Clinical Communications – Human Factors for the Hidden Network In Medicine

Abstract

Medicine is practiced not only through encounters and other interactions between patients and providers, but also through documentation of event-centered information via the patient record, and through patient-centered communications between clinicians and between clinicians and patients (and their families). Human factors has been heavily involved in the first two, contributing to design and evaluation of medical devices, identification and remediation of safety issues, and analysis and modifications to electronic health records and their interface. These same two areas have also received widespread research support and capital investment, while the third – clinical communications – has remained in the background for research, investment and human factors involvement. Yet clinical communication is vitally important. Health care providers communicate with patients directly in encounters, and when the communications fail, patients know it, are unhappy, and disparities in treatment, some systematic, arise (Brach & Fraserirector, 2004). In all but the simplest cases, providers also communicate with each other about the care of patients. These patient-centered communications (PCCs) occur through the hidden network of relationships linking providers with each other and with patients. These PCCs are largely ephemeral, occurring in encounter rooms and via phone calls, pagers, hallway chat, and increasingly, tasking within EHRs. Research has begun to indicate that this mesh of PCCs can have substantial effects on outcomes (Kahn and Angus, 2011). When these PCCs fail, negative outcomes occur, but we know little of what “good” PCCs look like, or how to encourage or train them. Virtually no PCC data is captured in EHRs or elsewhere. All this points to a fertile but undiscovered country for human factors. This panel brings together four leading researchers with different perspectives on this domain: how clinical communication has evolved with the practice of medicine and communication technology; what we know about and can learn from failures of clinical communications; how leading edge training technology can help clinicians acquire adaptive communication expertise; and how broader issues of teamwork and organization affect and are affected by communication needs.