The Importance of Communication Skills in Healthcare

Exploring the issue of the importance of communication skills and knowledge is somewhat like
discussing the need for eyes in order to see. No healthcare provider would argue either the
relevance or importance of these communication skills and knowledge (1). Effective communication
skills are necessary for the provision of high quality patient care by health-care professionals (6).

Del Mar (1994) in an assessment of related literature over a 35 year period, showed that providers’
good communication skills are associated with better care and even better health (3). There is
compelling evidence from the literature demonstrating that good communication is associated with
many important and meaningful health outcomes (7) and that poor communication has been
associated with lower patient satisfaction, treatment non-adherence and negative clinical outcomes
(8).

Maguire and Pitceathy (2002) point out that healthcare providers do not communicate as well as
they should. They summarise the case for better communication skill competency. If the
communication skills were improved, the quality of care would improve and the costs of this care
could be reduced (2).

Communication is a fundamental skill of medical practice and good communication skills are
essential for high quality, effective, and safe medical practice. These skills are used for information
gathering, diagnosis, treatment, and patient education and are critical to the practice of medicine
and nursing (9) and there is evidence that effective communication can be taught and effectively
trained (10, 11). However, while healthcare communications skills and knowledge is the subject of
many healthcare professional training programmes, they might not receive the attention they
deserve (1).

As the population ages, morbidity and mortality associated with chronic disease will increase. Some
patient-centered improvements have been made in health care services, but optimal health has not
been fully realized (15). The need for effective teams is increasing due to increasing co-morbidities
and increasing complexity of specialization of care. In delivering health care, an effective teamwork
can immediately and positively affect patient safety and outcome. Motivation of team members
should be backed by strategies and practical skills in order to achieve goals and overcome challenges
(4). An effective team is a one where the team members, including the patients, communicate with
each other (5).

The role of pharmacist has changed from distribution of medicines towards being a patient-centered
profession and putting the patient and not the medicine in the centre. Ideally, pharmacists use their
specialized health and pharmacotherapeutic knowledge along with communication skills (18).
Pharmacists’ work has evolved greatly over the past years, moving from a practice essentially based
on preparing and dispensing medicines to patients towards the development of a clinically based
relationship, which comprises monitoring of patients’ conditions and concomitant medication use. It
is known that most patients, particularly those with chronic ailments and medication adherence
problems, may benefit from this professional role that encompasses interventions designed to
improve patients’ health-related outcomes (17).

1
Several pharmacist communication guides exist. They describe how and what a pharmacist should
communicate, for example, the United States Pharmacopeia (1997) Medication Counselling
Behaviour Guideline (14), The Four Habit Model (15), and the Health Professions Core
Communication Curriculum. Based on a broad European expert consensus, the Health Professions
Core Communication Curriculum can be used as a guide for teaching communication inter- and
multi-professionally in undergraduate education in health care (16).

According to ‘the seven star pharmacist’ as identified by the WHO’s working group, the pharmacist
role includes being a communicator. The pharmacist must provide a link between physicians and
patient, and to other health care professionals. He or she should have complete knowledge about all
the pharmaceuticals with recent updates and be confident, while communicating with other health
care professionals. Strong communication skills will enable a pharmacist to establish the necessary
rapport to build a trusting relationship; and to ensure an effective exchange of information (12).

The importance of being a communicator is also addressed by the International Pharmaceutical

Federation (FIP) Codes of Ethics (2014) and requires for pharmacists to collaborate with other health
professionals to ensure that the best possible quality of healthcare is provided both to individuals
and the community at large, to ensure that all information provided to patients, other members of
the public and other health professionals is accurate and objective, and is given in a manner
designed to ensure that it is understood, to treat all those who seek their services with courtesy and
respect and to recognise and respect the cultural differences, beliefs and values of patients,
particularly as they may affect a patient’s attitude to suggested treatment (13).

Communication problems between healthcare professionals, such as doctors and pharmacists, are
prevalent and known to contribute to medication errors. In particular, poor communication has been
identified as one factor that can affect prescribing error. Strong collaboration between pharmacists
and physicians is necessary to improve patient care. Understanding the current barriers, attitudes,
and patterns between pharmacists and physicians will aid advancing overall healthcare (23).

Effective communication between pharmacists, doctors, and nurses about patients’ medications is
particularly important in hospital settings where high-risk medications are frequently used. (19).
Doctors, pharmacists and nurses in hospital settings have a role in providing information and
education about medications. The communicator’s role of the pharmacist is one part of the caring
professional role. Poor communication between healthcare providers, including pharmacists and
physicians, has been identified as a major contributing factor to medication errors and medication
misuse (20).

In May 2006 the Council of Europe issued a document on Patient Safety that says “medication errors
are the most common single preventable cause of adverse events and European health authorities
should consider them as an important public health issue.” Many studies have indicated that
shortcomings in communication and management may lead to unsafe practices and that medical
care in hospitals is increasingly dependent on seamless cooperation between medical specialists and
other professionals (21). In 2015, the EU regulatory network released a two-part good practice guide
on medication errors to support both the pharmaceutical industry and regulators (22).

Hospital pharmacists are experts in most aspects of safe medication practice. From drug selection by
means of the hospital formulary; support for physicians regarding dosing / individual dose
2
adjustments, interactions and therapeutic drug monitoring; to acquisition of high quality drugs,
either by purchasing or in house production and quality control, logistics; and finally drug
distribution to the patient. Only the pharmacist is equipped to overview this whole process and the
hospital pharmacist is the key stakeholder. The main reasons for a physician to contact a pharmacist
include checking on medication adherence, providing a refill prescription, discussing possible
medication-related options and checking drug plan coverage for their patients (23).

Communication can lead to better health include increased access to care, greater patient knowledge
and shared understanding, higher quality medical decisions, enhanced therapeutic alliances,
increased social support, patient agency and empowerment, and better management of emotions
(24).

The results of a study by Street Jr RL et al. (2009) show that transitional care of the elderly consists of
six main challenges (themes) in which quality is at stake. Quality was impaired by a lack of systematic
information exchange between health care professionals and next of kin and limited involvement and
preparations for transitions of patients and next of kin. Health care professionals lacking professional,
system and role competence, difficulties related to information exchange between health care
professionals, lack of sufficient staffing and elderly patients experiencing multiple transfers and
challenges related to assessing the patients’ clinical conditions were other challenges. (25)

In addition to possessing competent clinical skills, pharmacists must further develop their ability to
communicate effectively with other health-care professionals and especially with patients and their
caregivers. Effective communication by pharmacists may lead to improved clinical outcomes as
described in the referenced communication literature.

References

1. Communication Skills for the Healthcare Professional 2nd Edition by Laurie Kelly McCorry PhD
(Author), Jeff Mason (Author). January 1, 2011.

2. Key communication skills and how to acquire them. BMJ 2002;325:697

https://doi.org/10.1136/bmj.325.7366.697 (Published 28 September 2002).

3. Communicating well in general practice. Del Mar CB. The Medical Journal of Australia [01 Mar
1994, 160(6):367-370].

4. Health care professional development: Working as a team to improve patient care. Amir Babiker,
Maha El Husseini, Abdurrahman Al Nemri, Abdurrahman Al Frayh, Nasir Al Juryyan, Mohamed O
Faki, Asaad Assiri, Muslim Al Saadi, Farheen Shaikh, Fahad Al Zamil Sudan J Paediatr. 2014; 14(2):
9–16.

5. World Health Organization. Being an effective team player. Available from:

http://www.who.int/patientsafety/education/curriculum/who_mc_topic-4.pdf

6. Adherence to long-term therapies—evidence for action. World Health Organization Web site.
http://www.who.int/chp/knowledge/publications/adherence_report/en/ Published January,
2003.

3
7. Effective physician/patient communication and health outcomes: a review. Stewart MA. Can Med
Assoc J 1996, 152, 1423-1433.

8. Quality in transitional care of the elderly: Key challenges and relevant improvement measures.
Storm M, Siemsen IM, Laugaland K, Dyrstad DN, Aase K. Int J Integr Care. 2014;14:e013.

9. Principles of training medical staff in psychosocial and communication skills. Roter D, Fallowfield
L. In Holland JC, ed. Psycho-oncology. New York, Oxford, Oxford University Press, 1998, 1074-
1082.

10. The development of a training model to improve health care professionals' skills, self-efficacy,
and outcome expectations when communicating with cancer patients. Parle M, Maguire P,
Heaven C. Soc Sci Med 1997, 44, 231-240.

11. Training Programs in Communication Skills for Health Care Professionals and Volunteers. KC
Rajashree. Indian J Palliat Care. 2011 Jan; 17(Suppl): S12–S13.

12. Seven-Star Pharmacist concept of WHO. Journal of Young Pharmacists 2(1):1-3 · June 2014.

13. FIP Statement of Professional Standards Codes of Ethics for Pharmacists. Approved by FIP Council
in New Orleans in September 2004.

14. Validation of the United States Pharmacopeia (USP) medication counselling behaviour guidelines.
I. Puumalainen, P. Halonen, H. Enlund, K. Johnson, M. Airaksinen. Pharmacy Education, Month
2005; 00(0): 1–10.

15. Patient-Centered Communication. Cynthia A. Naughton. School of Pharmacy, College of Health

Professions, North Dakota State University Fargo, ND 58108, USA; 13 February 2018.

16. A European consensus on learning objectives for a core communication curriculum in health care
professions. C. Bachmanna, H. Abramovitch, C. Gabriela Barbu, A.M. Cavacode, R. D. Elorzaf, R.
Haak, E.Loureiro, A. Ratajskai, J. Silverman, S. Winterburnk, M. Rosenbaum. Patient Education
and Counseling. Volume 93, Issue 1, October 2013, Pages 18-26.

17. Do community pharmacists actively engage elderly patients in the dialogue? Results from
pharmaceutical care consultations J. Pelicano-Romano, M. R. Neves, A. Amado and A. M. Cavaco.
2013 John Wiley & Sons Ltd. Health Expectations, 18, pp.1721–1734.

18. Facilitators and Barriers to Pharmacists' Patient Communication: The Pharmacist Profession, the
Regulatory Framework, and the Pharmacy Undergraduate Education. K. Svensberg. Doctoral
thesis 2017. Farmasøytisk institutt University of Oslo.

19. Pharmacists' Interprofessional Communication About Medications in Specialty Hospital Settings.

Rixon S1, Braaf S, Williams A, Liew D, Manias E. Health Commun. 2015;30(11):1065-75.

20. Improving Patient Safety Through Provider Communication Strategy Enhancements. C. Dingley, K.
Daugherty, M.K. Derieg, R. Persing. In Advances in Patient Safety: New Directions and Alternative
Approaches (Vol. 3: Performance and Tools). Denver Health Medical Center, Denver.

4
21. The Council of Europe recommendation Rec(2006)7 on management of patient safety and
prevention of adverse events in health care. T. Perneger. International Journal for Quality in
Health Care, Volume 20, Issue 5, 1 October 2008, Pages 305–307.

22. Medication Errors: New EU Good Practice Guide on Risk Minimisation and Error Prevention
Goedecke, T., Ord, K., Newbould, V. et al. Drug Saf (2016) 39: 491.

23. Communication in healthcare: a narrative review of the literature and practical

recommendations. P. Vermeir, D. Vandijck, S. Degroote, R. Peleman, R. Verhaeghe, E. Mortier, G.
Hallaert, S. Van Daele, W. Buylaert, D. Vogelaers. Int J Clin Pract. 2015 Nov; 69(11): 1257–1267.

24. How does communication heal? Pathways linking clinician-patient communication to health
outcomes. Street Jr RL, Makoul G, Arora NK, Epstein RM. Patient Educ Couns. 2009
Mar;74(3):295-301.

25. Quality in transitional care of the elderly: Key challenges and relevant improvement measures.
Storm M, Siemsen IM, Laugaland K, Dyrstad DN, Aase K. Int J Integr Care. 2014;14:e013.

Bibliography

 Communication skills for pharmacists: building relationships, improving patient care. Third
ed. Berger BA. Washington, DC, US: American Pharmacists Association; 2009.

 Communication: Core Interpersonal Skills for Health Professionals, 2nd edn. O’Toole G.
Chatswood NSW, Australia: Elsevier; 2012.

 Developments in health communication in the 21st century. Jones L, Watson BM. J Lang Socl
Psychol. 2012; 31:415-436.

 Pharmacists’ evaluation of key communication skills in practice. Hargie OD, Morrow NC,
Woodman C. Patient Educ Couns 2000; 39(1): 61-70.

 The silent impact of ageist communication in long term care facilities: Elders' perspectives on
quality of life and coping strategies. Lagacé M, Tanguay A, Lavallée M-L, Laplante J,
Robichaud S. J Aging Stud 2012; 26(3): 335-42.

 Visualising conversations between care home staff and residents with dementia. Baker R,
Angus D, Smith-Conway ER, Baker KS, Gallois C, Smith A, et al. Ageing Soc 2015; 35(02): 270-
97.