Chapter 4: Effective Communication

When implementing any new accessibility initiative at your organization, earning buy-in from leadership is essential. Support from leadership will ensure you have the resources necessary to successfully create and implement effective communication policies and procedures.

Actions and Tasks

1. Identify what types of leadership support and buy-in you will need.
2. Identify potential champions across your organization.
3. Identify how providing effective communication will fit within your organization’s existing priorities and initiatives.
4. Determine if your organization is involved in regulatory initiatives that require effective communication (e.g., Joint Commission Excellent Health Outcomes for All Certificate, state-level requirements, etc.)

Materials and Resources

• Appendix 0.3: Federal Requirements↗
• Appendix 0.10: Leadership Support: Key Individuals↗

*Appendices 0.3 and 0.10 can be accessed in the General Resources chapter↗.

Effective communication is a shared organizational responsibility that must be embedded into routine clinical workflows, rather than delivered only through consultative or specialty services. Consider including people across different departments and units within your organization on your implementation and leadership team(s).

Actions and Tasks

1. Identify the implementation team for providing effective communication.
   • Include leadership and others who have the authority to make changes.
   • It could be helpful to start with a pilot or testing team to work through challenges before expanding to the entire clinic or healthcare system.
2. Determine the implementation team meeting structure.
   • How often will the team meet?
   • Is this a project that will be part of a quality improvement team or embedded within another team?
3. Identify champions for the project.
   • Select person(s) to lead and champion the implementation team.
   • Are they able to implement changes?
   • Consider the role of the champion(s): will they be a clinical champion or a non-clinical team member? Are both clinical and non-clinical needed? Will you include multidisciplinary champion(s) to support system-wide implementation? Is there someone at the system level who has been assigned this task that can help? For example, a Disability Coordinator?

Materials and Resources

• Appendix 4.1: Effective Communication Implementation Team

Identify the current state of patient-facing communications at your organization using Appendix 4.2: Effective Communication Needs Assessment.

Actions and Tasks

1. Identify if and where effective communication policies and procedures are currently happening, including who is leading the work and the department or unit the work is happening in.
2. Engage with other healthcare organizations to understand their effective communication procedures, including what is and isn’t working for them. Consider joining the Disability Equity Collaborative’s Leaders workgroup to create a peer network.
3. Determine how you will include patient perspectives.
   • Will you include people with disabilities on your implementation team?
   • Will you convene a patient advisory board?
   • Will you conduct a patient experience survey?
   • Will you engage disability community organizations?

Materials and Resources

• Appendix 4.2: Effective Communication Needs Assessment
• Appendix 4.6: Effective Communication Accommodations Examples
• Disability Equity Collaborative’s Leaders Workgroup↗

Part A: Policy Writing

When composing your effective communication policy, consider all essential activities required in a visit (e.g., scheduling, navigating within the facility, communication during and after the visit, etc.). Patients with disabilities should be able to access each of these essential activities. For example, if you provide after-visit summaries, ensure patients with visual, cognitive, and communication disabilities can access the materials.

Actions and Tasks

1. Establish the team responsible for developing or modifying your organization’s effective communication policy.
   • Will this team be different than your implementation team?
   • Identify who will review drafts and ultimately approve your policy.
     • Is there a department typically responsible for administrative policies?
     • Do other policies (i.e., nondiscrimination, grievance procedures) already exist? If so, who drafted them?
2. Identify the scope of the project. Consider if this policy will apply organization-wide or to a single clinic.
3. Review legal, regulatory, and accreditation requirements to determine what must be included in your policy.
4. Draft the policy in accordance with your organization’s mission and values.
5. Engage the disability community and patients’ perspectives for feedback.

Materials and Resources

• Appendix 0.4: Disability Organizations↗
• Appendix 4.1: Effective Communication Implementation Team
• Appendix 4.3: Effective Communication Implementation Planning
• Appendix 4.4: Effective Communication Policy Planning Guidance

*Appendix 0.4 can be accessed in the General Resources chapter↗.

Part B: Communication Auxiliary Aids and Services (Accommodations)

Use the completed “Communication Auxiliary Aids and Services (Accommodations)” section of your Needs Assessment (Appendix 4.2: Effective Communication Needs Assessment) and reference Appendix 4.5: Effective Communication Accommodations Examples to determine what accommodations your clinic or organization will provide.

Actions and Tasks

1. Select the auxiliary aids and services your organization will provide.
2. Plan how equipment will be purchased, including which budget(s) will fund them.
3. Determine what staff (i.e., interpreters) your organization must hire, including what department will house them.
4. Identify the scope of the project. Consider if the accommodations will be available across the entire organization or a single clinic.
5. When procuring auxiliary aids and services, consider:
   • Who will purchase the necessary equipment?
   • How many of each accommodation will the clinic need?
   • Where will accommodation(s) be located?
   • How will clinicians and staff be made aware of where accommodation(s) are located and how to access them in real time?
   • How or when will new supplies be ordered?
   • How will accommodation(s) be maintained?
   • What infection control issues need to be considered?
6. Using Appendix 0.9: Disability Accommodations Inventory Table↗ in the General Resources chapter, decide how auxiliary aids and services will be provided within a clinic. Aim to integrate the process into existing clinic and system-level workflows when possible.
   • Identify how patients will be asked about their preferred communication strategies and accommodation needs.
   • Identify local barriers and facilitators to providing auxiliary aids and services.
     • For example, determine clinic level readiness and motivation for utilizing aids with patients, such as communication boards.
   • Use the Effective Communication Implementation Planning Worksheet (Appendix 4.3)↗ to specify site or clinic goals, strategies, timelines, milestones, and measures for implementing effective communication.
   • Create a workflow map, a visual representation of the actions, decisions, and tasks to be performed to successfully provide accommodations. See Appendix 4.11: Effective Communication Process Map↗ for a sample map of this process during a medical encounter.
     • For example, identify someone responsible for scheduling interpreter services.
   • Determine what can and cannot be adapted in the standard process for providing an auxiliary aid or service.
     • For example, there will likely be different processes for providing Communication Access Real Time Translation (CART) during the medical encounter versus providing pre-visit paperwork during registration.
   • Determine the resources needed to provide accommodations.
     • For example, you will need to dedicate time for staff to complete trainings.
7. Revisit the composition of the implementation team. Determine if additional individuals from departments or units that will be involved in any aspect of the workflow/process to provide an accommodation should be included.

Materials and Resources

• Appendix 0.9: Disability Accommodations Inventory Table↗
• Appendix 4.2: Effective Communication Needs Assessment
• Appendix 4.3: Effective Communication Implementation Planning
• Appendix 4.4: Effective Communication Policy Planning Guidance
• Appendix 4.5: Effective Communication Accommodations Examples
• Appendix 4.11: Effective Communication Process Map

*Appendix 0.9 can be accessed in the General Resources chapter↗.

Part C: Training

All patient-facing staff, clinicians, and interpreters should be trained on your effective communication policy and procedures to support successful implementation.

Actions and Tasks

1. Determine who will provide consultation to assist with training for staff and providers on your effective communication policy, the use of effective communication strategies, and providing auxiliary aids and services.
   • This person (or people) will offer expert guidance, feedback, and problem-solving to a site longitudinally.
   • This can be a practice facilitator or similar role.
2. Identify or create resources and trainings on effective communication strategies for staff and providers.
3. Identify or create resources and trainings on how to use auxiliary aids and services for staff and providers.

Materials and Resources

• Appendix 4.6: Effective Communication Training Resources
• Appendix 4.7: Verbal Communication Guidance
• Appendix 4.8: Written Communication Guidance
• Appendix 4.9: Deafness and Sign Language Guidance

Prior to implementation, consider the following actions to ensure staff, patients, and your organization’s systems are prepared to successfully implement effective communication.

Actions and Tasks

1. Determine who will provide technical assistance for both utilizing effective communication strategies, providing auxiliary services, and using auxiliary aids.
   • Is this a speech-language pathologist? Interpreter?
2. Determine how auxiliary aid and service equipment will be maintained.
3. Identify or develop tools that will encourage staff to utilize effective communication strategies.
4. Identify or develop patient-facing education materials to inform patients of the new effective communication policy.
5. Determine how success will be defined for effective communication, including appropriate metrics (e.g. were requested aids and services provided, patient, staff, and clinician satisfaction with the process, etc.).
   • Specify how you will monitor or assess whether patients are receiving requested aids and services.
   • Develop an evaluation plan to reflect your definition of success.

Materials and Resources

• Appendix 4.4: Effective Communication Policy Planning Guidance
• Appendix 4.10: Effective Communication Frequently Asked Questions
• Appendix 4.12: Effective Communication Barriers and Strategies

Roll out the implementation plan developed in previous steps to implement effective communication procedures.

Actions and Tasks

1. Track and communicate rates of compliance with effective communication policies, use of services, and provision of auxiliary aids and services to responsible individuals (e.g., leadership, those providing services or accommodations) and implementation teams.
2. Review site-level data on provision rates and determine if changes in workflow or strategies are needed. Determine if additional staff, services, or aids are needed.
3. Make and document all needed adaptations.
4. Conduct Audit and Feedback, an implementation strategy that includes providing site-level staff, provider, or team-level data on effective communication to those assigned to perform tasks.
   • For example, create a progress chart to display in a staff breakroom.
   • Audit and Feedback article↗ that details how to employ the strategy.
5. Recognize high performing staff, clinicians, or specific clinics or sites to recognize and celebrate high completion rates.
6. Continue to solicit patient feedback and make adjustments to your implementation plan as necessary.

Materials and Resources

• Appendix 4.10: Effective Communication Frequently Asked Questions
• Appendix 4.12: Effective Communication Barriers and Strategies
• Appendix 4.13: Effective Communication Monitoring Progress and Adaptations