Cultural Communicaons Sophia Bourne BMA Learning & …cl-assets.public-i.tv/bmawebinar/document/Cultural... · 2016-05-13 · Empathy Reassurance Pa3ent-centred ques3oning Friendly,

©British Medical Association

CulturalCommunica-onsSophiaBourneBMALearning&Development


Plan

The dynamics of communica3on

The context of your communica3ons

Understanding challenges and barriers to effec3ve communica3on

Exploring cultural communica3on

Developing sensi3vity and skills for cultural communica3on


Your needs and expecta3ons…

Which scenarios do you find the hardest to manage

What do you need help with?

Your communica3ons successes!


The dynamics of communica3on


“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel” Maya Angelou


What happens when we communicate?

Based on Clark (1996) Using language.

Person 1 Background

Common ground

Person 2

“Mental

Representation” (ideas, perceptions,

assumptions)


How does the model we have just discussed apply to communica3on with…? Older pa3ents

Teenagers

Non-na3ve English speakers

Senior colleagues

Junior colleagues

Others?


Non-Verbal Communica3on


Body Language


The context of your communica3ons


Good Medical Prac3ce (2013) - Domain 3: Communica3on, partnership and teamwork

31. You must listen to pa3ents, take account of their views, and respond honestly to their ques3ons.

32. You must give pa3ents* the informa3on they want or need to know in a way they can understand. You should make sure that arrangements are made, wherever possible, to meet pa3ents’ language and communica3on needs.15

33. You must be considerate to those close to the pa3ent and be sensi3ve and responsive in giving them informa3on and support.

34. When you are on duty you must be readily accessible to pa3ents and colleagues seeking informa3on, advice or support.


GMC’s “Leadership and management for all doctors” (2012)

1. 10. Mul3disciplinary teams can bring benefits to pa3ent care when communica3on is 3mely and relevant, but problems can arise when communica3on is poor or responsibili3es are unclear.

Alldoctors1. 11. You must make sure that you communicate relevant informa3on clearly to:

1.  a. colleagues in your team 2.  b. colleagues in other services with which you work 3.  c. pa3ents and those close to them in a way that they can understand,

including who to contact if they have ques3ons or concerns. This is par3cularly important when pa3ent care is shared between teams.


Enhancing your awareness of..

-  Impact you have on others -  Diversity -  Expectations – yours and theirs -  Doctor-Patient relationship -  Environment in which you are working -  Your Non-Verbal Communication


Communica3on Skills - E4 model

Find

Fix

Biomedical tasks

Keller & Carroll (1994) Patient Education & Counseling

13 May 2016


Communica3on Skills E4 model

Engage

Empathise

Educate

Enlist

Find

Fix

Biomedical tasks

Communication tasks

Keller & Carroll (1994) Patient Education & Counseling

13 May 2016


E4 Model - Communica3on tasks

Engage Making sure you engage with the pa3ent Making sure the pa3ent is engaged with you

Empathise Making sure you are looking for emo3onal signals Making sure you are giving appropriate emo3onal signals

Educate Making sure you understand the pa3ent’s posi3on Making sure the pa3ent understands your posi3on

Enlist Making sure the pa3ent is ready to take responsibility Making sure the pa3ent is willing to follow advice

13 May 2016 16


Challenges and barriers to effec3ve communica3on


Barriers to effec3ve communica3on: Personal

Language

Lack of understanding/skill

Lack of confidence/experience

Cultural differences and misinterpreta3ons

Assump3ons: judgement/prejudice/stereotyping

Emo3on

Expecta3on

Power imbalance

Undervaluing importance of communica3on


Barriers to effec3ve communica3on: Organisa3onal

Environment

Noise

Interrup3ons

Targets/maintaining throughput

Time

Pressure

Pa3ent communica3on difficul3es

Other factors beyond Doctor’s control


Challenges in Communica3ng

EmergencyRoomCubicle

-  Impersonal

-  Rela3ve lack of privacy

-  Prominent medical equipment

-  Doctor standing with pa3ent siing on a trolley or lying down

-  Environment designed to do the task at hand, par3cularly the physical examina3on and procedures

PrivateConsul-ngRoom-  Rela3vely comfortable & relaxed

-  Personalised with doctor’s effects

-  Doctor & pa3ent sit together

-  Environment designed to encourage trust, confidence and facilita3ve talking


Factors affec3ng listening

Human performance limitations Communica3ons training, fa3gue, emo3onal discomfort

Patient health literacy Over/under/misinformed, resistance

Authority gradient effects Role beliefs, exper3se beliefs, ownership

Peer-to-peer communication barriers Personality, jargon, cultural differences, structures

Patient centred practice Alen3ve listening, 3me limita3ons, targets

Denham et al. (2008) J Patient Safety Ha & Longnecker (2010) The Ochsner Journal

Kushnir et al. (2011) Family Practice


Know your triggers

Time pressure

Status/respect

Level of exper3se

Preparedness

Perceived relevance Comfort zone

Situa3on pressure

& others’ triggers?

Fairness

Security

?


Exploring cultural communica3on



Mental programming

Humannature

Culture

Personality

Universal Inherited

Specifictogrouporcategory

Learned

Inheritedandlearned

Specifictoindividual

Hofstede (2004) Cultures and Organizations: Software of the Mind


What is culture?

“the way of life, especially the general customs and beliefs, of a par3cular groupofpeople at a par3cular 3me”

- Cambridge Dic3onaries online

“Broadly, social heritage of a group (organized community or society). It is a paGern of responses discovered, developed, or invented during the group's history of handling problems which arise from interac3ons among its members, and between them and their environment. These responses are considered thecorrectway to perceive, feel, think, and act, and are passed on to the new members through immersion and teaching. Culturedetermineswhatisacceptableorunacceptable,importantorunimportant,rightorwrong,workableorunworkable.”

- BusinessDic3onary.com


Communica3on differences: personality What do we prefer, what do others prefer?

Focusandenergy‘Let’s talk it over’

Takingininforma-on‘What are the details?’

Decision-making‘What are the logical implica3ons?’

Dealingwiththeworld‘Let’s get this completed’

• ‘I’ll think it through’

• ‘What’s the big picture?’

• ‘What’s my reac3on and how will others react?’

• ‘Let’s leave our op3ons open’

Informed by MBTI – Myers Briggs Type Indicator


Developing sensi3vity & skills for cultural communica3on


Listen to the pa,ent, he is telling you the diagnosis

(Sir William Ostler, 1904)


Listening (and learning)

Understanding

Interpreting

Influencing

GoodCommunica-onSkills


Responding Skills

1.  Alending

2.  Following

3.  Ques3oning

4.  Reflec3ng

5.  Advanced responding skills


Avoiding unhelpful language

Compulsion — should, ought, must

Barrier — can’t, impossible, hopeless

Generalisa3on — always, never

Labelling — unfair, stupid, obstruc,ve, etc.

Discriminatory – stereotyping, excluding, patronising, offensive


When verbal communica3on is difficult...

-  Small amounts of informa3on

-  One subject at a 3me

-  Avoid jargon/acronyms

-  Clarify and check understanding

-  Signpost

-  Use diagrams and write things down

(From P. Washer. 2009)


Non-verbal communica3on: Conveying competence and warmth

UprightEyecontactSmileOpen

DominantGlaringPowerposturing

HunchedEyesavertedSeriousDefensive


Pa3ent-centred behaviours (from GP study)

VerbalEmpathy

Reassurance

Pa3ent-centred ques3oning

Friendly, courteous

Explain

Reinforce

Summarise

Clarify

“Good communica3on skills: benefits for doctors and pa3ents”, S.Hawken,

2005

Non-verbalNodding

Lean forward

Orientate body directly

Uncross legs/arms

Arm symmetry

Less mutual gaze


SBAR Tool – Colleagues

SBAR

Situa3on

Background

Assessment

Recommenda3on


RESPECT

Respect – verbal and non-verbal alen3on

Explanatorymodel– ask-tell-ask

Socialcontext– non-clinical factors

Power – explicit empowerment

Empathy– valida3ng emo3ons

Concerns– elici3ng worries (no stupid ques3ons)

Therapeu-crela-onship – building not assuming

Mostow et al. (2010) J Gen Intern Med


Thank you!

Documents

Cultural Communicaons Sophia Bourne BMA Learning & …cl-assets.public-i.tv/bmawebinar/document/Cultural... · 2016-05-13 · Empathy Reassurance Pa3ent-centred ques3oning Friendly,