Insights from Studer Group Experts

The Power of Our Words
By Regina Shupe RN, MSN, CEN
Studer Group Coach

Video Length: 12:01

What we say and the words we choose, has a tremendous impact on our patients. The right words can calm, comfort and reassure. The wrong words can produce anxiety and create confusion in a situation that is likely already stressful.

As healthcare providers we owe it to our patients (and ourselves) to communicate in a way that reduces anxiety. Not only is it the right thing to do for our patients, it also improves clinical outcomes. After all, when patients are calm, they engage with and listen to their healthcare provider—and that makes them more likely to comply with their treatment plan, get better and stay better.

Not surprisingly, when the patients' perception of care improves—this organically improves all quality metrics. (There is a well-established link between Patient Perception of Care and quality.) It's obvious why all of this matters in a pay-for-performance environment.

Healthcare leaders who make the connection between the way we communicate and the outcomes we achieve are embracing AIDET. AIDET is an acronym that stands for Acknowledge, Introduce, Duration, Explanation, and Thank You. AIDET is a communication framework that reduces patient anxiety and improves clinical outcomes. When used in conjunction with Studer Group's Evidence-Based Leadership (EBL) framework, AIDET will increase your likelihood of creating a culture of consistent excellence, a culture of "ALWAYS"—a culture that meets the tough requirements set forth by health reform.

Why is consistent communication a priority in healthcare today? Nursing communication is the HCAHPS composite that is most highly correlated with the Overall Hospital rating. Physicians who communicate effectively have fewer law suits, better patient clinical outcomes, better clinical compliance with treatment regimens, lower 30-day readmission rates and have a better patient perception of care. 

In order to assess and coach communication to employees and providers, I conduct one on one coaching in a simulated environment that is referred to as a communication skills lab. After conducting hundreds of communication skills labs across the country, some common trends have emerged. The words used in the context of AIDET that reduce a patient's anxiety are words such as care, concern, safety and privacy. I urge healthcare professionals to use them and use them often.

I have also found that there are words that cause anxiety or doubt or mean absolutely nothing to patients. These are words that we may not expect will cause anxiety. Take for instance the word "hope/hopefully". This is an innocent word that we use in the healthcare setting that causes doubt and concern in our patients. Take for instance saying to a patient, "Mr. Smith, I am giving you this medicine to reduce your pain. Hopefully this will take care of it." To a patient, that does not instill trust that we are going to work to relieve their pain. Hope is not a strategy. It's better to say "Mr. Smith, I am giving you this medication to reduce your pain. I will recheck you in 20 minutes, if this has not improved your pain to an acceptable range, I will check with the Doctor to review your plan and make adjustments." That describes a plan for this patient that instills trust and reduces his anxiety.

Another word that I hear repeatedly in healthcare is the word "probably". For instance "Mr. Smith we are probably going to get an x-ray of that ankle." We are either going to get an x-ray or not. ‘Probably' creates anxiety for this patient because it is vague and non-specific. We can say, "Mr. Smith, we are going to get an x-ray of that ankle, review and proceed from there with the appropriate treatment for this injury." That is a plan that instills trust and reduces anxiety.

The words that I hear most often that have no positive impact for a patient center on the "D - Duration" in AIDET. One of the priorities for our patients is to have an understanding of how long something is going to take. That is the number one driver of patients' perception of care in the emergency department. The words that I hear regarding duration include - "As soon as we can", "As soon as possible", "Pretty quick", "Few minutes". These statements do not give a patient an expectation of how long something is going to take. Staff and Providers admit they use these statements because they don't know how long something is going to take.

The truth is, we know more than we say. The problem with these words and phrases is that we leave it to the patient to set their own expectation of time—and we may or may not meet this patient's expectation. For instance, I may say "Mr. Smith, I am going to have you take a seat in the waiting room and we will get you to a room as soon as possible." I have left it up to Mr. Smith to determine what "as soon as possible" means. Now when I use a few different words, I set a very different expectation for this patient. For instance: "Mr. Smith, we are experiencing a high volume of patients in the ED right now. I am going to ask you to take a seat in the waiting room. We are committed to keeping you informed of your progress so we will be rounding in the waiting room every hour to check on you. If you feel your condition changes please let Mary, our triage nurse, know." This sets a more accurate expectation for this patient. Now he knows he can expect up to an hour wait and someone will be out to let him know the progress.

From here forward I am removing vague words from your healthcare vocabulary. They include: probably, hopefully, usually, try, as soon as possible, as soon as we can, and all the other non-specific words. Begin to listen to what words are used in your department and think about how we can be more specific and help get a patient closer to reality.

What's in it for you? You reduce the anxiety of the patient by setting a realistic expectation. When a patient is informed, they are calm which means less use of the call light, less coming out to the desk and less pacing around the room. What is in it for the patient? They trust us as their healthcare provider and are completely informed regarding their duration and plan of care. Both of these are top drivers in ED patient's perception of care—and both help us live up to our mission of providing great care.

- Regina Shupe RN, MSN, CEN