals are among the most highly educated in the service sector; however, the nature of professional education makes for a very complex tapestry of interrelationships. While interpersonal trust and collaboration are crucial, the goals, organizational power, and income all vary widely by profession and position. An understanding of these interworkings takes time and effort to develop and, assuming one knows more than one does, often leads to trouble (Garman, 2006).”  Rose’s role as company representative and explicitly shows the Johnsons’ that the facility is not fulfilling its obligations and violating its contract with the Johnsons.  Ultimately it is this interaction with Rose that leads the Johnsons to find a new healthcare facility.

Dr. Idea and Dr. Chan

Dr. Idea and Dr Chan are the roots of the problem the Johnsons are experiencing.  If their handwriting has been an on-going issue and they have failed to write more clearly, then they are violating their job roles of properly fulfilling their roles to the customer and the healthcare facility in which they are employed.  They are not only responsible for administering care to the patient but ensuring that the care is properly followed through.  If their handwriting is illegible and their orders cannot be carried out, then they are not following their patient care through to fruition.  They are also not fulfilling their role to the healthcare facility by causing billing problems with the patients and, ultimately, losing the Johnsons as customers.  Rose’s revelation that this has been an on-going problem, reveals a non-verbal cues on behalf of the doctors that either they do not care, or are above reproach in their handling of patients and administration.  This causes the Johnsons to lose confidence in their Doctors, whom, they perceive are either arrogant or indifferent to their responsibilities.

Administration

While in the periphery of the exchange between Rose and the Johnsons, the administration of the healthcare facility is ultimately responsible for the problem existing.  Rose’s response that the supervisor seemingly can’t do anything about Dr. Idea and Dr. Chan’s writing, reveals a facility that cannot manage itself and cure its own ills, let alone those of the patient/customer.  This is the essential “last nail in the coffin” for the Johnsons.  If they had confidence in the facility to right these wrongs, they may not have left, however, administration had shown a willing disregard to address the problems.  Furthermore, the facility continues to bill patients while well aware that they may be falsely billing the patient and violating the patient’s contract with both they’re insurer and the facility itself.

The insurer also plays a role in the exchange.  Some simple due diligence on behalf of the insurer to clarify the Doctors’ writings could have avoided the situation completely.  Instead, the insurer perceives the illegible handwriting as something not covered under the customer’s policy, rather than simply making a phone call to be sure as to the doctors’ orders.  This can often represent the most frustrating part of a patient’s negative healthcare experience in that the administrative level is where the patient has the least influence and limited ability to enact change on his or her behalf.

Resolution

While perhaps Rose’s interpersonal skills need a little work, it is difficult to change one’s ability to socially interact with people on behalf of a company.  Perhaps some re-training may be in order, but more effective would possibly be replacement.  While interacting with patients, Rose must remember that she represents the entire company, not just herself and therefore she should try to promote a competent image of the company rather than revealing internal conflicts and making the facility appear ineffectual.  Had Rose represented the company in such a way as to make it appear effective and competent, the Johnsons’ may have stayed, their confidence renewed that this mistake would not happen again.  However, when Rose told them that this was an on-going issue that could seemingly not be resolved by anyone in the company, she portrayed the healthcare facility in a negative light.

As much as Rose played a major role in the experience of the Johnsons’ the issue at hand is more widespread and has affected a number of different patients, therefore it is something that needs to be handled at the administrative level.  Firstly, Dr. Chan and Dr. Idea need to reform their habits, and be instructed to make an effort to write more clearly.  Secondly, if, in fact, the supervisor has spoken with them and been ineffectual, than it is time for someone else with authority to step in.  If a supervisor cannot handle the authority of his or her position, then they need to be replaced by someone who has the tenacity to handle situations involving professional egos and problem resolution.  “Without plans to act as guidelines, staff still do their best at getting their jobs done, or they do what they think ought to be done. Although this practice is functional, it is not teamwork; it is merely an individual effort performed in a group setting. Most importantly, work produced by individuals is usually not as effective as work by a well-managed team. Building and managing effective teams require a lot of planning, something at which many managers fail (Preston, 2005).”  If Dr. Idea and Dr. Chan, cannot reform their ways, than perhaps it is time to find some different doctors who are more willing to communicate in such a way that the entire organization can properly participate in the customer/patient’s care.  Communication is an effective tool in maintaining effective staff.  “In its analysis, Watson Wyatt found that, among employers that offer rich benefits but have poor communication strategies, the average turnover rate of top-performers is 17 percent. Among employers that offer less costly benefits but have effective communication strategies, the average turnover rate falls to 12 percent for top performers. Supplementing rich benefit programs with effective communication practices yields employers an even lower average turnover rate of only 8 percent (Marshall & Heffes, 2005).”

There is an alternative to personnel changed, though it may be a bit more expensive.  There facility could hire an additional office employee to audit any charges denied by patient’s healthcare in order to ensure the insurance company was accurately billed and is acting under their agreed contract.  This, however, would be a daunting task and probably require several new hires, which would ultimately cost the facility more and more money throughout the careers of the newly hired employees.

A second alternative may be more expensive up front, but would ultimately cost less in the long run as it represents a large initial investment for a short term period rather than a long term investment, which the company will have to continually pay (the new auditors).  The installation of an interactive computer system, in which doctors could use computer notebooks rather than paper note books, would ensure that there would be no errors related to handwriting, as everything would be on the computer.  It would also allow for faster more accurate billing, reduction in medication and insurance errors and actually lessen the need for on-hand staff.  “One crucial issue with respect to improving communications in hospitals is related to ownership of communication processes. The process improvement literature consistently highlights the need for clear responsibility and accountability for each key process within an organization. Currently, responsibility for ensuring the efficiency and effectiveness of communication activities is not sufficiently demarcated and assigned. To the extent that improving the quality of communications requires technological solutions and a detailed clinical process understanding, a multidisciplinary team that includes the hospital CIO, the Chief Medical Information Officer, the CNO, and the CMO would be able to provide the type of multifaceted understanding of hospital operations and the senior leadership and vision necessary to implement change (Agarwal, Sands & Schneider, 2010).”  Technology can ultimately integrate fast, accurate communication between the doctors, the facility administration and the insurance companies.  This could ensure that future communication issues involving inaccuracy in billing could be avoided and patient confidence and loyalty maintained.

References

Agarwal, Ritu, Daniel Z. Sands, and Jorge Diaz Schneider. (2010). “Quantifying the economic impact of communication inefficiencies in U.S. hospitals.” Journal of Healthcare Management 55.4.

Garman, Andrew N. (2006). “Knowledge of the healthcare environment.” Journal of Healthcare Management 51.3

Marshall, Jeffrey, and Ellen M. Heffes. (2005). “Healthcare: communication helps retain top workers.” Financial Executive 21.3

Preston, Paul. (2005). “Teams as the key to organizational communication.” Journal of Healthcare Management 50.1

Zubialde, John P., and Cheryl B. Aspy. (2001).”It is time to make a general systems paradigm reality in family and community medicine.” Families, Systems & Health 19.4