Thursday, April 7, 2011

Communication: The Basics

One of the most fundamental elements of communication is using the same vocabulary so that each participant can understand the others. The best example I have of this comes from my 3 year old daughter.

She was walking all kinds of funky across the living room. I called to her, "Anna, do you have a wedgie?" She turned around, looked me square in the eye, and with all the will in her little body corrected me, "No! My panties are stuck in my butt!"

Clearly, this was a situation where we were not communicating well because we did not have a shared vocabulary. Whether evaluating information to make knowledge, sharing knowledge to effect behavior, or developing understanding in the AURI cycle, all parties involved must have a shared vocabulary. In my experience, this is a common pitfall in HIS implementations and data-driven quality improvement.

So, how do you establish this shared vocabulary in teams utilizing clinical knowledge management processes or quality improvement initiatives, such as with the AURI cycle? Defining terms and establishing metrics must be your first order of business in any of these projects; there's really no point in participating in these processes if the participants are not able to equally engage and speak with a common vocabulary.

As clinicians, we all understood what a VTE was, but in the first meetings of the VTE team, we had to define VTE clearly and establish which VTEs would be included in our metrics. For instance, would we count hospital-acquired VTEs in upper extremities that were associated with PICCs or other central lines as nosocomial VTEs and include them as a target of our interventions? We also had to decide if we would include VTEs discovered as outpatients and during readmissions or only those discovered during a single hospital admission as part of our intervention. Ultimately, we chose to include all VTEs, regardless of physical location or the clinical setting in which it was discovered.

As you can see, making another choice would have changed our evaluation of metrics, knowledge, and understanding. The interventions described in the VTE project were the result of the definitions and metrics we agreed upon as a team. If we had not established a common vocabulary, we would have experienced significant delays in the progress of our project, and possibly have been significantly less successful than we were.

Keep in mind that communication is dynamic and anytime a new member enters, you need to ensure you re-establish the shared vocabulary. For instance, when writing out the above story, my 8 year old daughter read it. Then she turned to her mother and asked, "Momma, what is a weed-ghee?"

In my next post, I will outline the science behind communicating with the goal of effecting volitional behavior.

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