Introduction
Communication is a significant aspect that affects all the processes within the domain of healthcare. Medical professionals interact with each other and with the patients, which is an essential contribution to future diagnosis, care, and subsequent outcomes. On the other hand, ineffective communication can lead to adverse results that create challenges for both parties and induce an overall hostile environment. Moreover, a lack of specific guidelines based on existing theories can drastically decrease patient safety. This can cause malpractice, medical errors, and other issues that compromise the physical well-being of the general population. While the healthcare sector is already highly regulated in terms of interactions between doctors, nurses, and patients, specific theories can be applied for bettering communication and minimizing existing risks. This paper examines two relevant theories which can improve the situation by creating a more positive environment and an openness that allows people to interact and communicate within the medical facility where they operate. Literature suggests that using the social penetration theory and the norm of reciprocity can be effective in mitigating limitations and addressing certain issues related to professional relationships. Applying the models mentioned above as a base for prolific communication in healthcare can lead to positive results for both medical facilities, employees, and patients.
Existing Communication Barriers in Healthcare
It is certain that communication in healthcare is regulated due to the severity of the possible risks that may occur in the industry. Since people’s safety and well-being are at stake, all facilities have norms and guidelines in regards to how workers should address problems and topics that require discussions and dialogues. The problem is that while some aspects of professional communication can be regulated, others cannot since interactions mainly depend on the people who participate in the discussions. Furthermore, due to the fact that people are different, have various backgrounds, cultures, and overviews, it may be challenging to form a connection between two seemingly contrasting individuals. Thus, there is a risk that healthcare providers and their patients will not be able to form a connection that is so necessary for risk mitigation. The barriers that may occur can be based on cultural and language differences and privacy concerns.
Language/Culture Barriers
Interpersonal barriers are harder to identify and correct, while obvious ones, such as cultural and language barriers, are easy to determine and mitigate. According to researchers, language and culture barriers usually occur when patients with little to no knowledge of a country’s language and cultural aspects seek healthcare and cannot receive the necessary services (Schouten et al., 2020). While linguistic challenges can be mitigated through the use of technology or translators, the cultural ones require a level of understanding and compassion from both parties. Thus, both healthcare providers and individuals seeking their help have to find a way to communicate without bias and intrinsic differences creating barriers. Such challenges can be minimized if physicians and nurses apply specific techniques to overcome the cultural distance and make the patient feel comfortable enough to be open to honest discussions.
Privacy concerns
Among the possible barriers that affect prolific doctor-patient communication is a privacy concern. While dialogues with healthcare providers are supposed to be based on trust and openness, an existing limitation is the patient’s lack of desire to share intimate details in regards to their health, personal life, and other things that may be helpful in determining symptoms and building a recovery plan if necessary. Researchers have examined the topic and concluded that frequently, women who went through chemotherapy find it challenging to share information about concerns in regards to their reproductive system (Zimmaro et al., 2020). Moreover, the lack of confidence results in a lack of communication about the possible emotional distress caused by the cancer treatment. Such results illustrate that subjects that patients deem private and intimate are often left out during communications with medical professionals. Thus, it is important to build trust and openness to combat such damaging factors as privacy concerns. If individuals are confident that the nurses and physicians can be trusted with delicate information, there will be a more negligible risk for medical errors and issues left out during the treatment.
Effects of Ineffective Communication in Healthcare
As mentioned prior, communication in healthcare is such a crucial subject due to the possible adverse outcomes that may occur due to a lack of it. Since the health of the general population is at risk, it is inevitable that this aspect of healthcare is being addressed and guidelines are being implemented to reduce errors. Issues can happen when doctors cannot build trustful connections with patients and when medical professionals are not proficient in having dialogues. There are multiple negative outcomes that occur due to a lack of prolific communication, such as negligence and patient dissatisfaction.
Medical Errors
Minimizing medical errors is one of the main concerns within the healthcare domain. Furthermore, researchers point out that ineffective communication directly correlates with such errors (Peadon et al., 2020). On the other hand, researchers highlight that such issues are less damaging in medical facilities where communication is adequately addressed. Hassan (2020) mentions that medical workers who apply different techniques while sharing and receiving information from their colleagues and patients are less likely to contribute to medical errors. This highlights the damaging results that occur as a result of patient-medical provider and medical provider-medical provider inefficient interactions.
Patient Satisfaction
Patient satisfaction is the way the individual seeking medical care views the efficiency of services received. It is formed based on multiple factors, including safety, the performance of the providers, follow-up procedures, consent, and communication. Lotfi et al. (2019) specifically refer to a lack of communication as the main factor resulting in low levels of satisfaction among patients. Low levels of this measurement may result in less frequent doctor visits and a decrease in trust. These adverse outcomes are harmful since the patient may not choose to consult with a specialist in case health problems occur.
Relevant Theories in Combating Communication Barriers
The two theories that will be discussed as effective ways of creating an environment where open communication is encouraged are the social penetration theory and the norm of reciprocity. These models have been developed to build personal and professional relationships based on trust, openness, honesty, and two-sided interest. Social penetration is the method that helps people overcome the first introduction and move towards a more personal level of communication. The suggested tools are asking general questions and slowly building up the level of trust between the two parties. Nonetheless, the norm of reciprocity is the theory that helps maintain a healthy dialogue and effective interactions within the medical setting. The idea is that everything an individual gives creates a need for the receiver to return it back, creating reciprocity. Both models have been examined by relevant researchers and have been observed to lead to a positive environment in healthcare communication.
Social Penetration: Implementation and Results
As mentioned prior, social penetration refers to the transition from one communication level to a more advanced one. Altman and Taylor (1983) discuss how questions can lead to the advancement of a relationship and the mitigation of such factors as anxiety and a lack of confidence. Moreover, since any communication begins with shallow conversations, it becomes more intimate and personal as the conversations become more honest and open. The key objective of social penetration is self-disclosure, which is sharing personal information and intimate details about one’s medical, physical, and emotional concerns (Osatuyi et al., 2018). Based on this theory, the doctor or nurse has to start by asking shallow questions that are easy to answer and do not invade the privacy of the patient. The initial barrier is establishing trust, which is a critical aspect that contributes to openness (Chandra et al., 2018). Next, it is important to move forward and start asking questions that would be uncomfortable for patients to answer without the first step.
By slowly approaching the level of trust that would allow the doctor or nurse to receive fully transparent information, patient satisfaction would increase, and privacy would not be such a mitigating factor. Self-disclosure would be possible, and the healthcare providers would receive more helpful information (Lee & Lin, 2017). Furthermore, it is important to mention that social penetration is not only crucial in patient-doctor communication but also a useful method frequently used within corporate circles. Specifically, medical providers can use the same approach to form close professional relationships and strong teams based on trust and transparency. This is especially necessary when new team members enter the facility where they need to establish relationships with their colleagues. According to researchers, employees within the medical setting who use this theory to establish healthy communication with coworkers are more likely to be included in social circles (Tang et al., 2021). Such an approach leads to the team becoming more united, open to constructive feedback, and prone to helping one another.
Social Penetration: Limitations
The social penetration theory can be applied in different environments and types of relationships. However, researchers point out that it primarily covers intimate relationships (Carpenter & Greene, 2016). Moreover, the authors mention the limitation in terms of scope and long-term plan. Since the goal is to establish healthy and honest communication, it is challenging to predict how far the theory must go, especially regarding patient-doctor interactions. It is essential to illustrate the importance of ethical behavior in the medical setting. Since the social penetration model does not go in-depth in terms of identifying the exact level of professional intimacy required for honest feedback, there is a threat of overstepping privacy boundaries. Thus, there is no reliable suggestion from the authors of the theory regarding the limitations and the stopping point when it comes to professional settings.
Norm of Reciprocity: Implementation and Results
The norm of reciprocity is based on the theory of giving back. This model was initially published by Gouldner in 1960, who claimed that social environments create conditions that lead people to respond with reciprocity and feel an obligation to return something received (Kjørstad, 2016). Based on this theory, a medical provider who is open and transparent with the patient can expect the same in return. On the other hand, those who do not receive high-quality care and a perceived interest during their interactions with nurses and doctors will return the same level of indifference.
Such a psychological approach has been found to be effective in multiple settings. While this theory is often interpreted as one that refers to physical gifts and favors, it also applies to communication patterns. The norm of reciprocity is often used to build professional relationships and healthy interactions in the healthcare field in particular. It is certain that patients are more likely to find respectful and caring medical professionals trustworthy. On the other hand, perceived ignorance and a lack of interest are less likely to contribute to high satisfaction. Brandenberger (2018) refers to the norm of reciprocity as a long-term communication enhancer. Thus, patients whose doctors and nurses apply this model are more likely to be open and transparent with their concerns, feedback, and limitations during follow-ups. The evidence illustrates the efficacy of utilizing this theory as a method for establishing ethical and prolific patient-healthcare provider relationships.
The norm of reciprocity is also used in medical teams among coworkers. Team members who are actively trying to communicate, help and assist their peers are more likely to receive positive feedback and other benefits in return. Researchers point out that employees who use this theory during communication are more motivated and satisfied due to the overall attitude that their coworkers have towards them (Ullah et al., 2017). In terms of team-based interactions, it is inevitable that colleagues who offer help and make an effort towards creating a positive professional environment are more likely to receive the same attitude from their coworkers. In contrast, there is a risk that less communicative and helpful employees will not receive feedback, help, or instructions based on the theory of reciprocity.
Norm of Reciprocity: Limitations
Since the norm of reciprocity follows an eye-for-eye method, both negative and positive behavior is either rewarded or punished with similar deeds. Research done by Greco et al. (2019) has examined the phenomenon of negative reciprocity in work environments. Based on the observations, team members often repay their coworker’s negative actions or arguments with similar behavior. Moreover, the researchers have noticed escalation, which led to a more significant conflict. The conclusion illustrates that if a medical provider is not effective when it comes to communicating based on either personal or professional limitations, collages may further worsen the situation by entering into active conflicts and arguments. It is essential to mention that the theory does not only cover positive reciprocity. In case patients do not feel like sharing personal information or engaging in conversations with their physicians or nurses, there is a chance that the connection will not be possible based on the model of negative reciprocity. This limitation can be damaging due to the seemingly circular system in which parties cannot singularly influence the situation.
Discussion
Communication in healthcare is a pivotal factor that needs to be addressed. Since interactions among medical care workers and with patients tremendously contribute to the well-being of the level of services within facilities, it is essential to create guidelines and suggest theories that would address the subject. Two proposed models suggested in the existing academic literature that can mitigate the risk factors correlating with a lack of effective communication are social penetration and the norm of reciprocity.
Social penetration helps overcome the initial barrier when the person is not confident enough to share seemingly intimate and personal health concerns. As suggested by this theory, the doctor can start by asking general questions and slowly building up trust and honesty while achieving the next relationship level. The second model, the norm of reciprocity, is a long-term solution related to treating patients and colleagues the way one wants to be treated back. According to this framework, patients who perceive their interactions with nurses and physicians as open and transparent are more likely to follow the same communicative style. The model is also effective in professional relationships among coworkers who have to contribute to prolific interactions in order for the second party to use the same technique based on reciprocity.
Conclusion
Communication is an essential part of every environment, but it is especially critical in the healthcare field. Due to the fact that this domain correlates with the well-being of the general population, it is vital to suggest practical ways of mitigating risks that correlate with a lack of communicative measures. Some of the possible barriers include language differences, cultural misunderstanding, and a perceived intrusion in the personal space of the patient. These barriers may lead to a decreased patient satisfaction rate and medical errors. The two theories that can help mitigate such challenges are the social penetration model and the norm of reciprocity. Existing literature supports the two models by ensuring satisfactory results in terms of establishing relationships based on trust and increasing openness using reciprocity. Both theories are based on psychological tools designed to minimize the distance between patients and healthcare providers or among colleagues and create an environment that encourages communicative transparency. The suggested theories have an excellent potential of decreasing patient dissatisfaction, low employee morale within the social environment of the healthcare facility, and medical error.
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