Communication is a process that should be simple, easy to adhere to, easy to follow, and be effective. However, this is not always the case. We use communication in Occupational Health (OH) to help exchange information, thoughts, and feelings between individuals through a common system of signs, symbols, behaviours, and words.
Often, in the therapeutic elements of OH, such as Physiotherapy and Psychotherapy, we have the verbal communication of OH staff on one side, and the employee and their managers, or translators on the other.
We communicate in so many different ways, and these are typically split into two subsections:
Verbal Communication: this involves the use of spoken and/or sign language to transfer information. It is often thought of as the most common type of communication, the most important and most efficient. This is particularly prominent now, as many of us in OH are operating remotely and undertaking telephone appointments, therefore, we are relying heavily on verbal communication2, 9.
Non-Verbal Communication: includes factors such as; body language, gestures, and facial expressions to convey information to others. This can be both intentional and unintentional. Despite non-verbal communication making up the majority of our communication, we cannot rely on this when we are operating remotely4.
If we use “closed” body language in OH such as crossed arms or legs, hunched shoulders, or sitting behind a computer screen, it immediately creates barriers. Even whilst working remotely in OH, this is something we need to be aware of. When undertaking video appointments, we need to maintain eye contact and avoid sitting with our arms crossed or placing objects – such as books or papers – between us and the screen. The employee should feel they have our full attention and failing to give them our full attention is likely to result in poor communication, which is contrary to the codes of conduct set out by various healthcare bodies. This can make the employee feel anxious, angry, or nervous10.
It is our job as esteemed healthcare professionals to break these barriers down; not create them.
How many times have we heard someone say something akin to: “I saw this particular healthcare professional and they just stared at their screen the whole time, they didn’t even look at me when I entered the room”. This situation could easily be avoided with simple, effective, and purposeful communication to show someone that we care, and that we are invested in their wellbeing and health.
Between 70-80% of communication is non-verbal. In the current pandemic, many of us are undertaking remote, telephone appointments so we no longer have that non-verbal communication to rely on. We need to be even more aware of our verbal communication, and its importance and quality4.
When people enter the OH system, they may feel anxious because there is a lot of uncertainty: what treatment will I have? Who will I see? What if it doesn’t work? What does this mean for my job? I have been sent to OH, does this mean they trying to sack me? These are all common concerns and worries for someone coming to OH, particularly for the first time. It is so easy for employees to feel like they are losing control, this can make them feel anxious, lost, hopeless and helpless; not only will this negatively impact their chances of recovery but it may also cause them to act out of character. If we can ensure we are communicating effectively, these feelings and negative outcomes can be avoided and we can empower individuals to regain control of their health and their lives1.
Effective communication is therefore vitally important to all aspects of OH, as we often communicate with the client, employee and managers. Additionally, it can reduce the rate of re-referrals and, therefore, the cost for clients1. Another benefit is that effective communication can significantly help to reduce anxiety and worry regarding any medical jargon and conditions4. This can be done in our written communication in any reports, as this presents us with an opportunity to explain the employee’s situation and/or condition. It can also be achieved by taking the time to explain these medical terms to the employee in a way they can understand.
Our time is the most precious thing we can give to another person. When we show that we are prepared to listen to them, get to know them, and understand how they are feeling, we then show that we value that person and their feelings and needs.
Ultimately, we should be doing this in OH to make sure that the employee is at the centre of the care we are providing4,10.
How Do We Do This?
- Active listening
- Avoid using filler words such as “um”, “like”, “so”, or “yeah”
- Be intentional, and make a genuine effect to display positive and open body language
- Keep written communication simple, concise, remember not to rely on tone
- Review your written communication to ensure it is up to your professional and organisational standards
- Use visual aids when needed1.
What Else Can We Do?
There is a simple set of 3 that we all use, that we could implement more, The Three E’s:
Empowerment: we should give our service users within OH the authority and/or power to take control of their health and recovery. This can help them become stronger, and more confident, especially in controlling one’s life and claiming one’s right7.
Engagement: we should be present; we should be “in” the moment. This helps to build a rapport with our service users. Taking an interest in them – ultimately resulting in better outcomes1.
Empathy: we should take the time to understand the feelings of those we are working with and helping. Empathy is important in helping to support the employees in managing their health and returning to and/or being supported in the workplace12.
Written Communication & Documentation
The importance of written communication and documentation, particularly in OH, is well known11. Early in our careers, we are told of the importance of doing this, how to do it and we even get scored on it during placements we are audited in the workplace. However, as we get more comfortable in our practice we do not tend to document as thoroughly. This is usual for all clinicians, particularly those who have been working for several years3. We need to ensure we are using clear, concise, and accurate record keeping. This allows for good continuity of care8. Some of us may have had experiences where we have taken caseloads from our colleagues and not been able to follow their notes and record-keeping. This can mean having to repeat assessments, which do not offer the best continuity of care or value and increases the OH costs for the client. Additionally, if we can offer better continuity of care with the same clinicians, or between colleagues – including the wider multi-disciplinary team – then it can help support and aid in the recovery and management of conditions. Less time would be spent ‘repeating’ our assessments.
Furthermore, clinical notes, particularly in OH, may be required in legal cases. Therefore, any notes need to meet the professional regulations as, if they do not and the notes are needed in legal proceedings, this may have consequences for the clinicians.
The Take Home Message
References
- Braun, S., Roeser, R., Mashburn, A., & Skinner, E. (2018) “Middle School Teachers’ Mindfulness, Occupational Health and Well-Being, and the Quality of Teacher-Student Interactions” Mindfulness 10(1) 245-255
- Kourkouta, L., & Papathanasiou, I. (2014) “Communication in Nursing Practice” BMC Medical Education 26(1) pages 65-67
- Ley, P. (1998) “The Use and Improvement of Written Communication in Mental Health Care and Promotion” Psychology, Health & Medicine (3)1 page 19-53
- Marziniak, M., Brichetto, G., Feys, P., Meyding-Lamadé, U., Vernon, K., & Meuth, SG. (2018) “The Use of Digital and Remote Communication Technologies as a Tool for Multiple Sclerosis Management: Narrative Review” JMIR Rehabil Assist Technol 2018;5(1):e5
- Mathioudakis, A., Rousalova, I., Gagnat, A., Saad, N., & Hardavella, G. (2016) “How to Keep Good Clinical Records” Breathe 12(4) pages 369-373
- Merriam-Webster, 2020. “Communication”. Accessed from: 07/07/2020.
- Ocloo, J., & Matthews, R. (2016) “From Tokenism to Empowerment: Progressing Patient and Public Involvement in Healthcare Improvement” BMJ Quality & Safety 25(8) 1-7
- Penoyer, D., Cortelyou-Ward, K., Noblin, A., Bullard, T., Talbert, S., Wilson, R., Jason, R, Schaffhauser, B. & Briscoe, J. (2014) “Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System” Journal of Healthcare Management 59(2) pages 130-144
- Ratna, H. (2019) “The Importance of Effective Communication in Healthcare Practice” Harvard Public Health Review 23(1) pages 1-10
- Royal College of Nursing, 2017. “Why communication is important”. Accessed from:: 07/07/2020.
- Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W. & Vogelaers, D. (2015) “Communication in Healthcare: A Narrative Review of the Literature and Practice Recommendations” International Journal of Clinical Practice (69)11 pages 1257-1267
- Vogel, D., Meyer, M., & Harendza, S. (2018) “Verbal and Non-Verbal Communication Skills Including Empathy During History Taking of Undergraduate Medical Students” BMC Medical Education 18(157) pages 1260-1269
Hardev Singh Agimal is a Physiotherapist, working for PAM Group
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