Communication with your clinical providers is vitally important. When discussing provider communication, I often get the question, “Why is it so hard to communicate with providers?” Sometimes it’s followed by a joke, usually about providers not being able to read their email on a timely basis.
At that point, I usually have to explain exactly why it’s particularly challenging. To help that along, there’s a little concept that’s fairly well-known in engineering circles, and now as well-known in clinical circles.
It’s called a signal-to-noise ratio, sometimes written in engineering circles as “S/N.” And it’s a super-helpful concept in a lot of situations, from everything including tuning your car radio, to developing communication strategy in emergencies, to clinical workflow design, to provider communication and education strategies.
The gist of it is simple: as ambient noises become louder, a person raises his or her voice. But then others do the same, which makes the background noise louder, forcing them to speak louder, and so forth.
It’s easy for the signal-to-noise ratio to get out-of-hand. This is why, nationally, provider communications and education strategies are particularly challenging.
This is also why, when there are critical safety issues, and patient care is on the line, the most reliable mechanism you can use to ensure proper communication (and confirm receipt of that information) is a direct telephone call. Other methods (pages, texts, emails, etc.) are all valid forms of communication, but they are asynchronous, and may be prone to delays, or worse yet, they may get lost in the signal-to-noise ratio the provider is currently experiencing. Telephone calls are synchronous; if it fails, you know immediately that it has failed, so you can try another provider or try another mechanism.
This is also why a good provider communication/education strategy does not just rely on just one mechanism, but many.
Sample modes of provider communication/education:
- Telephone Calls – Directly to the provider
- Pages – Requesting a call-back from a provider
- Texts – Directly to the provider
- Emails – T the provider’s email inbox
- EMR Inbox/In-basket messages – To the provider’s EMR inbox/in-basket
- Screen Savers – On institutional computers, in nursing units, patient rooms, etc.
- Posters – On the walls of the hospital, office, nursing unit, or staff bathrooms
- Department Meetings – Scheduled meetings with the department members
- Workgroup Meetings – Scheduled meetings with a select set of clinical staff
- Committee Meetings – Regular meetings with selected committees
- Face-to-face communication – Meeting in a common location (e.g. cafeteria, staff lounge)
- Intranet – Creating a high-value communication/learning ecosystem for providers (containing high-value blogs, videos, and links to training and solutions)
- Social Media – Creating easy links to high-value communication/learning (e.g. videos, blogs, and links to training)
- Classroom Training/Web Instruction – Creating a defined curriculum and assessment tool, for use in a classroom or virtual web environment
- Configuration/Clinical Decision Support – Embedding EMR alerts, order set templates, and other tools inside the common EMR workflows, to help guide staff to desired outcomes
- Policies/Procedures – Tools used to define organizational standards and how to achieve them
- Guidelines – Tools used to educate staff about how to achieve desired outcomes
- Onboarding/Credentialing – Tools used to educate staff when they join your organization
- Re-credentialing – Tools used to educate staff at regular intervals (e.g. re-credentialing)
- Screen Savers – Tools on the computers in clinical and non-clinical areas that display important messages during periods of non-use
- Each of these tools has its own costs, risks, and benefits. And so, which tools you use, and who you direct them to, requires thoughtful analysis and consideration of things like the following:
- What exactly is the purpose of the communication?
- Who (exactly) is the desired recipient/audience for the communication? (Careful not to confuse provider service with provider specialty!)
- What is the criticality of the communication? (What if the communication fails to reach the desired recipient/audience?)
- What details need to be included in the communication?
- When and how often does the communication need to be delivered? (Once? Before a project go-live? Or a series of emails leading up to the go-live?)
- Which of the above tools are likely to be most effective with the desired recipient/audience?
- How often will the communication need to be updated? (Is it a one-time communication based on a particular project? Or trying to communicate a TJC standard that may be updated next year? Or trying to communicate a long-standing HR standard that is unlikely to change?)
- How often will the communication need to be delivered? (Once? In a sequence leading up to an event? Only during credentialing/onboarding? Yearly? Bi-yearly with re-credentialing?)
That being said, I’d like to leave a few take-home points:
- It’s helpful to understand the concept of signal-to-noise ratios, when analyzing your clinical workflows and provider communication and education strategies.
- Some ways to help minimize noise include fully building out workflows (to minimize communications related to clarifications), changing the supervision model (to help off-load some communications to other members of the care team, e.g. APPs), or changing communications modes and timing (to better target communications and minimize disruptions during patient care hours.)
- Good provider communication and education strategies do not rely on a single tool. They are a toolbox of tools.
- The tool(s) you use for communications and education should depend on a thoughtful analysis of the exact message, the desired recipient(s), the timing, the criticality, the frequency, and the anticipated need to update the message(s) in the future.
- Every role will have a different communication map. You can streamline your workflows for any role by making a map and then working to streamline your communications.
I hope this is helpful in guiding your clinical workflow analysis and your provider communications and education strategies.
To view a video summarizing these points, click here.