EPISODE 6: She Wrote the Book On Communication- Laura Cooley, PhD

Today’s Guest

Laura Cooley, PhD

Laura Cooley, PhD, leads education and outreach for The Academy of Communication in Healthcare. She serves as Editor-in-Chief for The Journal of Patient Experience, an open-access, indexed, SAGE publication, dedicated to presenting advances and applications that impact the patient and provider experience.

Additionally, she holds an appointment as Assistant Clinical Professor in the Department of Medicine, Vanderbilt University School of Medicine. In her primary role with  ACH, Dr. Cooley leads strategic efforts to develop and deliver customized communication skills training programs designed to enhance patient experience in partnership with organizations such as: Stanford Healthcare, Yale New Haven Hospital, Northwell Health, Adventist Health, Texas Children’s Hospital, Baylor Scott & White, & many more.

She recently co-edited the book “Communication Rx: Transforming Healthcare Through Relationship-Centered Communication“.

Contact Laura/Useful Links:

Email
LinkedIn
Twitter
The Academy of Communication in Healthcare

“Ask and Listen”

Key Takeaways:

• Dr. Cooley explains what the book, Communication Rx is all about.
• How communication impacts dynamics on the team.
• Laura comments on the effect technology has had on communication.
• The Academy of Communication in Healthcare’s mission.
• Improving interpersonal relationships within the team dynamic to elevate patient care.
• What made Laura interested in the work that she is in now.

Resources (Click for Amazon)

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Transcript

Andrew Tisser 0:13
Can you teach clinicians how to effectively communicate? What does the research say in regards to healthcare communication in today’s era? there in the answers to these questions, and many more on this episode of the Talk2MeDoc podcast.

Hey, guys, this is Andrew, thank you so much for being here today. If you’re already subscribed to the show, I really appreciate it. If you’re here for the first time, make sure you subscribe because today like in every episode, I’m bringing you the most amazing people throughout healthcare to discuss communication and how we can fix it. Today’s guest is a bit of a celebrity in the realm of healthcare communication. Laura Cooley, PhD leads education and outreach for the Academy of communication and healthcare. She serves as editor in chief for the Journal of patient experience an open access indexed, SAGE publication dedicated to presenting advances and applications that impact the patient and provider experience.

Additionally, she holds an appointment as assistant clinical professor in the Department of Medicine, Vanderbilt University’s School of Medicine, and our primary role with a CH Dr. Cooley Lee’s strategic efforts to develop and deliver customized communication skills training programs designed to enhance patient experience and partnership with organizations such as Stanford healthcare, Yale, New Haven Hospital, Northwell health, Adventist health, Texas Children’s Hospital, Baylor Scott and white and many more

She recently co edited the book communication Rx, transforming healthcare through relationship centered communication. I was personally introduced to Dr. Cooley after reading communication Rx, which was a very insightful book, compiling many different authorities in the field, and was masterfully written and edited. Well, without further ado, please welcome Dr. Laura Cooley on to the show. Dr. Laura Cooley. Welcome to Talk2MeDoc podcast. Hi there. How’s it going today?

Laura Cooley 2:32
Good. I’m excited to learn more about what you’re doing and to share whatever ideas that I might have to offer.

Andrew Tisser 2:39
Yeah, thanks again, so much for coming on the show. If you could give the listeners a few sentences about who you are and what you do and all that.

Laura Cooley 2:46
Sure. I work for the Academy of communication and healthcare and my background is an academic one rather than a clinical training. I have a PhD in communication health care, and so I’ve been devoting the last decade of my life to thinking about how we can improve patient experience and clinician experience across the healthcare team by having better communication and stronger relationships and healthcare environments.

So I’m delighted about the mission. You’ve started with this particular podcast. It sounds like you’re the perfect guest. I got introduced to by picking up a book that your co wrote, I believe communication RX. Could you talk about the book a little bit? Sure. The book is actually a compilation of expertise from faculty of the Academy of communication to healthcare. So my co author Calvin Chow, who’s a physician and PhD in San Francisco, and I led the charge on the book and had the privilege of CO editing it and authoring parts of it.

And when you flip to the table of contents, you’ll see that we have experts from all over the country, many of them who are doctors, by training physicians who are just deeply committed to how we communicate with patients from interpersonal perspective, and we We really look at it as a set of skills. And so the book really talks about the skill sets that one can develop to more effectively engage with and communicate to patients to really meet them where they are to elicit what their concerns are to address those concerns in a way that patients and families can understand.

And we not only talked about the fundamentals of the patient provider relationship and the skills surrounding it, but also dig into how communication impacts dynamics on the team conflicts that inevitably surface and health care, and then even some of the educational components of how do we teach communication skills? And what are the strategies that we have the academy have seen to be effective?

Andrew Tisser 4:41
Yeah, I really enjoyed the book personally, you know, you think communication that’s just talking, right? That’s easy enough. But the book really goes into the nitty gritty of how we form relationships, how we show empathy, and really a lot of actionable skills, and I really liked it.

Laura Cooley 4:57
Yeah, well, thanks for saying that. And You know,
the thing that’s really been exciting for us that came out a couple of years ago is that in the last decade, the health care business world has started caring about communication and relationships, which is something that our organization has cared about for the last 40 years. And now there are incentives on how to create better patients experiences, people pay more attention to clinician experiences. And I really believe that at the root of that is the opportunity to improve our skills, so that we communicate more effectively.

Laura Cooley 5:31
And now that there are incentives from a business perspective,
people need guidance on how to improve those skills and how to have better patient experiences rather than just imagining that communication is a nice to have or something philosophy.

Andrew Tisser 5:44
Sure, I mean, incentives will always lead people in a certain direction. Can you talk a little bit more about the academy and its mission for those of our listeners who are unfamiliar.

Laura Cooley 5:54
Academy of communication health care is a nonprofit group focused on education and research. Enhancing communication is essentially the communication that happens between patient and provider within members of the team and patients and families were not focused on public speaking or on electronic communication mediums.

Rather that deeply personal relationship that is developed in healthcare environments, often within the face of highly emotional and very important conversations is so he provide support by having a membership community of people who are academicians, clinicians, professionals working in healthcare that are really committed to communication, and also providing skills based training for healthcare systems or clinic groups that want to bring in expertise on how to develop stronger communication skills.

And so we go out and provide that and then we also have a research community we host an international conference on communication and healthcare where researchers in the field come together to present their findings and to share ideas So we’re growing and really open to anyone who’s also committed to this same mission of enhancing healthcare through better communication and relationships.

Andrew Tisser 7:10
Excellent. Yes, is really the goal of this show is focusing on the team itself rather than provider patient relationships. Besides from your organization, it’s not really talked about all that much. Do you personally think there’s an issue within the greater health care team in regards to interpersonal communication? And if so, does that trickle down to patients?

Laura Cooley 7:32
Well, I guess how do we define issue? I, I think there are some significant challenges right now in terms of how health care team members are interacting with each other or the lack thereof in terms of communication and real connection. I think there are many well intended things around electronic health records and the way we communicate through technology. And at the same time, I often hear my clinician colleagues talk about how they no longer have hope. conversations like they used to or you know, conversations in the lounge or the really personal face to face discussions that really helped them feel more supported and the healthcare team environment.

You know, some of that has been resolved in a sense because we feel we can accomplish things through technology. And there are a lot of intentions and meaning that can be lost or missed and those mediums and I find clinicians eager for better connections with their team members. And I think there’s been a lot of talk about safety and how to reduce risk and health care. And one of the key focal points is about improving team communication and decreasing hierarchy and how we need to help people across professions work better together. There are different strategies about how to go about that. But I think yes, there is an issue at hand and I think there are some opportunities that we can look to to help team members feel in better connection and more effective in the work that they’re doing together.

Andrew Tisser 8:57
Fair enough. How do you think that improved That interpersonal relationship within the team dynamic affects patient care?

Laura Cooley 9:05
Well, you know, I think that it’s quite obvious to patients and families when their healthcare team has failed to communicate or is in some kind of conflict or really just respects each other. I think it becomes really obvious we often hear patients and families feeling frustrated about the idea that the doctor doesn’t know what the specialist is doing, or the specialist doesn’t know what happened the day before a nurse doesn’t know what the nurse before him or her was doing on the other shift. And so I think there’s really a gap there. And when those team members are unable to connect properly, it definitely affects patient care, both from the way they feel and experience their care and also, you know, from some pretty significant safety situations.

Andrew Tisser 9:53
Can you explore that a little more those safety situations?

Laura Cooley 9:56
Yeah, so I think a recent study to look towards was some work done by CRICO, which is sort of the measuring safety incidents through the Harvard system. And a looked at what the litigation causes are in healthcare environments and about 33% of all kind of litigation cases, against healthcare professionals or Linux systems, boils down to communication. And it’s about a 5050 split on average between communication breaches between patients and providers, and the communication and breaches within the healthcare team

And so wait equates to millions or billions of dollars over a several year span, when we think about what is at risk, and we also know that there are a lot of preventable deaths that happen because of reaching communication. So there’s a lot of research to dig into for those who are really interested in looking at that and there’s no argument about whether or not communication has an impact on serious safety. events.

So, you know, to me, the field has been interested in communication and team in the last decade partly because of the focus on patient experience. But I think in the last several decades, it became very clear that there were safety concerns, and, you know, malpractice risks at stake when team members are communicating with each other and are communicating well with patients.

Andrew Tisser 11:23
Yeah, I mean, I think when you put it that way, that 33% figure is astronomical, I think that’s higher than I would have thought, but certainly will get some people listening when you’re talking about millions and dollars and whatnot. I want to go back to an earlier point when you were talking about the increases in technology and how there’s less Hallway Conversations and things like that. I mean, I know a friend of mine who works in the lab said, well, communication with physicians isn’t a problem because she doesn’t talk to them. She just sends them a message. Now we have a lot more healthcare delivery. As far as communications goes, do you think with the improved technology, there’s been a worse Meaning of interpersonal communication, or has it been steady? Or what are your thoughts on that?

Laura Cooley 12:04
I think it’s just different in some ways. I think that when we talk about human to human communication, like one of the greatest mistakes we make is assuming that our message was received. So I can say something to you in this conversation, and I intended it to transmit a certain understanding to you. And unless you actually understand it, and I checked to ensure that you understood it, then communication hasn’t really happened.

And I think that we often are entering things into electronic communication mediums, sending messages, uploading tons of data, and we’re assuming that somebody is reading that processing it that they have understood the message we were intending to communicate, I don’t think that’s always happening. And so we’re also overloaded by electronic messages. And so there’s some inability to process at all and so we have a lot of opportunities to leverage technology. Gee, and to use it to our advantage with communication. I just think we haven’t quite gotten there yet. And that’s one of the key frustrations that we see clinicians reporting about when it comes to burnout and job satisfaction. And so I think that striving towards having better communication and those mediums and making sure the messages are received and process is really aspirational goal.

Andrew Tisser 13:24
I mean, well, is to get rid of the handwriting issue, right?

Laura Cooley 13:27
Yeah. I mean, I certainly don’t want to go back. I would never say like, we should just handwriting and keep paper, that I think that the technology is important. And I think we’ll see improvements. I think the other thing is that outside of the healthcare world, we’re all using technology in various ways. And it’s not uncommon for you to see families and friends and lovers out to dinner or wherever and they’re more engaged with their phones than they are with each other is becoming a common refrain about cell phones and social media that we’re using that we’re not communicating our Person person perspective and face to face environments.

And I think there’s some real social ramifications at risk. It’s not just in healthcare. I think our humanity suffers when we are overly engaged in technology as our main communication medium. And I would argue, without a great lot of data at this moment, that that’s part of what we’re seeing with the burnout crisis, that it’s not that doctors or nurses need to be more resilient. They just need to be more supported. And I think having human connection beyond the technology, communication medium is a critical factor in helping us feel more human and the hard work that we do.

Andrew Tisser 14:37
I mean, absolutely. In my personal life, I know that I sent my wife a text message before and then she’ll come home later, completely misunderstanding what I had said and taking it out of context. Because just because you can’t, in a written word, you can’t express emotion. There’s no body language. There’s no other cues. So it’s interesting to see where the future will take us in regards to how we alleviate some of that lack of inner personal, just talking, you know,

Laura Cooley 15:03
and I actually feel really optimistic about the future in terms of technology and it’s not going away and I, you know, I’m in a relationship with my iPhone like I get it. I just I think that there are ways that it will get better when we start leveraging it. And I think there is a rising tide of understanding about the need for human connection, and making sure we’re having meaningful conversations that do address some emotion. And you know, our organization is really focused on helping people be skilled enough to have those conversations and I think technology has maybe decreased our skillfulness and some capacities regarding interpersonal relationship, and that we can claim that it does take intention

Andrew Tisser 15:44
Going back to your organization, so you guys go out into facilities and give onsite training?

Laura Cooley 15:51
We do.
So we have a group of experts within our academy when we refer to as faculty and they have regular jobs. as clinicians and academicians and healthcare professionals, but they will get invited to go to work with a healthcare system or some kind of, you know, medical or clinical group that wants to provide training for clinicians, or for healthcare teams regarding how to communicate either with the patient provider relationship, or within healthcare team environment.

And as you pointed out, shifting towards focusing more and more on how to support the healthcare team communication dynamic because it is such an important need. And so when we do this type of training, it is through face to face practice based environments where people get a chance to try out scenarios to get feedback on how they’re doing things very small group oriented so that people form connections in the learning space and have the safety to practice communicating in a way that might be a little different than what they’ve been doing for sometimes decades. And one of our biggest goals is to help equip healthcare systems with The ability to train their own people. So we do a lot of work in terms of just supporting program development and training trainers so that they have local expertise and can really sustain their own efforts rather than just having us visit.

Andrew Tisser 17:14
That’s wonderful. Do you ever get pushback from let’s say, some of the older season Docs or whoever just saying, you know, they don’t need any training or etc,

Laura Cooley 17:23
That’s pretty common. For a long time spent a little bit of an assumption that communication is just something that you’re good at or not. And that the way you communicate doesn’t matter as long as you have the proper, like clinical expertise. And what we now know from a lot of research and from the implementation of patient experience, metrics and in the life is that it doesn’t matter and the way we communicate has a big impact on whether or not teams are high functioning, whether or not patients are able to adhere to their treatment plan, whether they’re able to get better essentially, which is what we all hope for.

When we can kind of break through the barriers of saying like, you know, there are better and worse ways of communicating here are some skills. And here’s all the evidence that shows that these skills do make an impact in clinical outcomes, then we see the resistance drop of it, and it’ll just like any fundamentals communication, will we can establish some relationship and trust with those clinicians who are skeptical. You know, we can see opportunities for growth and development.

Andrew Tisser 18:30
Do you feel that there are any generational differences, you feel that younger physicians are more apt to be accepting of your mission versus older physicians or it’s pretty much across the board?

Laura Cooley r 18:42
I hate to make that generalization. I think that one of the big changes is that in the last 20 years, especially medical training has given more credit to the importance of communication and it’s become one of the core competencies of medical school. For example, and So I think there’s a little more respect for the idea that it matters. I think culturally, maybe some of the younger generations have greater openness to the idea that emotions are actually important and that we aren’t, you know, supposed to just operate as clinical machines or robots.

And I think that is sort of a generational variance. But you know, on the flip side, I think sometimes the more recent healthcare profession grads are coming out with a high reliance on technology and a lot of interaction via social media. And sometimes that means that actual traditional face to face communication and relationship building might be a bit of a gap for them, and they may just work on some basics of how to communicate with real people in real time.

I think there are sort of some back and forth items you can look at there, but I guess the shorter answer would have been to say, yes, there is a difference in generations. Another also differences In culture and differences in a region and the organizational environment, that one enters into some places, really bad communication, and others have a different take on it. And so I think all those factors come into play. Oh, that’s fair. They’re really interesting, actually, with the newer grads. Yeah, maybe we’re back to this technology issue. And

Andrew Tisser 20:20
so yeah, that’s really interesting. I never would have thought of it that way. What are you working on personally right now in regards to your own research?

Laura Cooley 20:28
I’m really interested in the next years ahead is actually what my focus and our organization focuses in terms of the patient provider patient clinician relationship into providing more support for the team based environment. I think we’re seeing a lot emerging in health care about the importance of teaming, Amy Edmondson has been putting out a lot of work.

People are paying attention to about how we create safety and psychological safety and team environments and this is particularly important Healthcare. And I think that the medium to get that to happen is communication, I think helping to equip leaders with skills, that flat hierarchy and that allow for kind of cross connection within team environments so that we can coordinate from a more relational perspective in the healthcare environment. I think those are the things that I’m really interested in helping to foster really thinking about a more integrated approach to improving healthcare experiences so that we can really impact the lives of patients and families we’re serving prevent people from becoming patients at all.

And really, I’m very interested in how helping foster better team communication and collaboration helps with this burnout crisis. We’re often saying in the press here, but fostering better collaboration at work that health care professionals and clinicians can feel better at work and then that serves us all. So those are the things I’m really like thinking about and wanting to Contribute to personally?

Andrew Tisser 22:01
Well, I’m excited to see what comes out. This burnout crisis is it’s now what this show is about, but it’s certainly good item right now is the largest exodus of 30 to 50 year old physicians in the history of time from the profession. So think anything will help

Laura Cooley 22:17
propositioning that, you know, if they were just having good conversations with each other, they wouldn’t leave. I think there are a lot of complicated factors. And I don’t think they just need to be tougher. I would just argue that communication and the people we work with can make a really big impact on our ability to be resilient and to manage challenges and to work together. And so if we can build to foster better environments in the workplace from a healthcare perspective, I think it will help people manage what will continue to be a challenging work environment.

Andrew Tisser 22:51
Oh, absolutely. I mean, some of my worst days in a hospital or made better just by the relationships I have with the nurses, the tax and everyone around me Because, you know, we’re all in it together kind of mentality. Yeah, that’s great. I like to shift the focus of the show right now just to get to know the guests a little bit better. You already talked about the acth in your book a bit. But what initially got you interested in this work when you started

Laura Cooley 23:17
I keep asking myself that question? How did I end up here? You know, I think that I have long felt some kind of striving responsibility to contribute to humanity, not just overemphasize what I’m doing. But there there was this point. When I graduated from college, originally, were working in sales and I like working with people and doing this traditional like sales pitchy kind of thing.

And then I decided I wanted to do something more meaningful. So I got interested in organizational communication, the way that businesses are coordinating together and how they exchange information. And then it was really when I was deciding where to go with a dissertation. topic in my PhD program that I heard a woman who I admire greatly, Elaine Wittenberg Lyles talk about end of life communication and a lot of her research in hospice, and just how special it was to be present authentically in the final stages of someone’s life, and that that can make a difference. And that there was this whole model around providing comfort and true authentic caring.

And I decided at that moment like this is it this is where I want to go, I want my life’s work to contribute to know how actually communicating and being authentic can impact somebody’s health, their life, their death, and that it doesn’t necessarily mean something negative that it’s actually like a great positive contribution. And then from there, I knew that I wanted it to be practical, and then I wanted to contribute in some way that would not just be producing academic papers or research.

While I think that is an Important that I wanted to translate that information so that people could receive it, and put it into practice in a way that would help patients that would help clinicians. And so, you know, I think the work is making a contribution, and it’s not really my work. It’s what I’m able to help channel or facilitate in this community that is actually important. And so, so grateful for all the influences I’ve had in this space.

Andrew Tisser 25:24
That is definitely a powerful message. The other question I wanted to ask you, if you said your own book that you helped put together, do you have a favorite book ever and book recommendation for the listeners?

Laura Cooley r 25:35
Well, I have become a big fan of a kind of a life philosophy book in a sense, which is not about health care communication, although I think you could make it that it’s a book called essentialism, the disciplined pursuit of less, which is by an author named Greg McEwen. And what I love about the concept is that it encourages us to get rid of the trivial many And to focus on the essential few. And so what that means to me is that I frequently try to start my day by asking like what’s actually important? Like, is this task is this goal and nine or 10 on a 10 point scale in terms of what’s actually going to make a difference? what’s actually going to leave an impact.

Laura Cooley 26:21
And if it’s not a nine or a 10, Then should
I say no to it. And I think the fall short of eating those aspirational goals, but I really hope that in healthcare, we can continue to think about what actually matters, what matters the most, to patients, what matters the most to clinicians that are colleagues, and really focused rather than being distracted by the trivial many. So that’s the spirit of the book and what it means to me and I would encourage everybody to read it.

Andrew Tisser 26:48
Yeah, I’ll have to check that one out, for sure. And I’m happy that this podcast made it to higher up on your level of the things that were important.

Unknown Speaker 26:56
Yeah, right now you know, it’s elevated. Now

Andrew Tisser 26:58
I’m even more honored. That’s my next question for you is, if you could give physicians and other clinicians just a single piece of advice in the area of communication, what would that be?

Laura Cooley 27:11
Ask and listen. Ask open questions and listen. And before we speak, we can accomplish so much more if we just ask him listen first.

Andrew Tisser 27:21
Fair enough. That’s great advice. I should follow it more myself.

Unknown Speaker 27:24
Well, you’re doing a great job of asking lots of questions and listening today. So you must be on track

Andrew Tisser 27:29
and dry. And finally, if people wanted to reach out either you personally or your organization as a whole, how could they find you?

Unknown Speaker 27:41
Well, a couple of ways. They can look me up through the Academy of communication and healthcare website, just Google it. That’s one good option, am on Twitter. So if people want to look me up, they’re just Laura Cooley. Co le y PhD. And I’m also on LinkedIn, just look up lyrical, a PhD pops up pretty quick. So love to connect with anybody that’s interested in this work and always happy to share ideas.

Andrew Tisser 28:13
Great. All that information will be in the show notes for the listeners. Well, Laura, thank you so much for coming on the show. I think we really touched on some very interesting topics today. And thank you for yourself and your organization for all the good work you’ve been doing to improve how we interact with each other and our patients and a lot of people will be helped by your work.

Unknown Speaker 28:33
Yeah. Well, thank you for inviting me. And I know it’s a ton of effort to get a podcast off the ground. So I admire your resilience and doing so and I look forward to seeing it unfold.

Andrew Tisser 28:45
Absolutely. Thanks again. All right, bye. Bye. Wow, what a great show with Dr. Laura Cooley. It was amazing to be able to talk with one of the authorities in the field and someone who has ongoing research studies in regards to health care. Communication, I really would suggest checking out her book as well. I really enjoyed it. I thought it was interesting that Laura mentioned that people are paying more attention to communication now that it is tied to some financial incentives. Maybe not the best reason, but whatever it takes. I also thought it was interesting to hear how Dr. Cooley feels that there is a real issue with how team members interact and a lack of a real connection. Hence this show. She states that it is obvious to patients and family when teams don’t communicate well, which I agree with. I was also shocked to hear her statistic from the research study that 33% of litigation cases or communication based. She also feels that as of now, technology has worsened in communication, however, she is optimistic. Do you want to hear a little bit more about that issue? Please the episode two with dr. john shreeka. Her advice to physicians is to ask open questions and listen to Before you speak, I certainly should follow that advice more often. Well, that’s all for this episode. Talk to me doc members, you are incredible and I really hope you enjoyed. If you haven’t done so already, make sure you hit subscribe because next episode, we’re going to have just as an amazing guest on the show. The other thing I want you to do after listening is go to my website and subscribe to my email list it’s talk to me doc pod calm that’s talk the number to me the OC pod calm, where you will get instant emails of all new episodes as well as some additional bonus content. Until next time, keep talking. I know I talk a lot about books on this show and one of my favorite ways to read a book is listening on Audible. So I’m happy to announce that audible is offering our listeners a free audiobook with a 30 day trial membership. Just go to talk to me doc pod comm slash audible. That’s talk the number to me the OC pod calm slash audible and browse the unmatched selection of audio programs, download a title free and start listening. It’s just that easy.