I am excited about this issue and the telehealth theme. There are innovative possibilities and opportunities for care management in primary and specialty settings outside of the traditional office or hospital environment. The advancement of telehealth in acute and chronic care management is also exciting because the technology highlights the power of communication. There are three major types of telehealth modalities: remote patient monitoring, synchronous and asynchronous. All methods require additional considerations when communicating with patients; however, the synchronous method is more effective when advanced communication techniques are applied.
Synchronous telehealth utilizes live telephonic or audio-video interaction between the patient and clinician. All of the traditional communication skills used during real-time, in-person interactions are important, but additional considerations are warranted. Patient-centeredness, attentive listening, empathetic responsiveness, use of open and closed-ended questions, nonverbal cueing and cultural appropriateness are a few of the communication skills that are routine in a patient-clinician relationship. Using these examples, there are other communication considerations when utilizing telehealth.
Patient-centeredness: Utilize teaching/training skills for patients who may not be familiar with technology and/or demonstrate patience with clients who may experience unstable internet connections.
Attentive listening: Establish visual connection to demonstrate attentiveness, i.e., professional appearance, look directly into the camera to engage direct eye contact, eliminate distractions.
Empathetic responsiveness: Modulate voice volume, tempo and projection to convey commitment and empathy to patient situation during assessment, evaluation, treatment.
Open and closed-ended questions: Utilize specialized interviewing styles, mediation if family members are present, anticipatory queries and guidance.
Nonverbal cueing:Coach the patient with camera angles to assist with whole body assessment, self-awareness of clinician’s activities and body language within video range.
Cultural appropriateness: Unconditional positive deference for patients and their families; non-judgmental communication tone/style, respect for patient autonomy/individuality, curiosity.
This is not an exhaustive list of skills and techniques necessary for effective communication during the patient-clinician experience, but rather a sampling of strategies that are critical to effective telehealth communication. Effective communication leads to better outcomes, and it is imperative that clinicians acknowledge the need for “ancillary” skills to complement “typical” communication during the telehealth interaction.
During this past year, many of us have come to appreciate the power of communication while utilizing technology in the form of audio-video platforms. I expect books, late night shows, and other media to have a plethora of content from communication fails and successes experienced by healthcare professionals who pivoted from in-person to virtual interactions. But these stories become data that can inspire better technology, advanced interpersonal skills for virtual interactions and new possibilities for care management that leverage the power of communication. This scenario is the epitome of “meeting patients where they are.”
As case managers, we must initiate and engage in advanced communication strategies to ensure effective communication with patients and families that may participate in a clinical experience within a larger environment of family, home life, and new windows into the full context of the patient determinants of health. I also believe that the future of telehealth is bright and will evolve into complex modalities and procedures for optimal use. The need for agencies, professional disciplines, and member associations to collaborate on patient rights, public policy, interstate licensure, reimbursement, clinically relevant communication standards and other considerations is important. For example, The Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, National Institutes of Health, associations such as the American Medical Association, American Academy of Pediatrics, American Association of Nurse Practitioners, National Association of Social Workers are a few agencies and societies that are excellent partners for these areas of collaboration. The Case Management Society of America is excited to embark upon a journey of collaboration with organizations that influence and impact care management and the profession of case management in this new year and beyond. After all, collaboration is another example of the power of communication!
Melanie A. Prince, MSN, BSN, NE-BC, CCM, FAANPresident of the Case Management Society of America