Interdepartmental Communication in Respect to Work Place

Safety in Trauma Situations

A Dissertation Presented in Partial Fulfillment of the

Requirements for the Degree of

Doctor of Business Administration, Management

By

Nicole T. Walton-Trujillo, R.T. (R) (CT), ASRT, ARRT, BSRS, NMSRT, MBAH, MOL

Colorado Technical University

September 15, 2019

Committee

[Research Supervisor name], [Degree], Chair

[Committee Name], [Degree], Committee Member

[Committee Name], [Degree], Committee Member

_________________________________

Date Approved

© Nicole T. Walton-Trujillo, 2019

Abstract

This study was exploring on the communication level between departments in clinical medicine on patients that are potentially violent while being treated by clinicians in an emergency health center in various departments. The study tried to address the ways through which the communication techniques can be improved between the various medical center departments concerning workplace safety in trauma situations. The researcher examined 20 emergency room nurses as well as health providers within the Presbyterian Healthcare Systems in New Mexico and University Medical Center of Nevada Health System. The conceptual framework utilized in the study started with the patient experience and how the clinicians directly connected with the patients in understanding the trauma situations and how they affect the healthcare environment. The concept utilized is the change management that allows for effective changes which might occur within the healthcare community. The data collection process mainly involved interviews with the 20 participants. The process started with the creation of lists of prospective research subjects. Interviews will be conducted on each subject with the same preset list of questions. The qualitative research will have numerous recordings, notes, and transcripts that will be up for statistical analysis. The data analysis process will involve reading through all of the collected research, listening to all available recordings from the one on one interviews, and organizing the research into common themes. All the aspects of the information gathered will be reviewed based on common themes that cannot be changed throughout a shared experience and the common themes will be organized and coded into sections that will keep the information objective. The research findings indicated that improved communication between departments in critical care medicine create a safer environment for the clinician.

Keywords: Change Management, Patient, Clinician, Provider, Communication

Dedication

Add a Dedication, if desired.

Acknowledgements

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Table of Contents

AcknowledgementsivTable of ContentsvList of TablesixList of FiguresxChapter One1Topic Overview/Background1Problem Statement2Purpose Statement2Research Question3Hypotheses/Propositions3Theoretical Perspectives/Conceptual Framework4Assumptions/Biases4Significance of the Study5Delimitations5Limitations5Definition of Terms6General Overview of the Research Design5Summary of Chapter One7Organization of Dissertation (or Proposal)7Chapter Two9Patient Experience9Proof it Happens14Communication18Management28 Change Management33Conceptual Framework38Summary of Literature Review39Chapter Three41Research Tradition41Research Question41Hypotheses (Quantitative Study Only)42Research Design42Population and Sample42Sampling Procedure43Instrumentation44Validity45Reliability45Data Collection45Data Analysis47Ethical Considerations48Summary of Chapter Three48Chapter Four*Participant Demographics (if appropriate)*Presentation of the Data*Presentation and Discussion of Findings*Summary of Chapter Four*Chapter Five*Findings and Conclusions*Limitations of the Study*Implications for Practice*Implications of Study and Recommendations for Future Research*Conclusion*References49Appendix A58Appendix B*Appendix C*

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Chapter ONE

Communication between departments is an ever-changing work process. Managing the communication between departments is what creates the most everlasting change across the healthcare environment. The main issue that will be reviewed across this work is the idea that workplace trauma occurs to clinicians every day in the healthcare environment. How the communication about potential dangers to the staff in the clinical environment will be addressed as well as potential effective changes that could increase the mental and physical well-being to the clinician. There is very little communication when there is a violent patient or potentially violent patient being treated by clinicians across multiple departments in emergency medicine. The overriding research question is as follows: How to increase interdepartmental communication in respect to work place safety in trauma situations.

Topic Overview/Background

Within the current body of knowledge; the reaction and long-lasting effects of work place trauma, the current process for communication between departments, as well as how change management can be applied to creating long lasting change. It is known that these issues exist in medicine today and that to increase the health and safety of the population; changing the way departments communicate is key.

When an engaged department is communicating effectively this creates an environment that is safer for the staff which decreases work place trauma and thus reduces workman’s compensation claims. A happier and safer department creates teams that provider better patient care, this increases patient care scores and that creates better revenue from Medicaid and Medicare plans (Rajpal, Peruchi, & Sawhney, 2013).

Problem Statement

The problem to be addressed in the proposed study is there is very little communication when there is a violent patient or potentially violent patient being treated by clinicians across multiple departments in emergency medicine. There is a documented history over the last five years of clinical experiences of work place trauma (Gillespie, Gates, Miller, & Howard, 2010). There is a current lack of interdepartmental communication that exists within the clinical environment (Wolf, Delao, & Perhats, 2014).

On the national level, there is a prevalence of post-traumatic stress disorder that arrives from the exposure to traumatic events such as workplace traumas and assaults by patients to health care providers and other first responders. This causes a loss of productivity and unfortunately the worst thing we can experience which is freezing up at work. Time is the enemy in trauma situations, and any delay can be detrimental to the care of our patients and communities (DeLorme, 2014).

When looking at the gap in the literature; the researcher can narrow it down to communication and then again to safety in the work place. Safety in the workplace is an important topic the researcher has been diligently researching. The researcher has personally been assaulted by a patient in the hospital and it affected the researcher’s future as well as the researcher’s education. There is not a lot of research done that has affected the front lines of trauma medicine in today’s clinical environment.

Communication in the medical field is critical to the continuity of care for the patients but also for the interdepartmental dependency of various departments. The proposed study will have the effect of creating a healthier environment by managing the communication between departments. This aligns with the doctorate of management degree currently being pursued at Colorado Technical Institute.

Purpose Statement

The goal of the research is to manage improved communication techniques between departments in respect to work place safety in trauma situations. The benefit to the medical community as well as to the patients is a more controlled and healthier environment for both the clinician and the patient within the healthcare environment. The work within the study that relates to managing change within and organization will be beneficial in all management areas.

The research that will be done is qualitative phenomenological research. The specific population that will be interviewed are clinicians in all aspects of medicine; from outpatient to inpatient, rural to urban environments across multiple states. There will be approximately 20 participants within the study.

Research Question

The research question for the study is as follows: How to increase interdepartmental communication in respect to work place safety in trauma situations? The specifics of the research question will keep a guiding path along the project.

Propositions

The proposition of the research in question are based on qualitative phenomenological research. The concepts in the literature review that make up the current body of knowledge are based on the overall lived experiences of the patients, healthcare providers, and leadership teams in healthcare environments today.

The research was started due to the lived experiences of the researcher while working in the acute emergency medicine hospital-based environment. The problem has been acknowledged and discussed in peer reviewed literature over the last five years and will be discussed with in the literature review. The current state of interdepartmental communication or lack thereof has led to many examples of trauma to clinicians.

Conceptual Framework

The conceptual framework within the study on interdepartmental communication starts with the patient experience. The patient and clinician experience directly connect to understanding how these trauma situations not only occur but how the effect the future work that occurs within the healthcare environment. The literature shows the current climate within the healthcare environment. Managing the communication between environments creates a stable and safe work environment. Using the concepts of change management allows for the effective changes that can occur within the healthcare community.

The theory under which the research falls is based on the Nascent theory where the qualitative approach usies a phenomenological style. This will allow the research to analyze the lived experiences of the research subjects (Kraus, Bakanas, Gursahani, & DuBois, 2014). Other research that has been done in the body of knowledge within the literature review are based on the lived experience of others as well as current work processes within the last five years.

Assumptions/Biases

The assumptions that are in place at the beginning of the study and during the initial interview process come from the researcher’s experience. The researcher experienced workplace trauma in the emergency medical environment. This was caused due to a lack of communication within departments. The assumption is that it occurs to everyone being interviewed and that it is the norm within medicine.

The biases that are in place at the beginning of the study are that there is not a current appropriate workplace policy that discusses communication between departments.

Both the assumptions and the biases will be managed within the framework of the study by not allowing the assumptions or biases to be exposed during the interview process. This will be done through the framework of the interview questions being neutral.

Significance of the Study

The study will be beneficial to all stakeholders within the healthcare environment. This includes patients, frontline clinicians, leadership teams, providers, executive teams, governing boards, as well as insurance providers. Globally this study, will help to create stability for patients and their quality of care. The study is unique in that although we can see the problem and its effects on others, there is not enough on how change can be managed in communication. The goal of progressive change to the work process will show how moving forward instead of maintaining the status quo; just because it has always been this way; does not allow for a safer and more clear level of communication for the clinician in the clinical care environment.

Delimitations

The boundaries of the study set by the researcher are current clinicians in nursing and imaging across inpatient, outpatient, rural, and urban medical environments. Indicates the boundaries of the study set by the researcher. This population has seen and have reported a measurable amount of experiences with these issues (Gillespie et al., 2010).

Limitations

The limitations of the study are in creating an environment that will allow for the research subjects to be transparent in their experiences. The memories of the research subjects are the key to clearly defining the current interdepartmental communication landscape in healthcare today. The memory variable is not one that the researcher will be able to control.

Definition of Terms

The key operational terms that are unique to the reader understanding the body of work within this study are as follows and are referenceable in Andreoli and Carpenter's Cecil Essentials of Medicine (Cecil Medicine) by Benjamin MD FACC FAHA, Ivor, Griggs MD FACP FAAN, Robert C., et al. | May 22, 2015:

Term: The term is clinician. This is a word that represents employees within the healthcare environment that provide care to patients.

Term: The term is provider. This is a word that represents Doctors within the healthcare environment.

Term: The term is order. This is a word that represents a request for a procedure to be done on a patient. An example is an order for labs such as bloodwork, or an x-ray such as a chest x-ray.

Term: The term is modality. This is a word that represents internal departments within the imaging or radiology department. An example is Computed Tomography or CT, MRI, Ultrasound or US.

Term: The term is portable. This is a word that represents a way of doing an imaging or lab procedure. A portable would involve bringing the imaging or lab testing equipment to the patient’s bedside on doing the study or procedure at the bedside.

General Overview of the Research Design

The overall goal of the research design is to asking pointed questions within a phenomenological qualitative interview. The same questions will be used regardless of the research subjects work history or clinical care environment. The research data will be analyzed and compared for continuity as well we opportunities for managing the communication needed to affect change.

Summary of Chapter One

The composition for the doctoral project is Interdepartmental Communication in Respect to Workplace Safety in Respect to Trauma Situations in Healthcare Facilities. The research question will be; “How to increase workplace safety in the midst of trauma situations in the healthcare environment concerning interdepartmental communications?” This topic will be reviewed in a multifaceted approach. The researcher will observe the current policies and practices in interdepartmental communication currently being practiced in hospital systems. The researcher will review the current histories of acute trauma situations aimed towards clinicians. The researcher will build thru research a hypothesis that will increase communications and workplace safety for clinicians in high-stress trauma situations.

Proposal for the Proposal submittal and Dissertation for the Final Manuscript

The final manuscript for the dissertation will be organized into 5 chapters as follows:

Chapter 1 - Chapter one discusses about the definition of the problem, significance of the study and the methodology.

Chapter 2 - Chapter two outlines the literature review. Further breaks down the topic into subtopics: Patient Experience, Proof it Happens, Communication, Management, Change Management.

Chapter 3 - Chapter three discuss about the methodology and research plan. This further breaks down the topic into subtopics: Research Tradition, Research Question, Research Design, Population and Sample, Sampling Procedure, Instrumentation, Validity, Reliability, Data Collection, and Data Analysis.

Chapter 4 - Chapter four outlines the results of the research on workplace trauma to clinicians and current communication processes.

Chapter 5 - Chapter five states the discussion and conclusions and recommendations for future research.

Chapter Two

There is very little communication when there is a violent patient or potentially violent patient being treated by clinicians across multiple departments in emergency medicine. The current climate between departments in the healthcare environment fosters communication but not to the extent that is needed for the overall safety of the clinicians in the clinical environment. To manage improved communication techniques between departments in respect to work place safety in trauma situations is the overall purpose of this body of work. Within the literature review the following areas will be reviewed: The patient experience, proof that work place trauma to clinicians happens, the current communication within departments in the clinical environment, how communication is currently managed, and the current climate of change management within the clinical environment. By the completion of the literature review we will see where there is a lack in the current body of knowledge that will allow us to find how to better manage interdepartmental communication in respect to work place safety in trauma situations.

Health and social care settings require that there is good communication between the staff and the service users. Health care professionals must acquire excellent and effective communication skills to communicate appropriately with service users. They should also learn to adopt professional communication techniques so that they provide a better and conducive health environment. This helps service users or patients to express their problems and facilitate their healing processes. Different forms of communication can be employed by the health care staff, such as verbal and non-verbal cues. These put them in a position to understanding the patient better and help in dealing with their health issues. Excellent communication skills are fundamentally crucial in providing adequate healthcare.

There are different approaches to communication that can be employed to help in the promotion of meaningful relationships between the care staff and service users or patients. Theories have been used to explain how communication impacts health care, and these theories include, humanistic, behavioral, cognitive, and psychoanalytic approaches. According to experts, these theories can help develop particular techniques in the health care sector and are, therefore, of great importance.

Apart from the approaches to health care, some challenges affect effective communication and result in negative consequences. Conversations in the hospital setting are affected by several factors that are universal for all types of communication. These challenges make communication challenging to comprehend between parties such as patients and caregivers. One of the parties may interpret the information given differently from the one mentioned. Communication in health care has been an essential issue for a long time now, and there is a need for health care providers to improve on the use of techniques so that there is ease in communication between patients and service providers.

Patient Experience

Communication in a work environment plays an integral part in the sense that it determines the success or failure of any process. In healthcare, particularly, in the emergence room, there need to be effective communication between medical practitioners and the patient to achieve the desired outcome. Previous cases that involved violent patients have inhibited effective communication, thus, hampering the efforts of medical practitioners to deliver the required due care. The point of contention that seems more of a dilemma to medical practitioners is that patients have a right to proper medication in all its forms (Hogerzeil, Samson, Casanovas, & Rahmani-Ocora, 2006). This is regardless of whether they turn out violent or cooperative. Violent patients are likely to subject clinicians to harm. Thus, there is need for obligatory protection.

A study pursued by Stuttaford, et al. (2014) aimed at establishing essential contributions towards the development of the concept and practice of the right to health in all its forms, exploring the right to traditional, complementary and alternative health across different context. Using primary data from interviews, as well as secondary data from the studies undertaken previously in 2010, the investigation uncovered a gap that needed more research to determine the legal basis, perform a comparison on various legal frameworks, as well as carry out an extensive exploration of patients and healthcare providers’ understanding of the laid down rules and regulations. The main goal was to attain a proper comprehension on how to balance protection to the involved parties and ensure the delivery of services in accordance to cultural values.

Some of the reasons a patient may turn out to be violent is when they consider an infringement being done to their beliefs. They tend to apply the principle of autonomy to decide whether they would accept the medication or not. This might undermine the legal duty of the medical practitioners as stipulated in various federal laws when it comes to the duty to rescue. Accordingly, Stuttaford, et al (2014) findings are backed up by support from Padgett (2011) research, which enhanced the awareness of safety and quality aspects that medical practitioners ought to pay close attention in a healthcare environment to achieve the desired outcomes. This would only be possible if the clinicians have a high level of morale, and subjected to a stress-free environment that can enable them concentrate adequately and minimize the chances of making errors in an effort to promote patient safety culture.

A study done by Ahmed, Burt, & Roland (2014) advocated for the need to provide patients with proper experience in an effort to deliver due care to patients. This is one of the aspects that patient advocates promote as established in another study pursued by Heiman (2015). The focus of healthcare providers is to deliver quality treatment to patients. The concept of quality is more diverse and a dependent variable to various elements such as patient experience, safety and clinical effectiveness. These elements relate to each other indirectly. Each patient has got different expectations from a care giver. It is the reason Ahmed, Burt, & Roland (2014) argued that the realization of an overall improved quality in healthcare relies on various strategies that require time to be sustained. Padgett (2011) emphasized the complexity involved in attaining the required quality service delivery in the healthcare, citing that the process of ensuring patient safety is multi-faceted. Accordingly, it is one of the reasons patient advocacies has emerged as an important area of focus.

Achieving the Triple AIM in healthcare is determined mostly by the rate of client satisfaction. In this respect, Heiman (2015) emphasized the need to comprehend the influence that patient advocates have on patient safety and satisfaction, their financial impact and how the healthcare provider perceive the advocacy. The primary aim was to create an equilibrium level between the care giver and patients by understanding the extent to which violence can be withstood during emergency medication to facilitate delivery of the required care. All of the efforts should be considerate of the complexities associated with the healthcare setting. Typically, patient safety can be achieved when the patients themselves cooperate positively with the providers. According to Heiman (2015), standard of care is very demanding, implying that any absence of quality of care can cause harm to the patients. The point of contention is that attaining a balanced care, and still operate efficiently and effectively might involve acceptance of some tradeoffs in quality, something that is not allowed in medical treatment. Increasing efficiency and quality at the same time is a struggle that healthcare providers continue to brainstorm upon to achieve the recommendations of patient advocates. There is need for extensive research into appropriate methodologies that can facilitate the attainment of this balance.

The complexities involved in ensuring quality care to patients can to some point be a contributor to violence in medical settings. A recent probe into some causes of violence in the healthcare environment was performed in one of the U.S Veterans Affairs healthcare systems. In particular, Purcella, Shovein, Hebenstreit, & Drexler (2017) intent was to get a glimpse of the staff’s perspective on the prevalence, causes and contributors of violence in a healthcare setting. The results obtained could be evaluated and a generalizability approach employed to understand the common causes of this problem in different work environments. Apparently, the respondents revealed to the investigators that some of the contributors of violence included complex and frustrating internal processes, stress due to overwhelming workload, and inadequate safety in the external environment. These findings expounded on Ahmed, Burt, & Roland (2014) and Padgett (2011) findings about the complexity nature of the healthcare environment, which inhibits the effective attainment of the required quality service delivery to patients.

From a professional point of understanding, the source of complex internal processes and overwhelming workloads should be the employer. In this regard, it is possible to handle these problems using effective communication. A case where the organization utilizes either democratic, transformational or participatory leadership style, employees’ opinions can be integrated into the organizational processes and evaluated based on the possibility of attaining a situation that suits the best interests of everybody. An organization that has a motivated workforce finds it easier to achieve the best performance, which include the required quality in service delivery, valuing the clients’ well-being through ensuring their safety and teamwork.

Accordingly, Lewis (2015) tried to uncover the above views in his study about healthcare leaders who influence the sustainability of high patient satisfaction scores. The themes that emerged from this research included effective communication between the management and employees to boost their morale, leadership effectiveness and engaged employees, leadership qualities and leadership desire to educate and encourage its workforce. Accordingly, participatory and visible leadership styles were identified as the best approaches to apply and realize the required patient satisfaction. It is quite evident that those organizations that experience most cases of violence have not been able to implement such leadership models. Perhaps, there is a reliance on authoritative and dictatorship, which lowers the self-esteem of employees, not forgetting that these styles are too outdated to be applied to millennials.

Bonalumi, et al (2017) performed a study that aimed at determining the various aspects that improved the patient recovery process. As per the study findings, a workflow process that boosted employees’ morale, enhanced communication and improved leadership effectiveness accelerated the recovery process of patients. This clearly shows that patient satisfaction also relies on conducive environment employees are subjected to. The rationale for this supposition is that a stress-free environment helps employees to concentrate fully on their work and deliver the required services in the right qualities. A stress-free environment is a concept that is also diverse and depends on various elements such as good pay, effective communication, and respectful leaders. Thus, balancing these elements in the most appropriate way and still meet the Triple AIM goal might be a challenge and one of the sources of violence in the healthcare setting.

Hogerzeil, Samson, Casanovas, & Rahmani-Ocora (2006) pursued an investigation that aimed at determining whether the right to health could be enforced through courts. The results showed that each individual was entitled legally to proper health. The investigation failed to examine the finite and scarcity nature of the required resources to fulfill this right in the most effective way. This means, patients would be entitled to this right theoretically, but not practically unless the State facilitated healthcare providers with the required resources. As part of the HIPAA provisions that are already out of date, Kumar, Henseler, & Haukaas (2009) suggested that such provisions be updated with some wording for them to be met by the healthcare providers as per the availability of the required resources.

Proof it Happens

Effective communication between different departments depends on a number of elements. In a healthcare setting, the medical practitioners, patients and the management have a role to play to achieve the required interdepartmental communication, especially during trauma situations. One of the elements that facilitate the attainment of proper coordination between different departments is the ability to uphold human rights. Amon, Baral, Beyrer & Kass (2012) performed an investigation into human research and ethics. The regulations that govern health researches provides that the subjects be protected. The predominant elements that are mostly considered include autonomy of the participant to provide certain information or avoid it if it might haunt them later. The second element is the anonymity aspect, whereby, it is the participant’s right to have their identities remain unknown to avoid future discrimination or conflicts. In reference to interdepartmental violence in the emergency room, no patient should be abused during treatment. The failure to understand the rights of patients to fair treatment is one of the sources of conflicts. In this respect, the authors emphasize the need for medical practitioners to enhance their attentiveness to human rights. This include engaging patients’ families and upholding ethical principles while handling patients.

Most assumptions that are made involve the failure of medical practitioners to uphold patients’ human rights. This assumption undermines the protection of medical practitioners from violent patients, as well as from rogue employers. On several instances, nurses have been assaulted as it was anonymously reported in the healthcare traveler periodical (Anonymous, 2013). It came out clearly that nurses faced maltreatment from the employer and patients. The fact is nurses have a responsibility to protect patients from any harm, especially those that are under their care. It should be understood that they too have a right to operate from a work environment that is safe and free from violence. Similar suppositions were made by Gillespie, Gates, Miller & Howard (2010), having investigated workplace violence in healthcare setting, primarily to establish the risk factors and their accompanying mitigation strategies. Evidently, nurses faced violence from patients and visitors, a fact that has mostly been neglected, given their duty to rescue and the provision of due care. The various protective strategies that Gillespie, Gates, Miller & Howard (2010) suggested included practicing self-defence, carrying a mobile form to alert others in case of violence, self and social support, and limiting interactions with potential and known perpetrators of violence.

There are cases where medical practitioners must interact with patients, regardless of whether they are violent or not such as pediatric patients in the emergency department who need diagnostic imaging more often as observed by Hernanz-schulman (2008). This does not bar them from applying Gillespie, Gates, Miller & Howard (2010) suggested protective strategies against violence. It is only when medical practitioners are subjected to a friendly environment that is stress free that they can deliver their best services and be able to promote the quality of life, as well as the safety of their patients. In fact, failing to understand and appreciate the safety of medical practitioners against violent patients is one way of not recognizing and valuing their needs. This can be a likely cause of conflicts and ineffective interdepartmental communication, given that nurses might not be able to work under environments that are prone to violence.

The supposition is greatly emphasized by Karaahmet, Bakim, Altinbas & Peker (2014), having evaluated the assaults that doctors in Canakkale had been exposed to in 2013. Using survey research as a data collection technique, questionnaires were distributed to the participants and the results evaluated using descriptive statistics. Evidently, the assumption that doctors or any medical practitioners are responsible for the violent cases they face from their patients is much worrying since is affect the performance of medical practitioners severely. As initially noted by Anonymous, (2013) and Gillespie, Gates, Miller & Howard (2010), medical practitioners are susceptible to violence from patients and visitors. The earlier this fact will be acknowledged will play an integral role in developing sustainable solutions to this issue, which is greatly undermined.

As noted by Kocabiyik, Yildirim, Turgut, Turk & Ayer (2015), cases of violence on medical practitioners have increased greatly. In a study that was carried out to determine the violence cases that healthcare practitioners in a mental facility get exposed to, a descriptive design technique was used as the main methodology. The findings indicated that quite a number of healthcare employees faced physical and verbal violence from patients. With the various evidence regarding this issue as presented in this literature, medical; practitioners deserve protection from any form of violence.

The same results were established from Burns (2014)’s findings after interviewing one of the psychiatric nurses. Assaults leave nurses fearful, a good implication that they can never deliver their best. The most worrying part from the interview was that whatever the nurses report as an assault, never reaches the designated personnel to handle the issue in its original form. This means, the proxies involved tend to alter the information as a way of refining it into something else that may not come out as an assault. In doing so, the nurses never get the required justice or attention, thereby, continue leaving in fear due to the unfriendly work environment they are subjected to. While in such a situation, they may never be able to communicate or react positively with patients in trauma situations, thus, a likely source of violence.

The same findings were demonstrated by Shiao, Tseng, Hsieh, Hou, Cheng & Guo (2010) after pursuing a research on the assaults against nurses of general and psychiatric hospitals in Taiwan. The main focus was to determine the risk of occupational assaults. Using a cross-sectional study conducted to provide a proper understanding of the incidence of work-related assaults in nurses, 842 nurses participated in the survey and completed the questionnaires as required. The results indicated that nurses in the general and psychiatric units were vulnerable to high risks of assaults. Accordingly, these assaults instilled fear into them just as established by Anonymous (2013) and Burns (2014). Eventually, nurses experienced an increase in work-related stress and a decline in their quality of life. Accordingly, Scott (1998) condemned the assault of medical practitioners while performing their duties. she proposed severe sentencing to the perpetrators of such mayhem.

Carr (2017) probed an investigation that aimed at evaluating the effectiveness of training for non-law enforcement personnel about the pre-behaviour indicators of the active shooter. The relevance of this research was on enlightening workers on how to deal with violence in their respective areas of operations. As seen from Burns (2014)’s study, most cases of violence that are reported never arrive at the top management in their right form. The biasness introduced in the original information hampers appropriate development of the solutions to these problems. In this respect, Carr (2017)’s active shooting will likely help nurses to defend themselves to their level best before handing the case if turns complex to the relevant personnel for further assistance. The worker’s initial effort to defend themselves will provide sufficient proof of a possible violation or infringement of human rights, thus, reduce the current alteration in the message being exhibited.

These findings are backed up by Ellies (2015), who evaluated an active shooter curriculum for institutions of higher learning. The ascertainment was motivated by the increased cases of institution shootings in the U.S. thus, the researcher aimed at providing the lessons from such incidents, alternative measures against active shooting, and alternative active shooter training. Evidently, active shooting subject individuals to unwelcoming situations that can inhibit their performance in whatever they venture in. It is a form of violence that may make medical practitioners to lose their entire concentration when attending to patients in the emergency situations. As a preventive measure, Carr (2017)’s study supports Ellies (2015)’s propositions on training individuals about alternative measures that can help them counter active shooting. The point of importance to ensure individuals operate from a friendly environment to help them attain the required concentration in productivity.  

Deflorio, Coughlin, Coughlin, Santoro, Akey & Favreau (2008) pursued an investigation that aimed at demonstrating the influence that changes in technology, staffing and departmental processes on service levels would pose to the emergency department. Apparently, it was revealed that various modifications to emergency department radiology processes can enhance the emergency department radiology turnaround time. The most valuable finding was about measuring and improving the processes by analysing the needs and resources by the joint effort from the emergency medicine and radiology crew, and the top management of the facility. This shows positive coordination from different departments, which can only come into play if there is effective communication between these departments. Eventually, such coordination contributes appropriately to better quality and safety of the patients.

Communication

Effective communication is an element that is pivotal to positive cooperation in the work environment, may it be between clients vs. employees, employees vs. the management, or employees vs. employees. As noted by Kozeal & Bean (2010), poor communication between departments results from misunderstanding other people’s needs. This finding is backed up strongly by the results of Coffey (2001), who probed an investigation into relational coordination between nursing units, emergency department, and in-patient transfers. The source of most conflicts was associated with patient overcrowding, which shows, the organization did not understand adequately how to take care of patients’ needs with utmost diligence. Kozeal & Bean (2010) established that poor coordination among the different units of the healthcare affect the organization adversely in the form of client and employee dissatisfaction. A case where the workforce is not satisfied, the likelihood of poor performance and failure to meet the desired outputs increase, which is the primary cause of customer dissatisfaction.

Angeli (2012) probed an investigation into networks of communication in emergency medical services. She suggested an approach of enhancing communication between clients and employees, as well as among employees through positive collaboration between different specialists, who include physicians, nurses, and social workers. This can be referred to as networking and may involve working together and making follow ups to patients and their families to ensure that they adhere to the prescription to prevent the chances of relapse. This approach backs up Kozeal & Bean (2010) observations about the sources of misunderstandings that results in poor communication. When specialists work together, it becomes easier to understand the needs of each other, thus, minimize the rate of miscommunication. This might involve strategies such as daily flash rounds as posited by Fredonia (KS) Regional Hospital (2010). When effective communication is ensured in the emergency department, the cases of violent patients will reduce since all the problem as noted earlier by Kozeal & Bean (2010) are attributed to inadequate understanding of other people’s needs.

Cappell (2009) provided a case study in which a supervisor coerced her into engaging in what she presumed was medically contraindicated and could constitute a malpractice. The task involved performing an emergency percutaneous liver biopsy on a client who she had never had an encounter with before, but was on the general medicine ward service. The dilemma came in when the practitioner realized that the patient was very unstable to withstand a liver biopsy. The same opinion as hers was provided by a colleague whom she consulted. In this case, a medically incorrect order by a direct clinical supervisor was the cause of the problem and could result in violence due to a misdiagnosis. This is a clear case of lack of consultation that could be easily countered using Angeli (2012) suggested approach of having different practitioners work together when helping the patient. The clinical supervisor relied on his knowledge, which in this case, was not sufficient, only to end up undermining the Hippocratic Oath as defined by Antoniou, et al (2010). Quite evidently, he looked down-upon the contribution of a junior employee, which on the contrary, was right.

In reference to healthcare code of ethics and its underpinning regulations, the case exhibited in the Cappell (2009) report concerns HIPAA noncompliance, which has turn out as a normal occurrence in the medical industry. From Basile (2014) empirical investigation on the increasing rate of HIPAA compliance, it is quite clear that the clinical supervisor was hired into the field, but the employer was inconsiderate of evaluating the practitioner’s knowhow in regard to individual implication of HIPAA noncompliance. Such a malpractice can end up the clinical supervisor in jail or into incurring fines as compensation to the client and the State. It is the reason Basile (2014) had to pursue her study to help in minimizing this unending internal noncompliance to HIPAA. Using survey instruments, it was established that medical practitioners who had information about the laid down regulations managed to uphold HIPAA compliance compared to those who had little information. In an effort to reduce patient violence in the emergency room due to misdiagnosis, the healthcare industry needs to take HIPAA compliance literacy with utmost seriousness. It is the only way the current cases of noncompliance as the one experienced with the clinical supervisor will reduce. From an intellectual point of view, you might realize that the clinical officer’s intentions were not related to committing malice, but rather, to meet his duty to rescue as provided by the federal laws. His insufficient knowhow in regard to evaluating the patient’s stability to undergo the diagnosis might have resulted into something else that could be equated to a malpractice.

Eadie, Carlyon, Stephens, & Wilson (2012) pursued a study on communication in the pre-hospital emergency environment. The primary goal was to come up and ascertain the execution of a communication board for paramedics to apply with patients as either an augmentative or alternative communication methodology towards meeting the communication demands of clients in a pre-hospital environment. The study’s methodology involved designing a double-sided A4-size communication board to be used in the pre-hospital setting. The front side of the board included expressive messages that could be utilized by the patient and paramedic, whereas the other side comprised messages that would be used to support patients’ comprehension and interaction tips for the paramedic. The board was placed in each ambulance and patient transport vehicle for easy access. The findings indicated that patients from culturally and linguistically diverse backgrounds benefited from the board. The paramedics supported the move for being effective in enhancing communication between medical practitioners and patients since it was easy to use, reduced patient frustration and enhanced communication. Accordingly, this is one of the efforts geared towards minimizing misunderstanding, while improving the ability to understand other people’s needs as suggested earlier by (Kozeal & Bean, 2010). Just as the networking model proposed by Angeli (2012), the communication board has the potential to enhance communication among patients. An extensive research needs to be done to establish whether the board can improve communication between the clients and practitioners, practitioners vs. their colleagues, as well as with the management. The rationale for this proposal is based on the fact that patient violence in the emergency room concerns each participant, ranging from other patients, to employees and to the management.

Delupis, et al (2014) probed an investigation into communication during handover in the pre-hospital/hospital interface using Italy as a case study. Using multidisciplinary handover simulations and debriefings as the methodology, the common problems of the pre-hospital/hospital handovers included absence of standardization of handover communication process between pre-hospital providers and emergence department personnel, perception by emergence personnel and nurses that rescuers do not transfer patient care responsibility. Individuals involved with patient safety during emergencies (rescuers) argued that nurses did not take into consideration the information communicated to them during handover as required. These findings are in concurrent with Kozeal & Bean (2010) about the source of conflict in the emergency room. It is all about poor communication and the inadequacy to understand other people’s needs. The Angeli (2012) model of specialist networking, where we can have the rescuers and triage nurses work hand-in-hand while attending to patients during emergencies has the viability to reduce this problem significantly.

Davenport (2010) delved on defining integrated healthcare as perceived differently by various stakeholders. This idea was motivated by the resurfacing of the medical industry in the U.S. Accordingly, different people have come up with comprehensive definitions to this term based on their understanding of what it entails. Using a phase concept analysis, the researcher investigated the existing literature, and performed interviews to determine a working definition to this notion. From the findings, integrated healthcare involved many people whose inclusion was vital. They included diverse staff, patient and family, whole personal treatment, community service integration, cost and insurance issues, medical home concept, and consideration of issues related to time. The researcher derived the following definition from these elements, “integrated healthcare is patient-family centered and it is facilitated by diverse healthcare teams under a single coordination, while taking a close consideration of cost, reimbursement, community, time and healthcare resources.” In reference to the research objective, violence can only ensue if all these aspects are not considered, which imply, the failure to recognize other people’s importance in patient recovery and the attainment of the Triple AIM.

Balcanoff (2003) engaged in a study that examined the influence that communication had on hospital nursing morale and retention. The researcher utilized the systems theory to get an understanding of the nurses’ experiences in regard to miscommunication in a medical setting. The results indicated that a positive input in communication by nurses resulted in both the management’s, nurses’ and client satisfaction. There was increased morale, as well as retention rate among employees. These observations depict an actual picture of what motivation does to an organization. In addition, they concur with Kozeal & Bean (2010) findings about the influence of positive coordination to an organization. Thus, they are feasible to the research objective and can be used to reduce violence in a hospital environment significantly.

Most health facilities continue to experience a deficit in communication. This was seen in Grace Dotson’s efforts to enhance this aspect and eliminate silos immediately after joining Greenville Hospital (Anonymous, 2010). Silos come into play when practitioners decide to concentrate on their work only. As such, they forget the fundamental value of teamwork. This issue can be handled using Hippocratic Oath, which comprises a synopsis of the moral code of ethics that contribute positively to the stabilization of the tri-part relationship among practitioners, patients and the diseases (Antoniou, Antoniou, Granderath, Mavroforou, Giannoukas, & Antoniou, 2010). This argument is backed up by Fields (2015) who emphasized the need to espouse the ethical value of empathy, given its benefits to the patients, practitioners and the management. This virtue can be achieved through proper communication between medical practitioners when delivering care to patients, especially in an acute medical environment. Thus, Forbes (2017) emphasize the need for nurses and physicians to relate positively and work cooperatively when attending to patients. Han (2015) supports this argument, having pursued a study on communication and compliance in the context of extreme events and healthcare. His findings revealed that effective communication and compliance was integral in all walks of life. It gives the patients a sense of hope, thus, promote their recovery process.

Hatva (2013) probed an investigation on how regular briefing enhances transparency and patient safety in healthcare facilities. The researcher used Norton Suburban Hospital as a case study. In the course of the facility’s transformation process, a number of challenges were uncovered. The problems experienced were all associated with ineffective communication. As such, the research emphasized the vitality of maintaining open and effective communication between and within the various departments of a health facility. This is essential when it comes to maintaining adequate focus on patient care and safety.

Lancaster,  Kolakowsky-Hayner,  Kovacich & Greer-Williams (2014) investigated interdisciplinary communication and collaboration among physicians, nurses and unlicensed assistive personnel. Using qualitative semi-structured face-to-face interviews as the primary methodology, it was revealed that most of the time, physicians, nurses and UAPs operate independently. Staff speak to each other on rare cases, which is a sign of ineffective communication. As seen earlier, effective communication among practitioners is an apparent indicator of positive cooperation. A case where the employees of an organization work as a team results in effective delivery of due care. Given the unique expertise each individual has, their combined effort is essential for tackling the patient’s illness from a three-dimensional angle, thus, facilitate the attainment of the Triple AIM as established earlier by Kozeal & Bean (2010) and Coffey (2001). The same findings are emphasized by Kozeal & Bean (2010), having indicated that the source of conflicts in a work environment is ineffective communication among employees, which leads them to be unable to understand other people’s needs. Hatva (2013) study is found relevant to these suppositions by emphasizing regular briefing, which enhances communication and the ability to understand each other and promote positive patient care outcomes.

Maughan, Lei, & Cydulka (2011) performed a research that aimed at identifying emergency department handoff practices and described handoff communication errors among emergency physicians. According to the research findings, errors and omissions committed by physicians in the emergency room were as a result of variation in handoff time per patient. This can be attributed to poor communication among practitioners. As such, when deriving standardized protocols, handoff error reduction techniques, and the influence that handoff has on patients, it is essential to ensure effective communication among physicians is exhibited. The same confusion experienced in handoff time is the same that was discussed by Delupis, et al (2014) during handover between safety rescuers and nurses in case of an emergency. All these problems are associated with poor communication.

McBeth (2015) investigated a study that worked towards implementing a daily morning huddle at a certain children’s hospital by enhancing interprofessional and interdepartmental communication and collaboration. The research reported on various changes in patient flow before and after implementation of the daily huddle, as measured by pediatric emergency department boarding times. Using non-random purposive sampling and inferential statistics, huddles were found to be essential in enhancing patient flow through their ability to improve interprofessional and interdepartmental cooperation and communication. The findings are in line with the rest of the literature that has emphasized the need for effective communication among different departments, as well as practitioners when handling patients in emergency rooms. These findings were enhanced a little bit in another study that was carried out by McBeth, Durbin-Johnson & Siegel (2017). The investigators added that admitting patients from the emergency department to their respective units to receive the required specialty care on a promptly basis posed a higher probability to enhance the quality and safety of patients. This can only be achieved if there is effective communication and positive collaboration among the involved medical practitioners.

Naz & Gul (2014) pursued a study that investigated the relationship of communication satisfaction and turnover intentions and to uncover the moderating role of organizational commitment in the relationship of the two variables. The research findings indicated that communication satisfaction was inversely correlated with turnover intentions. Organizational commitment played the role of a moderator between communication satisfaction and turnover intentions. As such, it became quite apparent that communication satisfaction among co-workers, supervisors and the top management affected negatively the turn over intentions. As such, organizational commitment, which implied working as a team towards the attainment of the set objectives was found valuable to bring a balance between the two variables. This supposition agrees with McBeth, Durbin-Johnson & Siegel (2017) and McBeth (2015) that have recognized the importance of positive cooperation among employees to quality and positive patient care.

Sujan, Chessum, Rudd, Fitton, Inada-Kim, Spurgeon & Cooke (2015) carried out an investigation on the emergency care handover across care boundaries, particularly, on the need for a joint decision making and consideration of psychosocial history. Using audio recording of interdepartmental conversations as the main data collection technique, it was discovered that conversations associated with ambulance services were predominantly descriptive, unidirectional and had a close focus on patient presentation. Referrals were all about collaborative talks in regard to admitting and providing immediate care needs to patients. Very little conversation was related to the patient’s social and psychological needs. Thus, it was quite apparent that the practitioners could not understand the needs of the patients due to negligence. As posited by Coffey (2001), the source of most conflicts in the emergency rooms is due to the inability of the practitioners to understand other people’s needs. Even though the practitioners might have been putting in more efforts to provide care to patients, their inadequacy to understand their social needs would be good enough to escalate conflicts between patients and medical practitioners.

Valecha (2015) performed a research on information and communication in mediated crisis response. Three essays were explored with the first one delving on communication issues in the dispatch-mediated local emergency response system. The second essay investigated information issues in the crisis microblogs, whereby data was characterized by big-data driven methodology. The last essay discussed quality issues in crowdsourced crisis response through the development and validation of an information categorization system that would offer pragmatic directives to crisis practitioners for crowdsourcing. Evidently, effective communication proved to be essential in attaining the desired outcomes in all the three sources. The involved practitioners had to cooperate positively through addressing issues as a team to achieve their objectives.

Nagula, Lander, Rivero, Gomez & Srihari (2006) concentrated on investigating the use of continuous quality improvement tools to streamline the workflow of ancillary departments. Apparently, patients admitted to the emergency department required the services of both the laboratory and radiology departments. In this regard, a positive correlation between the two teams was essential to ensure the delivery of the required care to patients. In this study, process mapping and time studies were utilized to determine the flow of operations between the two departments. Just like it had been the case with other studies, ineffective communication was one of the core sources of failure in delivering the required care. Conflicts between different practitioners from different departments was predominant, primarily because each individual had been used to focusing on their unique functions, thus, coordinating with others who were handling other tasks to achieve the desired recovery outcome posed a challenge to them.

Approaches to Health Care Communication

Humanistic Theory

The humanistic approach mainly deals with the fact that people tend to seek self-esteem and self-actualization (Fertman & Allensworth, 2016). It explains the fact that people born and live a healthy life always have high esteem as compared to those having dysfunctional esteem issues (Kaakinen et al., 2018). This is where health care professionals, who include therapists, have to provide an environment where their patients can interact freely without having to be judged for who they are. This theory brings out the fact that everyone in society has to enjoy life, be a positive contributor in community and love and be loved as a member of a particular society (Hogan & Brashers, 2015). This approach aims at helping people reach their full potential in optimization and to be critical thinkers. Health care professionals and service providers who include nurses have to be enrolled in training programs that help deal with particular situations effectively.

According to the hierarchy of needs as described by Abraham Maslow, there are conditions to be fulfilled before reaching the self-actualizing point of life. People first have to secure the basic needs that include food and shelter to keep them alive. They, furthermore, need to be satisfied with their secondary needs that involve safety, self-respect, and a sense of belonging to a group or groups (Hogan & Brashers, 2015). Achievement of these entire needs enables one to have a drive that propels their lives on where they want to go and what to do about their experiences. At this point, motivation only emerges since one is satisfied with the experience and has a purpose. Some fail to reach this point in the hierarchy and therefore, have not found their purpose in life. This causes a disturbance in their mental stability and is not able to sort their issues as they cannot understand themselves (Kaakinen et al., 2018). Humanistic psychotherapists have, therefore, developed techniques to deal with similar experiences on their patients. These techniques are used on patients to help overcome their fears of reaching their full potential. They help patients deal with concerns about the past, the future, and the responsibilities that prevent them from pursuing their inherent capabilities (Kaakinen et al., 2018). These techniques play with emotions and help in reconnecting individuals to their embedded wishes and dreams.

Besides, the techniques enable patients to heal from their past experiences and have the motivation and ability to take up future roles and responsibilities in society. Good communication skills between the patients and health care staff help in learning the patients' problems and issues and therefore, get the required attention (Fertman & Allensworth, 2016). This promotes comfortability to the point where patients express their emotions and feelings to the service providers. This, in turn, helps faster healing process because health care providers can understand and relate with the patients' situations. It is therefore vital for health care providers to employ effective communication techniques as they promote trust between themselves and the patients hence more natural interactions.

Behavioral Theory

This theory explains that an individual’s behavior is acquired depending on the environment they are exposed to. It analyses behavior and the consequences of it as per the surroundings, and those that have been acquired from the past interaction (Montano & Kasprzyk, 2015). Operant conditioning, as a behavior modification, can be used to determine the likelihood of a behavior repeating itself. It can be used to either increase or decrease the likeliness of a behavior reoccurring (Glanz et al., 2015). It relies on the facts that people can respond to stimuli if paired with specific stimuli with the same behavior and hence react to such change. This works either changing their behavior or making them avoid the behavior. In operant conditioning, the technique used is reinforcement where an individual is encouraged to repeat action which in most cases is a pleasant one. Positive reinforcement involves rewarding an individual to continue displaying positive behavior (Montano & Kasprzyk, 2015). On the other hand, negative reinforcement is introducing punishment to make an individual avoid repeating a specific unpleasant behavior these both result in a positive effect. This technique can be applied by caregivers in rehabilitation centers and in mental hospitals where the patients are rewarded for being drug-free for some time or for behaving pleasantly (Montano & Kasprzyk, 2015). This, therefore, makes the individual want to repeat such and be appreciated. This theory of communication promotes positive behaviors among inmates and hence brings forth individuals who are changed and are accepted in society.

Social Cognitive Theory

Social Cognitive Theory explains the influence of one’s past experiences, environmental impacts, and actions of others towards one’s health behavior. As a communication theory, it, therefore, provides a platform for caregivers and service users and patients to address their issues and finally solve these issues. Patients with Post Traumatic Stress Disorder (PTSD) can be helped using this theory (McDonald et al., 2019). These patients suffer from trauma due to maybe a fatal accident or their personal experiences (Montano & Kasprzyk, 2015). This provides the caregiver with information on how to handle the patient. Motivating the patient to open up to the health care professional, who in this case is a therapist and in other cases, a doctor during an examination, in case of rape is essential. This helps in getting information on the condition of the patient and how to help get through the situation. Creating an environment for proper communication can help in bringing things back to normalcy. This speeds up the process of healing, and the service user can get their lives back (McDonald et al., 2019).

This theory also helps in supporting individuals with depression. In understanding this theory and its applicability, caregivers can provide support to depressed individuals. These individuals can be those recovering from drug addiction and are trying to stay clean. One of the results is depression (Montano & Kasprzyk, 2015). Good communication skills are, therefore, effective in providing this support. Health professionals can better their services when health problems are better stated, and this is only effective and possible with communication. Lack of communication here leads to a more depressed individual who may, in the end, fail to get the required medical attention.

Psychoanalytic Theory

This theory is based on the argument that human behavior is due to the relations in the id, ego, and the superego. It is also based on the idea that past experiences during childhood contribute to the behavior of an individual as an adult. It involves the investigation and treatment of mental disorders that resulted from childhood experiences. This theory postulates that the unconscious can be made conscious of creating insight (Waterworth et al., 2018). Therefore, events from the pasts might be suppressed, that is why they do not show but it does not mean that they have been forgotten. People suffering from phobias of different types can be cured through psychoanalysis. Health care professionals can adopt this technique to help in reducing the impacts of past experiences by neutralizing the event (Waterworth et al., 2018). For this to take place, there should be an understanding between the patient and the caregiver and this leads back to communication; for a service user to be attended to and for treatment purposes, there should be communication where each of the parties is comfortable to talk about issues. This psychoanalysis technique helps in creating insight. The more significant issue of a problem is dealt with first before the point of phobia is brought up. It is of importance as it helps in simplifying issues into smaller tasks that have to be dealt with. Good communication is equally important in the social care setting.

Challenges Facing Effective Communication in Health Care

Language Barrier

One of the biggest challenges to communication is the difference in spoken languages. There is a misunderstanding in the language spoken between the caregiver and the patient (Patterson, M. E., et al., 2019). This significantly affects how a problem is addressed as it may be of different degrees to one of the parties. Poor communication between a patient and a nurse can lead to dangerous outcomes; for example, the patient fails to understand the dosage of medicine they are supposed to take and ends up overdosing (Patterson, M. E., et al., 2019). This can be devastating because the patient could die as a result of this. It is, therefore, vital to know that there is excellent communication to avoid dangerous or fatal outcomes.

Alarm Fatigue

In a hospital setting, there could a lot of noises from the alarms everywhere. This can hinder communication between nurses, physicians, and more so patients. Most of these alarms do not require immediate attention, but due to the sharpness and the noise it produces, it can make patients panic not knowing what the emergency is about (Baig GholamHosseini & Connolly, 2015). Nurses can also be affected as they have to stop what they are doing to check on them (Baig GholamHosseini & Connolly, 2015). They might be in the middle of an operation, and they need to step out to turn them off. This could lead to confusion in the procedure, and the patient at hand can suffer blood loss or even death. When not in use, these alarms can be switched off, or the volumes reduced so that people can talk and understand each other in the hospital. Most importantly, to avoid raising false alarms that cause panic.

Security Breaches

The use of mobile phones in the hospital could lead to security breaches that expose confidential reports of the patients. This is a barrier to communication because it prevents the principle of confidentiality and exposes data that is against patients’ consent. This can be devastating as this information can be used to blackmail the patient later on in life (Baig GholamHosseini & Connolly, 2015). Mobile phones should be used by caregivers where appropriate but not while on the line of work. It is a matter of a great deal because it becomes a legal issue to get information out without the consent of an individual. It is also costly to violate the Health Insurance Portability and Accountability Act (HIPAA) and may not be possible to recover or seal important information once it is out to the public.

Psychological Barriers

People with psychological instability can be less assertive and fail to grasp what they are told to do. People with low self-esteem may be uncomfortable expressing themselves as compared to those with high esteem (Hussain et al., 2019). The latter can express themselves in bold because they have nothing to fear and are proud of themselves. People with stress cannot pay attention as they are worried the whole time. Until they find a solution to their worries, they are not alert, unlike those that have tress management skills. Caregivers need to understand the mental state of the patient to determine whether they can contain specific information about them.

A Delayed Nurse or Physician Communication

Hospitalized patients need nurses and doctors to examine and check on them from time to time. Delayed communication from both the caregivers brings uncertainty in the patients, and they may start to be unsure if they are to make it out of the hospital. Patients tend to be affected negatively on these occasions, and faster recovery may not be recorded. Nurses and physicians should be able to communicate on those dates that they may not come in for the routine check (Hussain et al., 2019). This helps in preparing the patient psychologically and not raise alarms or doubts about specific issues. This also facilitates faster recovery of the patient as they have an idea of what is happening, unlike when there is lack of communication.

Overcoming Barriers of Communication in Health Care

Listening and Understanding

Most people often forget what they have been told. It is always a good idea to listen and understand as this minimizes chances of forgetting. People tend to hear but not listen. When one hears, it makes one lose attention or focus on what is being said. It, therefore, leads to negative outcomes that may prove dangerous and negative. Health care providers and service users should be able to listen and understand each other so that neither of them acts differently from the required. It, therefore, reduces the chance of forgetting and promotes comprehension of the subject matter.

Usage of Clear Language

Using a language that is easy to understand promotes effective communication. Using some other language that has ambiguity and possibly understood by only a few becomes challenging to understand each other cation (Clark Whitt & Lyons, 2019). Hospitalized older adults may not understand even the universal language, so it becomes essential to get someone who understands their language to explain certain things to them. Medical practitioners should avoid using jargons while conveying information to their patients. This is because the patient might interpret the same information differently from the way it should be, and it may cause damage or injuries to a particular person.

Being Visual and Recording Visits

It is essential to use images and videos to keep records of each session one sees a doctor. This helps prevent forgetfulness of essential and crucial information from the other visits. This also helps breaks down information into smaller parts that can easily be applied and absorbed into one’s mind. It is, therefore, essential to consider ethical impacts while recording because it may implicate some medical aspect that is crucial (Shaw, 2016). This can cause problems for the health provider because it is a legal issue that applies when certain rules are violated.

Impacts of Technology on Health Care Communication

Technology has created so many advances and opportunities in health care communication. Since the technological advancement in this 21st century, so many patients have benefitted from the positive impacts on communication in this particular setting. Technological information has brought forth undeniable results that have facilitated in the treatment and diagnosis of various aspects of illnesses that have been promoted by effective communication. Caregivers have since been able to digitalize the form of communication used between themselves and the service users and the patients. Several impacts on communication have been recorded, and since then, many health care providers have decided to adopt techniques that support good communication skills in hospital settings. This advancement also extends to the palliative care where the patients cannot or may not speak for themselves. It is important to incorporate technology information in health care communication as it helps in minimizing errors that can occur within this environment.

One of the positive impacts of technology in health care communication is there is improved health care quality and safety ( Sawesi, Rashrash& Phalakornkule, et al.,2016). The combination of information technology and good communication skills promotes the quality of health care and brings patients closer to their healing. Health care safety and quality are made possible only when technology is applied in areas where the records and relevant information of patients are kept under encrypted files where they are safe from the public. Caregivers do not have to worry about having to arrange hard copy documents in files since they are already sported, and this further prevents time wastage. Patients' information is always safe and free from breaches as these files cannot be accessed by any other person except for the specific caregiver that who is trusted by the patient (Sawesi, Rashrash& Phalakornkule, et al., 2016). This level of safety is available only when health providers employ information technology and excellent communication skills.

Additionally, technology has enabled increased efficiency in the service delivery of public health (Carayon et al., 2018). Introduction of information technology has increased how fast service is provided to the patients. This is made possible where computers are used to store plans of how medical distribution is to take place. This has helped in reducing medical errors that arise due to misunderstandings in communication between health care professionals and patients. This is because of the high degree accuracy of these technological tools that help in alleviating errors and hence promote faster recovery of the patients. Computer machines used during surgeries have almost, or at least no error and therefore, are trusted. Effective communication through technology supports the trust that patients give to caregivers to help them get through their medical conditions (Carayon et al, 2018).

Technology has, however, affected health care in negative ways as well. There is a disadvantage in electronic health records that are stored by caregivers to provide safety of the information (Jungwirth & Haluza, 2019). These records may, however, lack interconnectivity hence preventing communication among each other. This can lead to considerable loss as the patients' records are at risk, and the patients may fail to understand whatever is going on (Jungwirth & Haluza, 2019). Many of the networks such as the recording system work well, rather than other networks which have not been sorted out properly to create a flow on the works. The lack of communication and poor communication may put the lives of the patients in danger, and this is a substantial legal and ethical issue. The medical practitioners have to face consequences of neglecting patients and therefore, resulting in risks in their lives.

It is, however, necessary for health care providers to incorporate technological knowledge on their places of works. This can be of a great deal of help ranging from safety, adequate health care, and most of all, efficiency in service delivery to the public. Patients can relax and not have to worry about their information being exposed to the public. In as much as there is an excellent side to this approach, there is also the other side of a coin that is negative. Lack of interconnectivity in the system network can result in systems being hacked and therefore, failure in relaying information. This causes a breakdown of communication to the patients, and they end up at risk and may even die. It is therefore essential for health care providers to know the appropriate situations to apply technology.

Suggestions and arguments from different authors prove the fact that communication is vital in health care. It is, therefore, important for service providers to put into consideration the strategies to help in effective communication between health professionals and patients so that there is understanding of matter at hand. Presence of effective communication between people helps in reducing time wastage trying to explain things over and over. It helps avoid repetition, which may be tiresome and boring. To reduce uncertainties in the medical professions, medical practitioners should develop a good communication environment which promotes provides for effective communication. They should also put into consideration techniques that are used to promote understanding between patients and doctors. Excellent communication skills should be presented in a hospital setting so that patients and caregivers get to understand each other and avoid difficulties.

Management

The success and attainment of organizational goal depends on proper coordination between the management and employees. In addition, proper interdepartmental coordination is key since different departments rely on one another, thus, must collaborate positively. This is possible if the organization has an effective communication system that is used to pass information across different departments. Effective leaders must be in a position to set up such a communication system. Zack (2014) provides valuable insights in regard to three key skills that leaders need to have. The first one is interdepartmental collaboration, whereby the management must be in a position to link healthcare practitioners from the top down to make them think about the big picture and how the overall processes in the healthcare system influence patient outcomes. Another core characteristic that Zack (2014) discusses is diverse experience, which is essential for understanding the various healthcare processes comprehensively. They also need a data-centric approach, which is vital in facilitating a proper understanding of how patient data is collected and measured. This eliminates data silos and ensures that data remain central to business decisions.

Accordingly, these skills can be applied in appropriate coordination of different departments. Woodward (2008) pursued a study about radiologic procedures, policies and protocols for paediatric medicine. Evidently, it was established that proper development of protocols between different departments requires a multidisciplinary approach to meet the required straightforwardness and any form of complexity that might arise, such as time-sensitive needs for the emergency department patients. For instance, imaging evaluation requires radiologic technologists to collaborate with other experts who include radiologists, transporters, nurses and coordinators and work under an accelerated routine to achieve the desired outcomes.

Wise (2014) elaborated on the importance of positive coordination between different departments. The author drew from different case studies that involved analysis of partnership between different companies. Apparently, it was clear that organizational success depended on proper relationship among different processes. This can be achieved through having a well-established communication system in place. In most cases, poor adoption of the required processes causes miscommunication in the organization that eventually translates to low productivity.

Virtue, Chaussalet & Kelly (2013) probed an investigation into healthcare planning and its potential role in increasing operational efficiency in the healthcare sector. The primary methodology used was the review of existing literature, as well as drawing information from different viewpoints. The authors aimed at considering quite a number of issues that surrounded poor adoption of healthcare simulation models and tried to reflect on whether or not, there had been a significant failure of academic healthcare simulation modelers to develop approaches that could reflect real medical challenges as uncovered by different stakeholders in the medical sector. The study reviewed the role of healthcare planners within the medical sector and proposed that they well suited to play the role of change agents to enhance the adoption of simulation within the healthcare sector. Typically, the success of the planners was attributed to positive coordination among themselves, which was enhanced through proper communication and the urge to understand each other. In that respect, the planners managed to avoid creating conflicts so that they could concentrate on the attainment of the desired outcomes. Accordingly, the researchers established a strong link between healthcare planning and the stakeholders of the healthcare. As such, they proposed that healthcare planning could play the best role in the adoption of healthcare simulation modeling to improve operational efficiency.

Most of the time, obstacles arise to disrupt effective management of processes. Priesmeyer & Murray (2012) described new concepts and methodologies that managers can utilize to counter the occurrence of disruptive obstacles in a large-scale hospital setting. In particular, the authors aimed at addressing challenges with service quality that may be experienced as a result of disruptive events. The researchers introduced the notion of “wholism” as a fundamental basis of fostering interdepartmental responses. Also, the investigators presented an instructional method for training interdepartmental interdependency in organizations. Apparently, positive coordination among different individuals of the organization was core to appropriate management of disruptive events.

The ability to manage processes through countering potential obstacles is a strategic capability that managers need. Karadjova-Stoev & Mujtaba (2016) pursued a study on strategic human resource management and global expansion lessons from the Euro Disney challenges in France. Typically, the emphasis was to encourage managers to view the strategic role of human resource management as a vital aspect of an organization’s success in attaining the desired outcomes. Basically, the authors illustrated how organizational decisions from the HR department were integral for an entity’s success. Evidently, strategic planning was demonstrated through the Euro Disney case as a human resource imperative that ensured proper coordination among different departments of the organization. The absence of strategic HR management caused the organization not to achieve the desired results in its initial strategy. Thus, this aspect is worth considering appropriate management and coordination of the organization’s resources.

Based on the Euro Disney case, it came out clearly that managers in different regions apply varied management styles. In this respect, Culpan & Kucukemiroglu (1993) performed a comparison of the U.S and Japanese management styles and unit effectiveness. They used a conceptual framework that comprised of six managerial dimensions that included; supervisory style, communication pattern, decision making, interdepartmental relationships, control mechanisms and paternalistic orientation. From their study findings, both U.S and Japanese styles had salient features. The leaders from both ends demonstrated the desire to learn from different management systems to gain effective aptitude for comparative studies. The investigators still felt there was need for further researches in the future to advance on their current findings, particularly, through developing alternative models with robust capabilities for effective management of organizations.

There are quite a number of approaches and leadership styles that managers apply based on what they think suit their personalities. Cooper, Porter & Endacott (2011) carried out a study on mixed methods research for emergency care. Modern views on mixed method approaches were considered with the main focus being directed on the design choice and amalgamation of qualitative, as well as quantitative data that emphasized the timing of information collection for each methodology, the relevant weight and how they would be utilized. The advantage of applying mixed designs, especially in the emergency care is to meet the varying needs of patients. The study presented best practices for consideration. Their findings indicated that the application of mixed design in clinical settings had increased. The primary aim had been to respond to the question “how many” and “why” in the same study? In the same respect, it is questionable to apply more than one management style in the same organization. But still, it is relevant when it comes to achieving the Triple AIM, which to some extent, requires a 3-dimensional and multifaced efforts from the manager. The leader can apply different styles based on the prevailing circumstance and the goals to be achieved.

The available styles that leaders apply in the contemporary management arena include transformational, transactional, participatory, democratic and servantiship styles. Golm (2009) explored into some of these approaches, particularly, transformational, transactional and change-oriented in reference to their influence on leadership effectiveness. Using a tagged multifactor leadership questionnaire as the main methodology, the data was collected from the sample population that had been selected randomly. It was then analyzed using correlation coefficient and multiple regression. From the findings, there was a strong correlation between the three leadership styles when it comes to management effectiveness. Both of them exhibited the trait of motivating the staff to work as a team. This shows that either of the three styles can be applied by leaders, even though they exhibit few variations. An important point to note is that their application should be made relative to the ability to meet the prevailing organizational needs. Thus, it is a good illustration of leadership skills diversity.

The three leadership styles demonstrate the capability of a leader to serve, follow and lead. This concurs with the investigation pursued by Penny (2017) in a radiologic setting. The main focus was to demonstrate the diverse skills that radiologists need to possess, given their diverse roles that need at least minimal understanding of every aspect for effective delivery of services and their effects on the organization and patients. The emphasis was on the ability of the radiologists to work as a servant, follower