Module 12- Communication and Customer Service

Business Letter Formats

Letters can be created for many purposes, and templates are often used for creating them. Templates are sample letters that provide the format, and the user adds the words where appropriate. Proofreading is important to ensure the letter is free from errors and is grammatically correct. Letters may be created to address a concern with a third-party payer, write a patient about their past-due balance, or request a consultation from another medical provider. Letters include the date, address, salutation, body, and complimentary closing and are done on letterhead for the health care organization. They are more formal in nature and usually mailed using the United States Postal Service (USPS) or another professional service. Certified mail can be used to ensure the letter has been received by the intended party in circumstances where it is imperative that the information is received. An example of this would be if a patient needs to be informed of concerning lab results and cannot be reached by phone or email or if a provider makes the decision to terminate a relationship with a patient.

Which of the following communication styles is patronizing?

Manipulative

Patient Characteristics Affecting Communication

Many factors that can affect communication must be considered. This includes potential barriers such as language, culture, or comprehension level. Proactively determine and address conditions or situational needs that apply. It is just as important to adjust accordingly as it is to identify any accommodations. As a rule, it is better to ask the patient how they would prefer to be assisted rather than making assumptions about their abilities and needs. Provide an interpreter for patients that have minimal understanding of the language being spoken. Family members can be considered if the patient has agreed to allow them to be informed of their medical information. In such circumstances, avoid using medical terminology and always convey messages using lay terms. Patients who have physical impairments can be assisted best by asking them how they would like to be assisted. When speaking with a child, use terms that they can understand based on their developmental level. ​​​​​​​ Effective communication with a patient who has experienced hearing loss can be accomplished with appropriate language use, facing the patient, enunciating each word, and asking if they have any questions or concerns. When summarizing information for the patient, use a repetition of words from the explanation provided. Then, ask the patient to repeat the information back to assess their understanding of what was communicated.

Nonverbal Communication

Nonverbal communication can be just as important as the words being spoken. Nonverbal communication is any type of communicating that does not use words. Nonverbal communication should be used to support a message being given and should not contradict the intended message. Body language is an example of nonverbal communication. Body language is the use of gestures and movements while communicating. It can include facial expressions, eye contact, gestures, and mannerisms. Ensure that the message and nonverbal communication match to add to the accurate understanding of the receiver. For example, when expressing empathy for a patient who has just received a terminal diagnosis, follow with a look of care instead of a smile.

What is the importance of the words matching the actions?

Nonverbal communication should be used to support a message being given and should not contradict the intended message. Body language and nonverbal communication can be just as important as the words being spoken in avoiding miscommunication.

Open-Ended

Open-ended questions ask for general information and can be used to start a conversation. This type of question can establish the conversation and create a comfort level of discussion. It can give the patient freedom to share what they feel is imperative regarding the topic. "How are you feeling today?" "Can you describe your symptoms?" "Can you explain the type of pain you are feeling?"

Five Ps of Telephone Etiquette

Polite. Use a soft tone. Prepared. Have all the relevant details (names, numbers, dates). to the Point. Don't beat around the bush. Perceptive. Don't waste people's time by talking on irrelevant topics. cooPerative. Provide the information needed. If you can't help, find someone who can or tell the caller you will call back with the information.

Telephone Communication

Privacy, security, and confidentiality must be followed using Health Insurance Portability and Accountability Act (HIPAA) guidelines when speaking with all vested members in the health care process (patients, caregivers, third-party payers) on the telephone. HIPAA will be covered in greater detail in another module.

Demonstrate Professionalism

Professionalism is a must in a health care organization. It must be present in all aspects of the overall environment. Professionalism encompasses the following. Behaviors Appearance CommunicationVoice: tone, attitude, and word selectionWritten Work ethic Relationships All members of the health care team have their own roles and responsibilities that fit together to form a well-organized machine. All team members must be courteous, knowledgeable, and respectful in their presence and approach with the patient. The MA will be one of the first encounters that a patient has in the health care experience, and the first impression is important. Maintain a professional manner with a positive attitude of encouragement and support. These behaviors will help to build a relationship based on trust and respect.

characteristics of active listening

Remaining nonjudgmental, positive body language, and allowing time to digest words or intended message.

communication

Sending and receiving information, thoughts, or feelings through verbal words, written words, or body language.

Which of the following is an example of body language?

Shaking hands

Which of the following actions should be followed when on the phone with a patient?

Smiling while talking

Stereotypes and Biases

Stereotypes are generalized assumptions about a person or group of people. Biases are prejudice against a person or group of people. Both can enter the communication process and should be identified and eliminated to ensure effective communication with patients, families, and medical professionals. Addressing stereotypes and biases efficiently will help to contribute to the sending and receiving of the intended messages. A greater understanding of the diversity of people can help to decrease stereotypes and biases. Language, customs, culture, economic status, and age are all factors that contribute to the diversity encountered in health care. Always be respectful and professional.

What is the best approach for an MA when speaking with a patient who is upset?

The MA must be patient, use active listening skills, and work with the patient throughout the communication process.

professionalism

The attitude, behavior, and work that represent a profession.

Communication for Diverse Audiences Patient and Families

The goal of all communication in health care is to positively contribute to the quality of patient care. The language used when communicating with a patient will be different than communicating with medical professionals. Medical professionals will use and understand more complex medical terms, while patients usually understand lay terms better. When speaking with the families of patients, be respectful of the patient's privacy. Confirm with the patient what information can be shared with their family. Ensure a release of information form has been completed and signed by the patient and has been documented in the patient's health record.

Scope and Boundaries

When acquiring information from patients, it is important to remain within the professional boundaries and seek information relating to their health. Do not ask personal questions unless it directly pertains to a person's health. For example, it would be appropriate to ask a patient if they may be pregnant when a radiology order is being written. It would not be appropriate to ask a patient if they are suffering from depression when they came in for a suture removal. Do not share personal information, personal experiences, peer experiences, or other patient experiences when talking with a patient. Maintaining appropriate boundaries and respecting privacy are essential components of communicating in the health care field.

Gender Identity and Expression

When addressing patients and other medical professionals, ask them their preferred name, preferred title, and what pronouns to use. Do not assume a person is married or single. Openly communicating with patients helps to build a rapport and relationship that will be conducive to creating a safe and comfortable atmosphere where they feel free to talk. When a health care service requires considerations based on sex characteristics (such as genitalia, uterus, prostate), refer to the patient's chart first. If clarification is still needed, it is appropriate to ask the patient.

Telephone Etiquette

When communicating using the telephone, it is important to be succinct because nonverbal communication and body language are more challenging to interpret. Avoiding medical jargon and complex medical terms will help to ensure the patient is able to communicate and understand what is being said. Ensure your vocal pitch and tone are not monotone or too loud. Clearly enunciate. It can be helpful to smile while on the phone, as it helps to present and convey a positive disposition. Active listening is important when using telephone skills. Give undivided attention to the person on the other end of the phone and be respectful and professional at all times.

What is a benefit of psychosocial care?

When provided effectively, it improves patients' overall health and quality of life.

Which of the following is an important aspect of communication in the virtual setting?

Word choice

Written and Electronic Communication

Written communication can occur with emails, letters, faxes, and chat features and are included in the permanent legal records. Communicating using written words must adhere to the professional and respectful requirements for the MA. It must also follow HIPAA guidelines for privacy, security, and confidentiality. Written communications must be grammatically correct and free from errors, as they are representative of the MA and the health care facility.

Communication styles

assertive, passive, aggressive, manipulative

The communication cycle

integrates a sender, receiver, and message

Characteristics of assertive communication

proper eye contact and body language with a respectful volume of voice

Kinesthetic communicators

tend to focus on hands-on learning.

Characteristics of visual communicators

tend to move their hands and use facial expressions. Body language can often say more about the message than the words being used.

Visual communicators

use pictures and prefer seeing information in writing. Visual communicators tend to move their hands and use facial expressions. Body language can often say more about the message than the words being used.

Auditory communicators

use the skills of listening when comprehending the message.

CRUCIAL CONVERSATIONS

At times it is necessary to communicate in a challenging situation, and it is not always possible to say what the other person is hoping to hear. It may be a conversation with a patient that is frustrated and in pain and possibly not thinking as logically as they normally would. A conversation may occur with a patient that is financially struggling and is being asked to pay the balance of their account while other bills are compounding. A patient who received a terminal diagnosis may call with a question or concern about their treatment plan, and they may feel anxious and uncertain. Challenging conversations should be handled with extra care and compassion. These types of situations require patience, active listening skills, and collaboration with the patient. At times, emotions can run high, and empathy can go a long way in helping the patient gain understanding and acceptance. Speaking with caregivers or health care surrogates also is an integral part of assisting the patient with their medical needs. Always ensure that the patient has consented to their health information being released to the person prior to the conversation.

Patient Cultures and Backgrounds

Be considerate of any cultural differences. A respectful disposition when reading nonverbal communication can increase the possibility of effectively communicating. Facial signs of confusion or grimacing in pain can help to understand the possible approach to take with assisting the patient. Do not make assumptions. Words and actions will vary with different types of cultural backgrounds. The health care services provided can also be dependent upon the patient's belief of medicine and treatments.

Which of the following is an example of email etiquette?

Being concise

telephone etiquette

Being respectful by using proper verbiage, tone, and manners when conveying information.

biases

Beliefs that are not proven by facts about someone or a particular group of individuals.

Nonverbal Cues in Telehealth

Body language and nonverbal language are more noticeable during in-person visits. Virtual visits rely on the words spoken for effective communication. Because nonverbal communication is not as apparent with virtual visits, it can be challenging to assess for understanding. Therefore, appropriate and effective verbal communication is essential. Ask for questions or concerns and for information to be repeated back to assess comprehension. Demonstrate proper eye contact and display facial expressions that support the interest in the patient's medical needs and reason for their visit.

Cause-and-Effect Analysis

Cause and effect play a factor in the overall health care organization's ability to provide patient satisfaction. Being proactive in this measure can decrease customer complaints. Additionally, patient safety and ensuring a safe work environment for employees must be considered. Risk management is the process of ensuring a safe environment for all vested members. It evaluates and analyzes the environment and how to apply improvements to make it safer. An example is walking through the facility to ensure there are no loose cords or areas where a person could trip over items in the open areas. Identify any potential causes of incidents and the effects that could result and put a plan in place to minimize that potential.

Closed-Ended

Closed-ended questions are seeking specific information and are more direct in nature. They can include brief answers such as yes or no to confirm information. "What is your current address?" "Are you feeling better today?" ​​​​​​​ "Do you have a sore throat?"

Professional Presence

Displaying a professional presence is essential for an effective career. Other contributory factors in ensuring a professional environment include work ethic, positive and polite demeanor, willingness to assist, cooperation, and effective time management skills. Personal boundaries are essential within all relationships in the health care organization—personal relationships must be kept outside the work environment. Dress and appearance must be within the professional limits established within the field, and individual health care organizations will have policies and procedures to be followed relating to dress and appearance. When communicating, follow professional standards at all times regardless of the behavior of the other participants in the process.

Communication Cycle

Effective communication is a tool used in all aspects of the medical experience and includes all vested members (medical professionals, third-party payers, patients). The communication cycle integrates a sender, a receiver, and a message. The communication is effective when the message is sent and received with the intended purpose.

Facilitate Teamwork and Team Engagement

Effective teamwork and engagement are a must for any health care organization. They contribute to the flow of a positive environment, which helps ensure patient satisfaction. Each member of the health care team makes an impact on the overall health care experience for patients. Each member performs their own responsibilities, and the members work together to ensure that all tasks are completed. Gossip, negative tone and word use, and dramatic outbursts have no place in the work environment. While personal feelings related to workplace events and interactions are expected, health care professionals must not allow those feelings to hinder their professionalism or the way in which they provide patient care. Working together in a cooperative environment helps to engage each of the team members, which increases the patient satisfaction levels. Quality health care services are provided to patients by a team that works well together where each member is involved in the process.

Which of the following should be included in the work environment?

Engagement

active listening

Engaging with the sender regarding the message and the intended interpretation (e.g., focus solely on the conversation, do not interrupt, confirm the message speaker has said, be respectful and professional).

How can an MA build a relationship with a patient based on trust and respect?

Exhibit a professional manner with a positive attitude of encouragement and support. These behaviors will help to build a relationship based on trust and respect.

Forms of Nonverbal Communication

Eye contact Facial expressions Posture Haptics or touch Gestures​​​​​​​ Personal space

Letter Styles

Full block format. All lines are flush with the left margin. Modified block format. The address and body are left justified, and the rest start at the center of the document. Modified block format with indented paragraphs. The address is left justified and, the rest start at the center of the document with indented paragraphs. Simplified format. The information is left justified, and it does not include a salutation or complimentary closing.

What should be done to minimize stereotypes of bias in communication?

Gaining a greater understanding of the diversity of people helps to decrease stereotypes and biases and includes respect and professionalism in all communication with all people. Building a rapport and relationship with the patient will be conducive to creating a safe and comfortable atmosphere where they feel free to talk.

Challenging Customer Service Occurrences

Handle challenging customer service occurrences with professionalism and respect. It may be challenging to communicate with a person who is upset or frustrated. It is important to maintain composure. It is never appropriate to match any negative energy in response to the challenging situation. Refrain from becoming defensive and remember the goal is to provide quality health care services. Building a good relationship based on trust and professionalism can help to enhance the patient-centered care experience. Another action that can help to minimize any defensive responses can be to use "I" statement instead of "You" statements. For example, "I understand that it is difficult making healthy eating decisions," instead of "It seems you have a hard time making healthy eating decisions."

Which of the following is an open-ended question?

How are your current symptoms impacting your life?

feedback

Information relayed to the message sender regarding how the message was received and interpreted.

therapeutic communication

Interaction between a patient and a medical professional focused on improving the physical and emotional well-being of the patient.

Examples of open ended questions

"How are you feeling today?"

Incident/Event/Unusual Occurrence Reports

"If it isn't documented, it didn't happen." This common phrase reflects the importance and necessity of documentation. All types of communication must be documented to ensure the event is on record. It must be detailed with the date, time, persons involved, and overview of the conversation including specific details. This practice protects the patient, as well as the health care professional.

What are some ways a MA can help to ensure that a patient is satisfied with their health care experience?

A medical assistant can display a positive, professional attitude towards each patient. Provide excellent communication and listen to patient concerns. Engage with each patient respectfully. Inform patients about delays. Respect patient privacy. Develop rapport with patients. Provide a clean and safe environment. Ask patients to provide feedback.

Example

A patient declines a blood pressure medication that the provider feels strongly about prescribing. On the surface, the preferences of the patient and provider are mutually exclusive: either taking the medication or not. After the MA discusses the situation with the patient and provider, it becomes clear that both agree that the patient's blood pressure should be lower and that it should be managed in a way that is safest for the patient. They disagree on the best way to accomplish their shared goals. Once there is a shared understanding and alignment, further conversation can include both parties sharing their individual views. To resolve this concern, the provider agrees to pause the conversation around the potential prescription for 6 weeks, while the patient agrees to meet with the MA for health coaching around diet and exercise to lower blood pressure and monitor their blood pressure every day. ​​​​​​​ They agree to revisit the conversation in 6 weeks to discuss how impactful the diet and exercise have been. This also provides time for reviewing the risks and benefits of the medication if the provider still feels it is needed.

templates

A sample of written correspondence or email that is established with appropriate components that will be personalized to fit the need of the sender.

Which of the following actions should an MA take with a patient that is yelling at them?

Allow them to vent

Interviewing and Questioning Techniques

Ask clear and professional questions when interviewing a patient. Screening questions can be used to determine the medical needs when scheduling appointments and to determine the reason for an office visit. These questions can be asked in an open or closed form. To obtain more information from a patient, ask probing questions—open-ended questions that ask general information to start a conversation. For example, "Can you explain how this happened?"

Which of the following communication styles is ideal for health care?

Assertive

What is the importance of effectively communicating with the health care team?

A good rapport built on trust and teamwork positively contributes toward ensuring great quality of care is provided to the patient by the health care team.

When to De-Escalate Problem Situations

Communication experiences that can become challenging should be de-escalated as soon as possible to prevent them from becoming uncontrolled. Communications within the health care team must be professional and respectful. When conflict arises, it may be necessary to involve a supervisor for assistance with resolution. Open communication, allowing the patient to vent, and active listening skills can help to minimize the potential for conflict and will aide in effectively communicating. Professionalism and respect will help in minimizing any drama, gossip, or judgements. When a conflict arises while communicating with patients, remember to be patient and listen to their concerns. The communication process must be free from distractions and interruptions. The patient should feel heard and that their concern will be considered. Set healthy boundaries in the discussion, both physical and psychological. The assertive communication style should include a tactful and courteous response. Use active listening and respect, and engage in appropriate communication by responding to appropriate verbal and nonverbal cues from the patient. If the situation escalates and attempts at resolution have not helped in controlling the situation, it may be beneficial to include a supervisor or another additional person to help in the de-escalation process. Another proactive measure in trying to minimize potential challenging communication experiences and de-escalating a situation is to remove any potential barriers. Barriers can include language differences, lack of personal boundaries, cultural differences, judgements, and stereotypes.

nonverbal communication

Communication that occurs through expressive behaviors and body language rather than oral or written words.

Oral, Telephone, Email, and Text Communications

Communication types and styles will have a direct impact on the sending and receiving of the intended message. The communication style being used may depend upon the reason for the communication or the intended purpose and can be a blended combination of styles. The communication style being used by the sender may also determine the receiver's response or action.

Communication for Diverse Audiences Medical Professionals

Communication with other medical professionals must be professional and respectful. A positive working relationship must be maintained by all members of the health care team. A good rapport built on trust and teamwork positively contributes toward ensuring great quality of care is provided to the patient by the health care team. An assertive communication style is effective in the health care field with medical professionals. Open communication will minimize the potential for miscommunications or misunderstandings. Nonverbal communication must also reflect a professional disposition and match the intended message being given by the words spoken.

Conflict Management and Complaint Resolution

Conflict management is managing a situation where differences occur and there appears to be no resolution that will be effective. Effective communication can help to minimize the possibility of conflicts. There must be a process in place to assist when situations escalate to a level where intervention is needed. Patients must have a resolution process that can be followed when they feel their concerns are not being heard and addressed. The goal is effective and respectful communication and that a win-win resolution can be achieved. Patient satisfaction surveys can be offered to see how happy patients are and what possible suggestions or concerns can be addressed. Methods of conflict resolution can include allowing the other person to express concerns, practicing active listening, determining possible solutions or outcomes, and concluding that all vested members are satisfied. At times, it isn't about one side being right and the other side wrong; it can be respectfully coming to a conclusion that is satisfactory for all. Understanding the underlying goals, rather than the specific asks, of each party can promote resolution. Many times, there are likely to be more similarities found when positive communication is pursued.

Coaching and Feedback

Consider the patient and any considerations that should be put into place when effectively communicating with them. Ensure opportunities for the patient to give feedback. Consider the patient's ability to comprehend information. For example, the level of understanding approach of communicating information with a child compared to an older adult would be different. Practice empathy. When speaking with a patient who has received a new diagnosis of a disease that will require intensive medical treatments, be patient and keep the conversation around how the patient can be assisted. Patients can be in pain or have strong emotions; remember that a frustrated patient's words are not personal attacks. Provide positive reinforcement of behaviors and choices to encourage continued positive life choices that have a direct impact on the patient health.

What considerations ensure effective communication when speaking with a patient?

Consider the patient's ability to comprehend the information. Show empathy for the patient's current situation. Be encouraging and patient.

Which of the following is included in professionalism?

Courtesy

Audience Considerations

Customize the communication process to meet the needs of the intended receiver. Use active listening skills to help to ensure that effective communication is achieved. If a patient has hearing loss, speak clearly while facing the patient to ensure that they can read lips. Provide patients who have visual impairments larger print documents when needed. Ask patients if they have any questions or require any type of clarification. When communicating with a patient who has a cognitive impairment, use words and phrases at the appropriate level the patient can comprehend. Consider the age of the patient. An individual would communicate differently with a 5-year-old than a 65-year-old.

Cultural, Religious, Psychosocial, and Economic Considerations

The patient population is diverse. Patients will have different backgrounds, traditions, values, and beliefs. Knowledge and understanding of different cultures can help to prevent the possibility of stereotyping and offensive assumptions. However, be careful not to generalize about patient care based on your understanding. Generalizing is making a general assumption based on a small amount of information. An example of a generalization is assuming that a patient will not accept blood transfusions or organ donations based on their religion. Always verify with the patient in a professional and unassuming way their treatment preferences. Affiliation with a group does not always direct an individual's behaviors or choices, so all treatment options should be presented. Cultural differences can arise in the way that people believe conditions should be treated, whether it be holistically or with medications. In certain cultures, it can be seen as a sign of weakness to express the feeling of pain. A patient from such a culture may have difficulty communicating their needs with the health care team. Work with the patient and provider to identify where cultural differences may affect understanding and adjust your language as needed to ensure the medical team can meet the patient's needs. A benefit of being culturally aware is providing psychosocial care. Psychosocial care is providing psychological, social, and spiritual care through therapeutic communication with cultural sensitivity. When provided effectively, it improves patients' overall health and quality of life. Examples of psychosocial care include motivational enhancement, relapse prevention, structured counseling, and psychotherapy.

TYPE OF VISIT CONSIDERATIONS

The type of visit will help to determine the best route to take when evaluating the communication process to use. Checking the audio and visual components of virtual visits is a must at the beginning of the visit. This will facilitate an easier visit, save time, and increase the opportunities for effective communication. Appearance, facial expressions, gestures, and eye contact are essential parts of the communication process for both in-person and virtual visits. For patients who have hearing or visual impairments using telehealth, it is important to use active listening skills to evaluate the patients' medical needs. In addition, some telehealth features offer a closed caption option that allows patients the opportunity to read live written captions of their visit, which allows for more effective communication.

Email Etiquette

There are many advantages to using email, such as speed of receipt and simplicity of responding. Always send emails using a secure email software program. Check for spelling and grammar errors and do not include jargon or slang. Professionalism is a requirement of writing emails to patients, medical providers, or third-party payers. The message should be concise and to the point. The email must include a subject line, salutation, and proper closing with contact information. Proper etiquette includes using polite conversation and not writing using a conversational approach, such as that used when texting with a friend. Do not abbreviate words, as this could lead to misinterpretation and miscommunication. Documents such as reports or statements can be attached and should be referenced in the body of the email.

What can be done to assist patients who feel they are not being heard?

There must be a process in place to assist when situations escalate to a level where intervention is needed. Patients must have a resolution process that can be followed when they feel their concerns are not being heard and addressed.

Assertive.

This is the ideal communication style in health care. Assertive communication is a firm and direct style of communication. It includes proper eye contact and body language with a respectful volume of voice.

Manipulative.

This style does not tend to be effective, as it is not a genuine communication—it can be very one-sided with ulterior motives. This style can feel patronizing.

Aggressive.

This style is abrasive in words and body language. Individuals that use this style tend to allow for minimal personal space and use loud and fast gestures. Communicating with someone using the aggressive style can feel intimidating. Respond calmly and never try to match a level of aggression.

Passive.

This style is more submissive. Individuals that use this communication style will use a quiet, soft voice and may display hesitancy. Approach this style with a more assertive response.