TJC: New patient-centered communication standards good for education
Learn what will be expected at various points of care
The new patient-centered communication standards issued by The Joint Commission support the work patient education managers already have been doing, according to Amy Wilson-Stronks, MPP, the project director on health disparities in the Division of Quality Measurement and Research.
PEMs have been advocates for writing patient materials in clear language and using communication techniques that make sure patients understand their medical condition, treatment options, and how to adhere to an agreed-upon treatment plan. Good outcomes occur when there is dialogue between the patient and health care provider during the education process.
A new standard in the provision-of-care chapter of The Joint Commission's accreditation manual clarifies that effective communication is a dialogue. It is not only providing information to patients in a manner they understand, but also allowing the patient to provide information and be part of a two-way conversation, says Wilson-Stronks.
In the realm of patient education, this requires that providers learn good education techniques, such as speaking in plain language and avoiding medical jargon. Also, this might require giving examples while teaching and using models and diagrams, or pictures, to illustrate a procedure or condition. Assessment of understanding must be routine, using such methods as "teach back," where patients are asked to explain to the provider what they were taught.
In addition, patients can learn how to obtain basic health information by asking questions and using techniques to remember the information, such as note-taking.
Information on how to prepare to comply with the new standards for patient-centered communication has been prepared by The Joint Commission. It is titled "Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals." The roadmap can be downloaded for free from The Joint Commission website at: http://www.jointcomission.org/PatientSafety/HLC/.
Changes to the standards are subtle but significant, says Wilson-Stronks. Research indicates that patient/provider communication can be linked to patient safety. Therefore, it is not only an issue of a patient's right to effective communication, but also a necessary component of the provision of safe, quality health care, she adds.
In the past, the standards addressing effective communication were found in the patients' rights chapter. While these standards are still in this chapter, a new standard was added to the provision-of-care chapter. This standard states that hospitals are to effectively communicate with patients. To meet this requirement, staff members must identify the patient's oral and written needs and communicate with the patient in a manner that meets the patient's needs, explains Wilson-Stronks.
"Again, communicate with, as opposed to provide information to," she emphasizes.
Support by peripheral standards
Changes and additions have been made to standards in other chapters of the accreditation manual to support patient-centered communication as well.
In the human resource chapter, standards on the provision of interpreter and translation services have been clarified. These services must not only be provided, but also trained and skilled individuals must be used for interpretation or translation services. Health care professionals are not to rely on a patient's family members, friends, or colleagues when communicating with patients.
Changes have been made in the chapter focusing on patients' rights as well. The standards now state it is a patient's right to have a support person during the course of his or her stay. This person can help with communication if the patient is not feeling up to communicating. Also, the person might act as a second set of ears, be alert to safety issues, such as reminding a physician to wash his or her hands, and advocate for the patient. Wilson-Stronks says that a support person often makes a patient feel at ease, so he or she has a better care experience.
The other rights issue that peripherally supports effective communication is the nondiscrimination piece, says Wilson-Stronks. She explains that when The Joint Commission developed the standards, those working on the project looked at the issues in the broader context of effective communication, cultural competence, and patient- and family-centered care. Some needs were specific to certain populations, such as patients who have disabilities, or those who may be lesbian, gay, bisexual, or transgender. For example, sometimes same-sex couples are held to a higher burden of proof than heterosexual couples in terms of domestic partnerships or marriage.
"We felt it was important to put into place a requirement that emphasizes the need for hospitals to have strong systems for preventing discrimination whether intentional or unintentional," says Wilson-Stronks.
She adds that health care organizations should make sure patients have advance directives in place to avoid any confusion. This is a good area for patient education, says Wilson-Stronks. She suggests health care organizations educate consumers on the wisdom of having advance directives.
Finally, the standard that directs hospitals to collect data on language and communication needs became more specific, stating that the data should include preferred language for discussing health care. Data on race and ethnicity were also added, with an understanding that often minority groups as a whole, rather than individually, tend to have lower health literacy.
These data can be used by organizations to determine which languages are encountered most frequently, helping them prioritize the documents they need to translate. The Joint Commission recommends that vital documents be translated. Those that support patient education can be vital, because they support informed consent and discharge planning. "You want those discharge materials to be useful to the patient, so they know what they are supposed to do when they leave the institution," says Wilson-Stronks.
Will hospitals be expected to have materials translated in a patient's preferred language?
The quick answer is "yes," says Wilson-Stronks. "That is a qualified yes, because it is not going to be the expectation that every single document is translated into every single possible language. That's unrealistic, particularly if you want to have the documents translated appropriately and accurately," she adds.
Hospitals will be expected to use the data they collected in determining which documents to translate. In addition, they will be expected to comply with the existing laws and regulations.
Use roadmap as guide
The "Roadmap for Hospitals" can be used in a variety of ways to meet the new standards, says Wilson-Stronks. For example, appendix D has information on what is required by law for translating documents and providing interpreters for the deaf and individuals with limited English proficiency.
An item highlighted in the roadmap, to which Wilson-Stronks suggests health care organizations should pay particular attention, is the issue of sight translations. It is never appropriate for a health care provider to hand a document, such as an informed consent form, to the interpreter and ask that he or she verbally translate it for the patient.
A better method would be to have the provider verbally explain the information contained on the consent form with the aid of the interpreter. Wilson-Stronks explains that the purpose of a consent packet is not just a signature on a document, although that is the legal support, but the process is the education and making sure the consent is informed. "To be informed, you need to be educated," she adds.
The two-way communication is important to note, for the new standards support exchange of information in all circumstances, including the times patients are unable to speak due to their medical condition or treatment, says Wilson-Stronks. This is an instance where the patient's chosen support person could intervene.
The roadmap was designed in a manner where it can be used in its entirety or divided according to different areas of responsibilities across an organization, says Wilson-Stronks. It also follows the general care process covering admission, assessment, treatment, end-of-life care, and discharge. An overall organization readiness chapter helps managers and administrators make sure system supports are in place to comply with what The Joint Commission recommends at admission, assessment, treatment etc.
Although chapters must be read for a comprehensive understanding, checklists are included to help managers make sure that what is required is occurring, says Wilson-Stronks.
Patient education managers should make sure staff are aware of the processes related to effective communication as spelled out in the treatment chapter and during discharge and transfer, for those are often the points of care at which a lot of patient education occurs, says Wilson-Stronks.
Patient education managers might also look at ways in which the organization can proactively engage patients, families, and the community, so they are prepared to be that active partner in the care process, says Wilson-Stronks.
In addition, patient education managers will help support staff in their communication efforts by providing educational materials that are translated into foreign languages and easy-to-understand copy for people with low health literacy.
Also, patient education managers will provide resources for staff to teach patients in their preferred learning method.
"Hopefully, the standards will support the fact [that] we need to have a blend of services provided for languages, for documents that are translated and written in other manners, and for other educational supports and opportunities," says Wilson-Stronks.
Source
Amy Wilson-Stronks, MPP, Project Director, Health Disparities, Division of Quality Measurement and Research, The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000.
The new patient-centered communication standards issued by The Joint Commission support the work patient education managers already have been doing, according to Amy Wilson-Stronks, MPP, the project director on health disparities in the Division of Quality Measurement and Research.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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