I’m always fascinated by the different methods hospitals and health systems have in place to get information from one clinician to another. I’ve seen everything from NASA-level flow charts to third-party call centers to systems that seem like a step away from carrier pigeons. Effective clinician-to-clinician communication is essential to nearly every initiative a hospital has on its plate these days – meeting new regulations, driving new quality initiatives, moving to new models of care, etc. – but it’s often an afterthought, or as I’ve seen all too often, completely overlooked. Here’s my take on what every hospital exec needs to know when struggling with this issue:
1) Communications technology is useless without considering the process it must enable – Many hospitals and health systems still see technology as the end-all be-all for fixing what ails them. This is one of the reasons why we see so many point solutions trying to solve problems. But without an understanding of the complex processes between clinicians both inside and outside the walls of the hospital, there’s no technology solution that will improve efficiency. It’s not about smartphones or text messaging or pager replacement software, but about the process of who needs to talk with whom and when – and what changes need to be made in the current workflow to make that happen in a reliable way. With all the competing priorities hospitals are facing today, many don’t even understand their current workflows – and certainly don’t know what it should or could be. But sticking technology into a flawed workflow will only lead to an automated, flawed workflow. So hospitals need to identify the current state and the needs and concerns of clinicians, make improvements to processes as necessary, and then apply technology to the new and improved workflow. Only with an understanding of the process will hospitals be ready to start thinking about and implementing a successful clinical communications strategy.
2) Think beyond the text – I’ve seen a lot of confusion in the marketplace around text messaging and what the HIPPA regulations says about it; and quite frankly, the law doesn’t say anything. There’s nothing in the HIPPA regulations that states clinicians cannot send text messages. What the regs do say is that organizations must assess their risks around transporting and protecting patient information in all electronic forms and establish policies they can defend to protect that information. When we think of text messaging, our concept is most often one or two clinicians using smartphone devices to carry on an interactive conversation. However, every day in every hospital there is a huge volume of one-way text messaging as nurses speak with call center and answering service operators to contact physicians. Not to mention the Web messages nurses sometimes create from the wireless carrier Web sites – which most often end up as SMS texts and alpha pages on unsecure devices. And we haven’t even considered the voice messaging that occurs. So when it comes to communications, we need to shift our focus beyond text messaging to include ALL clinical communications in our concept. We need to be thinking about the risks, how to best manage that risk and how that plays into the entire communications process in our organizations – whether text, voice, Web, e-mail or phone.
3) Nurses and physicians are key to communications evolution – When hospitals try to fix failing communication systems, it’s really more about change management than technology adoption. Clinical leaders need to be aware of and bought into the clinical and business results they need to drive – from a quality, operational improvement or efficiency standpoint. While IT certainly needs to play a role, no one is closer to the “real” flow of communication than the physicians and nurses who are interacting with each day about their patients. They need to know their role in achieving those results and the benefit to them if they participate in driving that change.
I’ve seen too many clinical communication initiatives that are a house of cards – one soft breeze and the whole process falls to pieces. Now more than ever, hospitals and health systems need to take a step back and implement a solid communications strategy that evolves processes between clinicians as the industry moves to more collaborative, efficient and better care.