Sometimes Silence Isn’t Golden: Improving Patient Engagement by Encouraging Openness

by Burl Stamp

Like most of our experiences in life, the patients and families we remember best are the ones whose satisfaction with our care falls at the extremes.  On one hand, the family that is effusive in their praise is one everyone likes to remember.  At the other extreme, we can’t forget the families who are disappointed and seem to be critical of virtually everything we do.  Even months after they’ve left the hospital, the experience of dealing with them is indelibly burned in our memory.

While the families at the extremes of the satisfaction scale may be most memorable, the majority of the patients we care for likely fall somewhere in the middle.  These are the families that come and go rather quietly, neither sharing significant praise nor criticism.  By their silence, they appear satisfied with their care, so we may not feel the need to spend as much time with them.

Patient Rounding

But families who quietly go through their hospital stays have expectations that can be just as high as more verbal families.  Communication with these less noticeable patients may seem easier during their stay, but in actuality they present some of our most significant communication challenges.  Paying close attention to the way we communicate with the “silent majority” can be just as important as how we deal with openly critical families.

Communicating well with more reserved patients and families can pay dividends not just in their own level of satisfaction, but also in the outcome of their care.  Patients sometimes detect and feel things that even the most sophisticated technology or advanced diagnostic test can’t reveal.  But we can only benefit from this “unscientific” insight if we encourage open, frank, compassionate communication.

Communicating well with more reserved patients and families can pay dividends not just in their own level of satisfaction, but also in the outcome of their care.

Following are several ideas for fostering more productive, positive interactions with patients and families who may, for a variety of reasons, be reluctant communicators.

Recognize the Quiet, Reserved Patient as a Communication Challenge

By definition, we usually label and think about patients who are “communication challenges” as those who push back, criticize and openly complain.  So the first important step in communicating better with more reserved families is to acknowledge that they present challenges that can be just as daunting.  Knowing that we will have to adeptly apply all aspects of C.A.R.E., the model we’ve developed to improve communication effectiveness among healthcare professionals, can help us focus on approaches that will improve interactions with these patients.

Start Strong with “C” (compose)

Individuals who are reluctant to open up can see our lack of focus as even more reason to shut down.  Our distractions may cause the patient or family members to be reluctant to bother us since we appear so busy.  Or even worse, if we don’t appear to care enough to stay focused on what they have to say, why should they take the time to share more information?  While the “compose” step is important in any communication situation, it is especially critical when talking with individuals who would rather stay quiet and not share what is on their mind. Entering conversations in a “composed” state clearly communicates we care.

Use Active Listening to Elicit Key Information and Feelings

The quiet, reserved individual will test the active listening skills of even the most skilled communicator.  In these situations, we have to “listen” with more than just our ears; watch for non-verbal signals that the patient or family is confused, fearful, angry – or experiencing a variety of other emotions that may be at the heart of their quiet demeanor.  Don’t be afraid to sensitively ask questions.  But also don’t go so far that it seems you are trying to pry information or feelings out of them that they may not be ready to share.

Build Rapport and Trust to Open Communication

Sometimes, opening the lines of communication with someone who is reluctant to share simply takes time.  Of course, with today’s shorter lengths of stay, our window for establishing rapport and trust with families has been dramatically reduced.  The sooner you can identify some common ground – even if it seems to be on a trivial topic – the better chance you’ll have to get family members to share more important facts and feelings during the stay.

Consistently Evaluate How Communication is Going

Stepping back and objectively evaluating how communication is progressing with individuals who are more reluctant to open up is particularly important.  Again, remember that it may take some time for reserved patients or family members to feel comfortable sharing information. Considerately asking what else they need, how they are feeling and whether there is anything else we can do to help can make them more receptive to opening up.

To best meet the needs of all patients and families, remember that the “silent majority” may not always be as satisfied with their care as we might hope.  Working to open the lines of communication with all families – even those who are most reluctant to share – can help ensure all patients leave feeling they have received the very best care possible.

Stamp & Chase offers unexpected solutions to universal challenges facing leading healthcare organizations. To learn more about our robust tools and approaches that help healthcare leaders transform patient and staff engagement, visit Stamp & Chase.

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