GLD.3.1 |

My intention in bringing this post to a Health Information Management (HIM) / Medical Records (MR) practitioners reader specifically and to all other readers in general, is to understand the dynamics of communication and your role in managing patient-specific information in a hospital setting when the leaders of the hospital agree to an essential condition whereby effective communication must prevail among and between professional groups; structural units, such as departments; between professional and non-professional groups; between health professionals and management; between health professionals and families; and with outside organisations.

In making this agreement for effective communication throughout the hospital setting, I agree the stipulations that this issue is primarily a leadership function of the hospital’s leaders. This agreement is stipulated in the Joint Commission International (JCI) Standard MCI.4 which states that “Communication is effective throughout the organization”, especially so if you are practising in a hospital accredited or seeking JCI accreditation status or undergoing re-survey for JCI accreditation status.

The reader as a leader of a structural unit setting and relevant service needs to be aware of the following conditions in this agreement for effective communication:

for patient care to appear seamless, processes must be in place for communicating relevant information in an accurate and timely manner throughout one’s structural unit, such as the HIM / MR department and between other structural units in the hospital; this is to ensure that the processes are designed and implemented to support continuity and coordination of care as patients move through the hospital from admission to discharge or transfer, several departments and services and many different health care practitioners may be involved in providing care; for example from emergency services to inpatient admission
the hospital defines the patient-specific information, example patient’s weight and other physiological information available from the medical record, required for an effective review process and is facilitated by a record (profile) i.e via medication administration records (MAR) or medication list, also to be found within a medical record for all medication administered to a patient except emergency medications and those administered as part of a procedure; the medical record folder is updated after a review of a patient receiving medications, example the folder is tagged with an alert sticker for allergies or sensitivity; this review also facilitates the medication reconciliation process across the continuum of care and the process continues upon discharge and transfer of the patient, and the complete list of patient medications is shared with the next provider of patient care
effective communication occurs in the hospital among the hospital’s programs ranging from the emergency services, inpatient admission, diagnostic services and treatment services, surgical and non-surgical treatment services and outpatient care programs for seamless care
since patients frequently require follow-up care to meet on-going health needs or to achieve their health goals, there is a plan by the hospital’s leaders with the leaders of other health care organisations in its community for effective communication to occur between the leaders of these other health care organisations in its community during referrals; the plan establishes contact with known resources i.e. the patient’s home community and identified specific individuals and agencies that are most associated with the hospital’s services and patient population in order that they help support continuing health promotion and disease prevention education
there are policies and procedures developed to support and to promote patient and family participation in care processes to ensure that continuity and coordination are evident to the patient; effective communication thus occurs with patients and families in these circumstances:
1. patients and families are involved in care decisions by effective communication thus occurs with patients and families when (i) they understand how and when they will be told of planned care and treatment(s), (ii) understand their right to participate in care decisions to the extent they wish and learn about how to participate in care decisions
2. inpatients and outpatients who leave against medical advice when patients, or those making decisions on their behalf, may decide not to proceed with the planned care or treatment or to continue care or treatment after it has been initiated guided by a process for the management and follow-up of such cases
3. effective communication thus occurs with patients and families when those who provide education encourage patients and their families to ask questions and to speak up as active participants
4. effective communication occurs with patients and families when indicated, planning for referral and/or discharge begins early in the care process ie. soon after admission as inpatients and, when appropriate, includes the family
5. effective communication occurs with patients and families when patients are reassessed to plan for continued treatment or discharge
6. effective communication occurs with patients and families such that symptoms and complications are prevented to the extent reasonably possible during the care of the dying patient
and finally. the reader as a leader must not only set the parameters of effective communication but also serve as role models with effective communication of the hospital’s mission and appropriate policies, plans, and goals to all staff.

I acknowledge the role of effective communication and its pervasiveness in creating, gathering and sharing health information in meeting challenges and improving health care outcomes. In this post, I think I have achieved to address some pertinent issues relevant to effective communication when implementing the requirements of the JCI Standard MCI.4 specifically and also delving into the issues of effective communication in general.

References:

Dale, EB & Daena, JG (eds.) 2009, Communicating to manage health and illness, Routledge, London, UK
Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
Michelle, AG & Mary, JB 2011, Essentials of Health Information Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, NY, USA
Sheila, P & Sandra, H (eds.) 2007, Health communication Theory and practice, Open University Press, McGraw-Hill Education, England, UK

It is natural to think of the Public Relations (PR) department of a hospital when a hospital needs to deal with a community it serves to facilitate access to care and access to information about its patient care services. Thus, it is not surprising to pass the buck to a representative of the PR department of a hospital sitting in a Management Of Communication And Information (MCI) Committee to deal with, and in order to comply with the Joint Commission International (JCI) Standard MCI.1 which states “The organization communicates with its community to facilitate access to care and access to information about its patient care services.”

I think if you are a leader championing the JCI MCI standards, this leader must not merely delegate this MCI standard to the PR department representative to deal with, but must also nurture as teacher, mentor, colleague, and friend to guide and be responsible to coach in the implementation and compliance of this standard, thus to care for and encourage the growth or development of MCI standards for the hospital. In this scenario, it is important for this leader to be knowledgeable in PR by at least researching the subject matter and linking his or her literature reviews with this standard.

From my interactions with representatives of PR department of hospitals, they normally deal with the management of both internal and external communications. They told me they are responsible for promotions of the hospital and implementation of the hospital’s marketing programmes that are related to overall mission and vision of the hospital, also manage and improve the flow of information within the hospital and between the hospital and the community it serves. Public relations professionals also serve as liaisons to the community and work closely with other health partners in the locality in preventive health. The responsibilities of a PR person in a hospital setting includes writing and distributing news release, feature articles to the press, compiling press list, witting of newsletters, handling and maintaining a media information service, arranging press, radio and television interviews for management, preparing marketing plans for various programmes and create strategies in promotional and marketing efforts. In summary, the PR department is responsible for community relations, hospital publications, media relations special events and support for fundraising.

Since the measurable elements for this standard requires a hospital to (i) implement a communication strategy, (ii) provide information on its services, hours of operation, and the process to obtain care through mass media interventions, such as those delivered by leaflets, booklets, posters, billboards, newspapers, radio and television, and (iii) provide information on the quality of its services, “the quality of services as is always determined by certain attributes that they have or should have. The most important attributes health services should have, are accessibility and availability,usage facility, public’s acceptance and all these always in relation to their cost.” (Athina and Andriani, 2012, p. 205) which is provided to the public and to referral sources with defined communities and populations of interest, I personally think that the PR department in a hospital is best suited to manage and measure this standard based on what I have already said in the preceding paragraph.

With all what I wrote above and what I intend to say in the next paragraph, let me remind you that all of us serving in the socioeconomic system of healthcare, including doctors and patients carry on our lives as person-systems within a hierarchy of multiple and overlapping systems of family, community and wider society. The internal needs of patients as person-systems, i.e. the patient is unwell, the patient’s family, workmates, employers and hospitals will tend to accept the sick role of this patient. After a defined length of time, the patient seeks the professional endorsement of a doctor for a clinical transaction, which is a subsystem of the hierarchy of systems comprising health care. At the end of the day, the person-systems of doctor and patient constituting of the patient, members of family, community systems and professional (e.g. the doctor) or economic systems, all support a speedy and complete return to health for the patient.

Members of the MCI Committee must be aware that the approach it chooses in understanding and measuring as well as complying with this standard, is driven by the care delivery for the population served by the hospital in advising patients on how to leverage the system to ensure coordination of care across the continuum, integrated across the continuum among defined communities and populations of interest with healthcare specialists in the hospital.

So what is this “defined communities and populations of interest”, if you are a member of a MCI Committee, you need to focus on?

Marie and Sandra (2011, pp. 46-47) define population of interest as “a population at risk or those with a common risk factor leading to the threat of a particular health issue. It also may be defined as a population of interest known as a healthy population who may in fact improve their health by making certain choices that will further promote health and/or protect against disease or injury. For example, an adolescent population that engages in alternative sports and chooses to wear protective gear avoids serious injury.”

I have been asked how and what does the PR department do in order to understand patterns and trends within this population of interest. First, I think it is the best interest of the PR department to be comfortable enough with information technology to collect and organise data, initiate and develop appropriate databases for their practice to better assess and serve the population of interest. I also think the PR department must design cross-sectional studies at finding out the prevalence of a phenomenon, problem, attitude or issue by taking a snap-shot or cross-section of the population. Pre-test/post-test studies could also be undertaken to measure the efficacy of a program on the same population to determine if a change has occurred.

I have also been asked how and what does the PR department do when identifying defined communities. My advice is that the PR department must be involved in gathering census data that provide the PR department with evidence about the overall health status of the population living in a particular community. The PR department could use the Internet which provides a wealth of data such as geography and history of a community as well as census track boundaries and data.

Armed with knowledge on defined communities and populations of interest, the PR department must surely be able to show evidence that there is (i) a communication strategy to reach the defined communities and populations of interest , (ii) information on its services, hours of operation, and the process to obtain care, and (iii) information on the quality of its services, which is provided to the public and to referral sources with defined communities and populations of interest, in order to fully comply with Standard MCI.1.

All this is possible when the hospital and the PR department jointly develop and revise strategic and operational plans to address community needs for a healthier community within larger geographic or political areas as reflected in the hospital’s mission and required by the JCI Standard GLD.3.1 which states that “Organization leaders plan with community leaders and leaders of other organizations to meet the community’s health care needs.”, thus recognising that they have responsibility for and can achieve an impact on the community.

References:

Athina, L & Andriani, D, 2012, Quality assurance in healthcare service delivery, nursing, and personalized medicine: technologies and processes, Medical Information Science Reference, Hershey, PA, USA
Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
Kingsley, N & Sam, S 2009, Problems With Patients: Managing Complicated Transactions, Cambridge University Press, Cambridge, UK
Louise, LI & Carolyn, LB 2008, Public Health Nursing: Leadership, Policy & Practice, Delmar Cengage Learning, New York, USA
Marie, TL & Sandra, BL (eds.) 2011, Public health nursing : practicing population-based care, Jones and Bartlett Publishers, Sudbury, MA, USA
Stephan, J & Frank, MG 2011, Information and Communication Technologies in Healthcare, CRC Press, Boca Raton, FL, USA