What is effective communication, and how do you overcome the restrictions of PPE or time?

The aim of this blog is for us to dip our toes into the art of communication.  It's a broad subject and a critical tool in our armamentarium. In fact, it's somewhat assumed dental clinicians are naturally great communicators, however, this is simply not true. some find the art comes more naturally but many spend much time developing communication skills to enhance our patient and team engagement.

Effective communication is communication between two or more persons where there is a clear message sent, which is then received and understood by the recipient(s). 

The negative effects of inefficient communication are endless but here are some of the common problems it causes in dentistry.

• Conflict
• Poor uptake of treatment plans by your patients
• High turnover of staff
• Errors, and time-wasting
• Unnecessary stress
• Increased workload

We naturally assume that when we send a message it is clear and understood because it makes perfect sense to us. 

So, how do you tell if it is received in the way you intended?

Argyle et al 1970 conveys the meaning of a message as 93% is interpreted through body language with the actual words heard being accounted for as little as 7%.

  How a message is received and interpreted is broken down as:

• Words 7%
• Voice Qualities 30%
• Body Language 63%

On the telephone when body language is missing the interpretation of the message is:

• Words 30%
• Voice Qualities 70%

In the dental setting, we have to not only send messages but also receive them. Thinking of yourself as the receiver, what qualities do you require?  It's well documented the best communicators speak less and listen more, therefore you as the receiver are required to listen and observe.

This allows you to enhance the communication process by auditing language and sensory cues.  Sensory acuity is similar to meditation, the more you practice self-awareness and that of others the more you pick up and the better you become at noticing the nuances.   Doing so gives you the opportunity to seek clarity and question to ensure you understand the sender’s message.

Many factors cloud our success at listening; external sounds, distraction thinking about something different from what is being said, formulating your response, making a judgement on what they are telling you, or feeling uncomfortable in the situation. 

These factors commonly run daily in a dental practice among team members and patients alike, and then to throw a spanner in the works, you add PPE!!

How do you manage communication with the added barriers of wearing PPE and compromised appointments regarding the fallow time?

It has been a stressful time for most clinicians and team members as we have had to adapt to the ever-changing regulations. The discomfort from wearing some PPE items, adapting the patient journey as well as running a business is not without its challenges and we have certainly seen variations in workflows.  Now, more than ever we must continue to adhere to the guidance to keep our patients and each other safe.

We also don’t know if we will return to ‘how we once worked’ and if we do, what the time scale for that will be.  To put yourself in the best position possible to manage your operations and communicate effectively you might need to think about your internal dialogue and the whole way that your team communicates with each other and with your patients.

When we were first introduced to the 'new SOP's in June 2020  every practice had a team meeting to discuss the guidance and run through the new normal protocols. Everybody has had to consider what they can and  ‘can’t do’ and, in the early days, there would undoubtedly have been challenges and stresses in the operations and communication. 

It’s been over a year now since we returned to practicing dentistry and it has been less restrictive for practices that don’t work to fast quick appointments, however, every type of practice has had to change and adapt and with change often comes stress. 

In your practice do you hear ‘we can’t do that because of Covid’?  This could be to your patients when scheduling an appointment, or from a clinician when recommending an appointment or between team members.  If you do, consider this: this language is potentially keeping you in a negative stuck state and unknowingly you could be presenting barriers and obstacles to your patients and each other instead of opportunities and solutions.  As well as that it can programme our default position to ‘we can’t’ which can then slowly become your 'culture'.

How do you enhance your communication in covid times?

Firstly, as just described, think about your communication as a team and drop ‘we can’t …because…’ language.  By looking at your patient journey and identifying the changes you need to make in how you do things you can develop a communication style that has a more positive intent and create a positive environment.

By deleting ‘we can’t because…’ and replacing that with stating your position in positive terms such as ‘in order to do…we need to do…’.  This really helps to change the landscape and creates an optimistic mindset. Thus creating a  ‘can do’ attitude driving more creativity.

Secondly, as the sender of a message, there isn’t a lot of non-verbal cues that you will give to the listener when donned in PPE,  so you are relying more on your voice qualities and words, similar to how communication is relied upon, on the telephone. 

Think about all of the information that you impart to your patients frequently and if PPE or time restricts how effective your messaging is, consider making generic videos and supplement your communication with a personalised e-mail and link it to the relevant video.  This way the patient is still receiving the same great advice or education and you are going above and beyond what they expect.

The third element is as the receiver of the message, ensure you are fully present and use listening skills to seek clarification of the message.  You have the upper hand in that you can listen, use your sensory acuity and determine what the patient is telling you.  Be mindful to seek clarification. Active listening is a commonly used technique where you seek clarification by using accurate paraphrasing.  Aspects of active listening include:

1. Paraphrasing
2. Reflecting
3. Summarising

Reflecting and paraphrasing allow a person to feel heard and ensures a patient that you have understood.  When you, the listener can repeat back what the patient has told you the relationship is strengthened and communication enhanced.

An example might be:

Patient: ' I have generally been well since I last saw you. I did have a problem with sensitivity on the upper left which needs to be checked'.

Clinician: Ok, so what you are saying is that your well but have had an issue with sensitivity on the upper left that you would like me to address.

You may wish to consider some of the following language:

• “If I understand you correctly…”
• “Correct me if I’m wrong in thinking…”
• “So, what I hear you saying is…”
•  “It sounds like…”

Reflecting, mirroring the meaning and the feeling of what has been said is not so focused on the words.

It may look like this-:

• “I’m picking up you are concerned about the end result”
• “I’m sensing this is important to you”
•  “I’m feeling that this means more to you than not having a denture”

Summarising is always useful to encapsulate the conversation, particularly in treatment presentation because it enables you to pull all the rich information gathered by all aspects of listening and allows your patient to add more information or clarify points.

 So, what can you do straight away?

1. Get your language away from ‘we can’t…because…’ and adopt a more optimistic communication language instead.
2. Think about ways that you can deliver your messages that are somewhat restricted by PPE or time.
3. Active listen and seek clarification on what your patients or team members are saying to you.

What creative ways have you enhanced communication or customer service in your practice?