The art of active listening

Nothing has the ability to knock us off course quite like illness or injury. As a disruptive force that suspends ‘normal’ life, for whatever length of time, the uncertainty makes us feel vulnerable and distorts our view on pretty much everything.

This is particularly true of our perception of our interactions with others, which in the case of ill health means healthcare professionals (HCPs).

Clear communication, simple information and the room to express ourselves on our own terms, are the foundations that ensure we perceive our interactions as positive.

By definition the term patient experience is broad but in real terms it usually refers to the patient’s perception of their relationship with their HCP.

Over the past decade it has grown exponentially in importance and for many it may be as significant as clinical outcomes, particularly in chronic conditions or in areas where no or only partial recovery are possible.

After clinical competence, being valued and treated as an individual and not simply as a condition, is most highly rated by patients when it comes to experience.1,2

Positive patient experience hinges on effective communication. It is linked to better concordance and clinical outcomes.

That communication is key is no surprise. Yet, the HCP-patient dynamic still isn’t right, potentially because many HCPs, (doctors in particular) tend to overestimate their ability to communicate effectively.4

Research from GE Healthcare reveals the extent of the disconnect in the US, where 63% of HCPs believe they are delivering quality patient experience yet only 40% of patients believe quality is being delivered.

The figures will differ across regions, but the overall picture is likely to echo this sentiment.

Ineffective communication between HCPs and patients remains one of the most cited reasons for poor experience. There is a direct link between patient experience and the amount of information they perceive they have been given.

Good communication can help to regulate patients’ emotions, improve understanding of clinical information and help in the assessment of patients’ needs, perceptions and expectations.4

HCPs are also adversely impacted by ineffective communication. They can become frustrated or feel inadequate; feelings that are compounded if an official complaint is made. Most complaints about HCPs (again, doctors in particular) result from issues related to communication not clinical competency.5

Patients want HCPs who are equally skilful in diagnosing and treating their condition, as well as being able to communicate effectively.3

Active listening

Strong communication facilitates accurate diagnosis, fosters appropriate counsel and provides clear instruction, while good interpersonal skills with a focus on active listening helps to build relationships.

Active listening is key to being able to uncover and understand the chief concern of the patient. It is vital that patients are given the room to speak and describe their symptoms and feelings in their own words,6 without interruption or the ‘over-medicalisation’ of their language. This is no mean feat when the clock is ticking and there is a waiting room – virtual or otherwise – full of people.

In the relatively new world of remote consultations, there is even greater need for HCPs to listen intently to what is being said given the absence of clear non-verbal cues.

This provides industry with an opportunity to support HCPs to improve the quality of the consultation, irrespective of setting, and patient outcomes and experience. Quick, accessible materials that provide information on how to adapt current skills in a remote world and the opportunity to acquire new skills, which would help close the gap on the perceived quality of consultation, are needed now more than ever.

Checklist

There are some simple steps that can be taken to improve HCP-patient dialogue:

  • Listening
    • Not only should this be active, but it also requires HCPs to put aside their scepticism that the patient’s own words being a poor reflection of the current situation6
  • Resist interruption
    • It is crucial that patients are given room to speak (in their own words). Often the chief concern may not be the one that they are presenting with – they need time to feel comfortable to address what is really worrying them. If they are interrupted, they may never get the opportunity to voice this concern
    • HCPs should not be tempted to jump ahead but listen in full to what is being said
  • Clarity
    • Simple language delivered with empathy is vital but must strike a balance between managing fear and managing expectation
    • Literacy levels – it is important to understand the parameters of each patient’s understanding (average literacy in the UK, for instance, is 14 years-old) and how fear and being overwhelmed will likely reduce how much of the message they take away with them
  • Ask questions – what have they truly understood from the information they have been given
  • Provide supporting information; printed, Braille, web links, local community groups, helpline numbers.

The time to harness the opportunities that have arisen is now.

The art of active listening is one of a series of articles focused on how companies can make the most of these opportunities, exploring how communication between industry and HCPs, and between HCPs and their patients can be taken to the next level to improve patient outcomes.

Other topics covered:

  • A new role for industry in ensuring greater levels of patient concordance
  • Understanding behaviour change: the why, not the how
  • How the HCP-patient relationship impacts concordance
  • Patient experience: the role of active listening and the illness narrative
  • Patient empowerment: the role of self-care and shared decision making
  • How technology is aiding patient concordance
  • How HCP appetite for remote engagement demands that industry embraces technology.

To find out more and to download other articles in the series visit pageandpage.uk.com/media_lab

Clare Bates is deputy managing director of Page & Page

References

  1. Picker N, Coulter A (2007) Is the NHS becoming more patient-centred? Trends from the national surveys of NHS patients in England.

    https://www.yearofcare.co.uk/sites/default/files/pdfs/99_Trends_2007_final[1].pdf [Accessed May 18, 2020]

  2. Ridd M, Shaw A, Lewis G, Salisbury C (2009) The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.Br J Gen Pract59:e116-e133
  3. DiMatteo MR. The role of the physician in the emerging health care environment.West J Med. 1998;168(5):328-333.
  4. Ha JF and Longnecker N. Doctor–Patient communication: A review.The Ochsner Journal 2010, 10:38-43.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/pdf/i1524-5012-10-1-38.pdf

    [Accessed May 17, 2020]

  5. Tongue JR, Epps HR, Forese LL. Communication skills for patient-centred care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients.J Bone Joint Surg Am. 2005;87:652-658.
  6. Hyden LC. Illness and narrative.Sociology of Health & Illness1997;19(1):48-99.