Best Practices for Improving Patient-Provider Communication

Consider patient health literacy

Foundational to any patient-provider communication strategy is patient health literacy, or the extent to which patients understand and can use healthcare information. Patient health literacy can be divided into two segments, according to Healthy People 2030:

• 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.

There are some screenings healthcare providers can use to assess patient health literacy levels. In turn, providers can help patients grow in their health literacy levels. Right now, the Department of Health and Human Services says only 12 percent of Americans have proficient health literacy levels.

But health literacy should be top-of-mind even when clinicians do not know the specific level of their patient or when clinicians are addressing a group of patients. Most experts recommend patient education and other healthcare messaging materials be available at a 5th or 8th-grade reading level and in multiple languages other than English.

Relatedly, healthcare organizations should consider how to manage language barriers. When patients speak a language that is not English and their provider does not speak their language, it can harm the quality of patient-provider communication. In some cases, that can lead to poorer outcomes and quality of life.

Healthcare organizations may consider hiring a more diverse staff to decrease the odds of language discordance. Still, it may not be possible for organizations to always match patients with a provider who speaks their language. In those cases, it is important for organizations to have English language interpreters on staff.

Leverage patient engagement technology

Healthcare is increasingly defined by the technologies that help facilitate it, and that includes patient engagement technology. In addition to helping patients self-manage their illnesses, these tools can help remotely connect the patient and provider, mostly by way of secure direct messaging in the patient portal.

Direct messaging in the patient portal lets patients ask their providers questions, whether it be a therapeutic clarification after an in-person encounter or advice on a new set of mild symptoms that come up. This tool can also be useful for flagging major irregularities that require in-person treatment.

But despite those possibilities, the fact remains that provider inboxes are full. To ensure a good patient-provider relationship and to continue seeing the benefits of secure direct messaging, providers may consider outlining patient portal inbox expectations.

Those expectations may include:

• What types of questions are best for the patient portal
• How long it may take the clinician to answer the message
• Whether the message will be triaged to another clinician

Technology also helps practice managers keep in touch with patients. While some patients may still want a phone call to remind them about an upcoming appointment, many offices have integrated patient outreach technology that helps streamline this effort.

These tools can sift through patient records and pull up folks due for preventive screening, vaccination, or well visits and push out an automated SMS text message prompting the patient to book an appointment.

Experts have cautioned a few caveats with these patient outreach tools, noting that it is possible to send too many messages. Offices also need to remain flexible, as some patients prefer to call for an appointment.

Be mindful of open clinical notes

Part and parcel with the patient portal are the open clinical notes many patients can view within them. Mandated as part of the 21st Century Cures Act, open clinical notes are now viewable by all patients.

There are a lot of benefits to open clinical notes, ranging from more informed patient-provider conversations during in-person visits to flagging medical errors to better medication adherence.

Open clinical notes themselves are a form of patient-provider communication, and providers need to write them knowing that the patient is part of the target audience for notes. Studies have shown that notes with too much medical jargon have the potential to confuse patients.

2021 data published just around the Cures Act rule implementation found that there are some layperson words that could also be off-putting to patients. Words like “incorrect,” “obese,” “wrong,” “anxious,” “depressed,” “inaccurate,” or “elderly” came up fairly frequently as unfavorable to patients.

The researchers stressed that these are words that might be rude to use in any context, so avoiding them should not add much undue burden.

Practice “soft” communication skills

“Soft” communication skills, such as empathy, active listening, and other non-verbal cues, are equally as important as the information being communicated. These factors can sway how well patients perceive they are being cared for and can make all the difference to the patient experience.

After all, patients consistently say they want to feel like their needs are being taken seriously and that their providers truly listen to them.

In a 2022 report from Ipsos and The Beryl Institute, six in 10 said patients they want to know that their healthcare needs are being taken seriously, and 52 percent said it’s important to be treated with dignity and respect. Around half (46 percent) emphasized that they want to be treated as human beings rather than a set of symptoms or a diagnosis.

Some studies have even found that empathy can be helpful in overcoming instances of healthcare discrimination. Particularly, researchers say providers who empathize with care access barriers and offer clear healthcare communication can help improve the patient experience.

Demonstrating empathy will require providers to lean on a set of non-verbal cues. Eye contact, sitting level with the patient, and making appropriate physical contact to comfort patients are a good start, most experts say.

It also means practicing cultural competency and humility. Cultural competency will help clinicians avoid allowing their implicit biases to taint their patient-provider interactions. Perhaps more importantly, cultural competency will allow providers to offer patient-centered care. Accounting for patient needs, preferences, and customs acknowledges patients as a part of the care team, which goes a long way in building empathic rapport.

Focus on patient education

The American Academy of Family Physicians (AAFP) defines patient education as “the process of influencing patient behavior and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health.”

Patient education is a critical form of patient-provider communication because it equips patients with the information necessary to engage in their own healthcare. For example, patient education is important for a patient being discharged from the hospital to their home so they can fully recover and avoid rehospitalization. Patient education is also important for chronic disease self-management and public health.

Healthcare providers need to prepare for patient education by assessing a patient’s current skill or knowledge level, health literacy level, and personal healthcare goals, AAFP advises. Providers may also tailor patient education based on certain public health needs or new diagnoses.

Using patient education tools, which can come both on paper or via the patient portal or EHR, healthcare providers can supplement the messages they have already given to patients.

Patient education would be incomplete without patient teach-back, or the practice of ensuring patients understood the medical information. Healthcare providers should ask patients to repeat information in their own words so providers can determine whether the patient truly understood.

Focus on shared decision-making

Shared decision-making is a communication strategy that lets the patient engage in a healthcare decision. Providers must first outline treatment options, the costs of each, and the pros and cons of each. From there, patients can consider these options and their health-related goals and needs to form an informed decision.

Some healthcare providers leverage decision aids, which are either digital or paper tools that support the patient education necessary for shared decision-making. These aids should consider patient health literacy levels, just as any provider communication should.

Shared decision-making can have many benefits, including increasing patient access to preventive screenings. Some studies have shown that when patients are a part of the care access decision, they are more likely to access a cancer screening.

Similar trends have been observed in medication adherence; because the patient is a part of the choice to begin treatment with a certain drug, they are more likely to stick to taking the drug.

Notably, discussion of cost needs to be a part of shared decision-making. The most effective treatment is the one the patient will be able to afford and realistically access. Disclosing a high price tag during shared decision-making could sway the patient's decision, giving the patient and clinician the time needed to explore other options.

Time management

Of course, all of this is easier said than done in a job that’s characterized by quick turnaround times. Although the amount of time a clinician spends with patients in the outpatient setting has increased since the 1970s, many providers say it’s still not enough.

2022 data from the Physicians Foundation showed that most doctors don’t have enough time to get to the meat of things with patients, including their social determinants of health and health-related social needs. Other providers have said they don’t do shared decision-making because they don’t think they have enough time.

Although some researchers have provided evidence that certain patient-provider communication strategies don’t add much time to the clinical encounter, the reality is that clinicians are stressed, and burnout levels are high.

Healthcare organizations may reconsider how they build out provider schedules to ensure clinicians are able to spend enough time with patients to have meaningful discussions during the care encounter.

For the provider, assessing different time management techniques may also be fruitful. Using the patient portal to plan an appointment agenda could help patients and providers both prioritize discussion areas for that day’s appointment. Tools like worksheets that list out frequently asked questions and help patients prioritize discussion areas may also help manage time.

Patient-provider communication via telehealth

As virtual care technologies take hold, healthcare providers have had to adopt a new set of communication skills fit for telehealth encounters. After all, providers still need to build rapport, show empathy, and clearly communicate concepts all through a computer screen.

Since telehealth’s insurgence around 2020, some healthcare providers have picked up best practices to make sure they are still creating a good patient experience, even over digital technology.

Some strategies include ensuring clinicians look into the camera, not at the screen, to maintain eye contact. Dressing appropriately, even if they are taking telehealth appointments from the comfort of one’s home, is also a key strategy for conveying professionalism.

Healthcare organizations and their IT departments can also take matters into their own hands. EHR and telehealth integration can make it easier for healthcare providers to document during the clinical encounter. Providers will not have to change screens, which could increase their focus on the patient.

Telehealth integration with the patient portal may also make it easier for patients to get to the telehealth appointment, which could improve the overall experience.