The Institute for Healthcare Excellence President and CEO William J. Maples M.D. Co-Founds National Taskforce for Humanity in Healthcare

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Effective communication skills can help you bring awareness, advance care planning to patients

National Healthcare Decisions Day is April 16.

As a caregiver, have you ever encountered patients and families who have thoughtfully considered advance care planning? Most people don’t think about it – until it’s too late. It’s a conversation that might come up when families find themselves around a bed in an intensive care unit, not the kitchen table.

How do you encourage someone to make their wishes known? How do you start the conversation with patients about advance care planning?

The skills taught by The Institute for Healthcare Excellence can help get the conversation started and open the door to gently empower patients to think about their choices and make them known. In addition to contributing to patients’ peace of mind, you might contribute to your own, knowing that you’ve spurred communication between family members in your care.

Practicing the skills of respect, empathy, legitimization, trust and openness can help you offer the support your patients need to make decisions about their care.

“Good reflective listening and offering an empathetic ear can encourage patients to share their wishes and then discuss them with their loved ones,” Linda Scaz, RN, PhD, FCN, says. Dr. Scaz is a member of the faculty at The Institute for Healthcare Excellence and has served as a Senior Director of Clinical Care and Operations at Haven Hospice of Northeast Florida.

“It’s important to be mindful of where people are in their discussion of their current healthcare needs, and use effective communication skills to foster openness,” Dr. Scaz adds.

While it’s not an easy conversation, Dr. Scaz points out that with the right words, even reluctant patients might return to their healthcare provider to continue the discussion. You can be ready to gently open the door for them to start documenting their choices freely and without judgment.

“Effective communication skills are key to helping others express their wishes, help their families honor them, and help your patients be comfortable physically, emotionally and spiritually,” Dr. Scaz says.

Learn more about effective communications in healthcare.  |  See Dr. Scaz’s bio.


It’s important to review advance care plans whenever there is change in decade, death of a loved one, divorce, a new diagnosis or a decline in health. Honoring Choices calls these the “Five Ds.”

Building trust in healthcare teams

Delivering healthcare efficiently depends on trusted relationships between patients and their clinicians. As doctors, nurses and caregivers move to enhance the experience for their patients, their first challenge is often building trust within their teams.

“The foundation of trust within teams is in the relationships we build,” says Sandra Argenio, M.D., faculty member at The Institute for Healthcare Excellence, and a retired family physician at Mayo Clinic Florida.

Relationships, in turn, are built on effective communication. “Most people we encounter in healthcare want to improve their communications skills, and they answer positively to our question of whether they feel they can improve.”

“People who participate in The Institute for Healthcare Excellence courses plan to use their new skills immediately,” Dr. Argenio says. “They tell us that they’ve already tried and tested the skills at work and at home the next day after they’ve learned them with us.”

Dr. Argenio shares these skills to help build relationships that foster trust in teams: Presence, listening, check-in, gratitude.

“The skills are presented in an experiential, interactive manner,” Dr. Argenio explains. “It makes learning by doing easy and fun. It also shows that anyone can learn something new and add skills to their portfolio.”

Dr. Argenio will expand on ways to build trust during her presentation at the Excellence in Healthcare Conference in Charleston, May 20-22. Come and learn valuable skills that you can take back to your team the next day.

Why communication is a patient safety issue

Effective and efficient communication can help create a culture of excellence which in turn delivers value for patients, families, and fellow caregivers.  This value enhances outcomes, safety, and efficiency of care. It also helps patients go home with a plan to restore health and lessen the chances of repeat visits and hospital readmissions.

A study at the University of California, San Francisco, found more than a quarter of hospital readmissions could be avoided with better communication among healthcare teams and between providers and patients.

“A culture of safety is dependent upon moment to moment conversations between caregivers and patients,” says William Maples, MD, CEO of The Institute for Healthcare Excellence.

“How we communicate helps define the culture we create – and clearly drives teamwork. It helps us have meaningful conversations and connect in a way that creates a positive emotional tone.”

There are several indicators that communication is having a positive impact on safety:

  • Effective communication improves perception of teamwork, which is at the heart of safety
  • Effective communication allows for the ability to give authentic and constructive feedback necessary to create a learning environment and safety culture
  • Effective communication can foster psychological safety and promote a willingness to speak up in constructive ways
  • Effective communication promotes teamwork across teams

It’s important to nurture the communication skills to enable the best possible conversations.

“First, are we having the conversations at all, and if we are, are we creating a respectful, considerate, trusting environment,” Dr. Maples asks.

The ability to give open and honest feedback, and to not feel like you’re being criticized or punished in the process of giving feedback is key to creating a safe and trusting learning environment.

“When we don’t have the tools to know how to speak up, it can actually be a detriment for a team that’s attempting to develop a culture of safety,” Dr. Maples says.

Another key element is support from the top. When management views creating a culture of safety as a priority and supports this message, it will help move the culture in a positive direction. And when management’s actions match the message, and are transparent, it catalyzes cultural transformation.

There are three things that can help healthcare organizations develop a culture of safety:

  1. Develop effective communication skills. Skill development cannot be over-emphasized. “We think people come to the table with communication skills, and they may, but we tend to suppress them as we go through our medical career,” Dr. Maples says.
  2. Create a common language and common expectations across the entire healthcare team. Once you provide the skills, organizations can hold caregivers accountable for demonstrating the skills, and provide constructive feedback when a caregiver is not demonstrating the skills in a healthy and respectful way. This can be achieved when a common language and common expectations are provided.
  3. Demonstrate commitment from leadership. Management’s actions should follow words. Leadership will provide the support to hold each other accountable, and the necessary resources to move forward.

The cascade effect
When communication is efficient and effective, the patient and family experience an increase in value of care. By the same token, the bedside caregivers, including the physician and the nurse benefit from creating a team-based and trusting environment.

“Everybody goes home with the sense of ‘we’re on the same team.’ This invokes a sense of appreciation and creates positive emotions which foster engagement and safety for the entire team – with the patient at the center of the team.” It’s a win for everyone involved.

Join Dr. Maples at The Institute for Healthcare Excellence’s Regional Summit in San Diego, Monday, April 30, 2018. Expand your knowledge of effective communication in healthcare.