Physicians’ communication skills can hone health systems’ competitive edge

Prepare them now or pay later

"I just fired my doctor," exclaimed Tiffany Erickson, a 30-something hairdresser from Gainesville, GA. "He barely spoke to me, wouldn’t explain anything, and never smiled. You’d think a doctor who is an expert in high-risk pregnancies would at least talk to his patients."

Like Erickson, more and more patients are "voting with their feet" when they are dissatisfied with their physicians’ communication skills and bedside manners. And for health care systems that employ physicians who possess high technical competencies but poor communication and leadership skills, that means losing their competitive edge.

"Twenty years ago, doctors didn’t have to worry about this because patients rarely considered changing physicians," says Barbara J. Linney, MA, director of career development and a faculty member for the American College of Physician Executives in Tampa, FL. "But today’s consumers are more sophisticated and want the most for their already stretched health care dollar."

Physician recruiters, Linney adds, report that communication is the No. 1 skill physicians lack. "Most of their medical school training concentrates on creating technical competency, but these technical skills are wasted if physicians can’t communicate to the patient what they are doing," says Linney, the author of Hope for the Future: Career Development Guide for Physician Executives.

Physician relations professionals can help groom physicians to become better communicators by using non-traditional hiring and training techniques, Linney and other physician development experts say.

First, make sure the physician is assessed for communication skills before he or she is hired. Here are some tips to use during the interview process:

Ask open-ended questions.

"What today’s medical practice demands is flexibility and balance, so I ask open-ended questions and watch their body language," says Theresa Ryan Mitlyng, MD, medical director of Park Nicollete Clinic, HealthSystem Minnesota, a 380-physician organization. "What has been your exposure to managed care?" Ryan Mitlyng asks of the physicians. If a candidate has had a negative experience and is not open to the concept, then that is a warning sign that he or she may not be an appropriate choice, she says.

Observe behavior carefully. "Pay careful attention to how the candidate treats everyone," Linney says. "Check with your assistants to see how the person interacted with them. If they were haughty or arrogant, don’t hire them."

Donna Loy agrees. "This type of behavior is a red flag for me," says the regional director of physician recruitment, at CHI Reading and Lancaster, PA. "If they are demanding and rude to a secretary, how will they treat their patients?"

Loy also watches how they react to scheduling changes. "During the interview process, things never go exactly as planned. So observe how the physician handles that. Is he or she upset? Or do they take it in stride? It’s a good indication of flexibility."

Move outside their comfort zone. Loy recommends riding in a car with candidates and having a meal with them. "How well do they make small talk? If you begin by talking about your family, will they respond?" she asks. "In both situations, you’ve moved outside the office, so you can observe their flexibility and ease in other social situations."

Loy often invites members of the staff to join her and the candidate for a meal. "We intentionally keep the conversation light — this isn’t the time to grill the physicians about their clinical skills," she says. "But I do want to get feedback from the people the physician will be working with on a daily basis."

Linney agrees that watching how candidates relate to people can be the key to assessing their communication skills and how well they will communicate with patients. "If they clearly don’t like interacting with lots of people, then effective communication will be a real energy drain," she says.

Listen to their listening skills. "If the candidate talks incessantly, then this is a sign that he or she isn’t a good listener," Linney says. "A sign of a good listener is that he or she should be able to paraphrase important information back to you."

But innovative hiring techniques aside, physician relations professionals can’t depend solely upon physicians’ natural ability to communicate effectively. "Remember, their education doesn’t prepare them for good communication. In fact, it discourages the process — physicians are trained to find out the most information in the shortest possible amount of time," Loy points out.

That’s why in-depth training on communication styles is essential. "If a physician can learn about the various communication styles and find out what style he or she uses, then it follows that he or she can also alter that style to be able to more effectively get their message across to others," Linney says.

At HealthSystem Minnesota, Kathy Cummings, MA, director of performance development resources, is helping doctors do exactly that. As part of a leadership development course for physician and non-physician leaders, the communication component contains an inventory that measures each participant’s communication style based on behavior.

"They learn their style’s strength and weakness, as well as how to identify and understand the strengths and weaknesses of others," explains Susan Forstrom, RN, MSN, executive vice president of Creative Health Systems, a Minneapolis consulting firm that helps health care facilities with leadership development, care delivery, work redesign, and team issues.

The inventory, called DISC, does not measure intelligence, values, skills, or experiences but, rather, behavior and emotion according to the following four basic styles:

Drive. "This measures one’s response to problems and challenges, decisiveness, and authority," says Forstrom. A high driver, for example, likes to solve problems, while a low driver prefers solid directions.

Influencing. "This measures one’s interest in interacting with and influencing people, as well as factors of trust, openness," Forstrom explains. A person who scores high in influencing is articulate and enthusiastic, while a low influencer communicates with few words.

Steadiness. "This indicates how responsive one is to change along with activity and pace, consistency, persistence, listening skills, and stability," Forstrom says. A high score in this style denotes a loyal team player, while a low score indicates that the person prefers variety to routine.

Compliance."This measures how interested one is in following rules or procedures set by others, as well as accuracy and precision," she says. A high complier handles details well, while a low complier may be careless with details.

To find out which of the four basic styles they use, participants first spend 12 minutes selecting a series of words in 24 boxes that best describe themselves. The results are fed into a complex and sophisticated software program that measures the intensity of the style and creates a 15-page detailed report of the following information:

• What communication style do I use?

• In what type of environment do I function best?

• What is my distinct value as a team member?

• What should I do or not do in approaching another whose style is difference from my own?

For example, "High D" physicians should take time to explain why, to be more helpful, friendlier, and more open, while a "High I" should work at being less impromptu and listening more than talking, Forstrom says. A "High S" should work on sharing information more readily with others, and a "High C" needs to use fewer facts and data and more feelings and intuition. (See the chart, above.)

"Physicians reap tremendous benefits when they learn this," says Cummings. "They learn how to gain commitment and cooperation from patients and staff, how to build better teams, and [how to] resolve conflict."

Physician relations professionals also can reap the benefits of the behavior inventory. Because the software also creates an analysis of communication styles according to types of physician practices, the styles of surgeons, for example, could be compared to internists. "It’s like having an instruction manual for communicating with doctors," Forstrom says.