Effective Communication Skills in Health and Social Care

Introduction

Healthcare and social care settings rely on effective communication skills to deliver person-centred, high-quality care and support. Good communication benefits service users, maintains their well-being and positively affects health outcomes (NHS England). They also enable healthcare and social care workers to work well as a team to meet patient/client needs, wishes and preferences and build strong relationships with them and their families and caregivers.

Poor communication can lead to confusion, misunderstandings, errors and patient/client dissatisfaction. In worse cases, it can lead to reduced care, psychological distress, serious failings and harm. It can also negatively impact healthcare and social care staff, resulting in inefficiencies, loss of staff and wasted resources. The National Institute for Health and Care Research (NIHR) summarised a research article that found that communication problems were the top of patients’ concerns about hospital care.

Patients/clients and their families and caregivers want good quality communication when accessing healthcare and social care services. A recent report by Healthwatch highlighted that people feel ‘admin’ and communication can be slow, inefficient, and sometimes lack empathy. Therefore, it is vital for those working in the healthcare and social care sector to improve their communication skills. This blog aims to explore the key communication skills and strategies essential for healthcare professionals and social care workers.

Understanding Communication in Health and Social Care

Communication is the exchange of information or messages from one place or person to another. It is also one of the 6Cs of care, a set of values required by all healthcare and social care staff. The 6Cs define communication as:

“Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say. It is essential for ‘No decision without me’. Communication is the key to a good workplace with benefits for those in our care and staff alike” (NHS Professionals).

Communication is significant in delivering high-quality, person-centred care and support. It helps healthcare and social care staff build trust, foster positive relationships and make better decisions with their colleagues, patients/clients and their families, and other professionals. It also enhances teamwork and collaboration between multidisciplinary teams where everyone is on the same page regarding patient/client care and treatment. Overall, it can promote patient/client well-being, increase their satisfaction with services and improve their health outcomes (Sharkiya, 2023).

There are various forms of communication used in healthcare and social care, such as:

• Verbal – is where people use spoken language face-to-face, over the phone or via video conferencing to communicate, e.g. interacting, having conversations and discussions on diagnoses and care/treatment plans with patients/clients, families, caregivers, colleagues and other healthcare and social care professionals.
• Non-verbal – is communicating via body language rather than spoken words. It can include facial expressions, gestures, eye contact and posture. Healthcare and social care staff can use these cues to show empathy and reassure patients/clients and their families.
• Written – is where healthcare and social care workers communicate via the written word. It can include notes, emails, letters, writing care and treatment plans and maintaining accurate records.
• Visual – is the use of visual aids, such as diagrams, pictures, charts and graphs, to help patients/clients understand medical information and to enhance comprehension.

There are also types of communication for those with hearing and sight impairments, e.g. sign language, Braille and Makaton.

Communication can be formal or informal. The former is typically used between colleagues, healthcare and social care staff and patients/clients and follows structured and official channels. The latter is usually used with family and friends. Staff should use the most appropriate communication method and form for the person and situation.

When communication is effective, it:

• Enables healthcare and social care staff to build trust with patients/clients, as they feel listened to, respected and valued, and are more likely to participate in their own care.
• Promotes understanding, as information and messages are delivered in a way that patients/clients can understand.
• Streamlines operations and enhances overall efficiency so patients/clients get a better service and are more satisfied with their care and support.

Active Listening

Active listening is a critical communication skill in healthcare and social care. It involves not just hearing what a person has to say but being fully present, listening intently and giving them full attention without judgment. It also encompasses understanding what a patient/client means and their intent by the following:

• Reflect on what was said and seek to understand meaning.
• Repeat what was said to check accuracy.
• Ask open-ended questions to check understanding.
• Avoid distractions when talking to them and be fully engaged to show interest.
• Use posture, body language, eye contact, facial expressions and tone of voice to indicate a willingness to listen and pay attention to their cues.
• Summarise to demonstrate they were heard and understood.

Active listening is a pillar of patient/client-centred care. It demonstrates to patients/clients that healthcare and social care staff are genuinely interested in their needs, emotions and concerns. It also makes them feel heard, valued, and respected, which can foster positive relationships, encourage them to engage in collaborative care, promote shared decision-making and enhance healthcare and social care outcomes.

Some strategies that healthcare and social care staff can adopt for active listening include:

Maintain good eye contact – to show interest and engagement and be fully present in the conversation. Maintain eye contact in the right way, as overusing it can make people feel uncomfortable. Be mindful that in some cultures, especially Middle Eastern, eye contact is less common and considered less appropriate (TransCoCon). Verywellmind has some good tips for making eye contact here.

Avoid distractions – to provide undivided attention to the patient/client. It is hard to listen and follow what a person is saying if there are constant distractions. Eliminate distractions where possible, e.g. put phones away and erect do not disturb signs to focus on the conversation.

Use open body language – to appear approachable and put the patient/client at ease. As well as eye contact, the following demonstrates open body language:

• Face the patient/client. When typing notes or looking at computers, return to face them as soon as possible.
• Avoid crossing arms and legs, as it can appear defensive.
• Keep limbs relaxed and open and arms by sides.
• Lean in to demonstrate attentiveness.
• Smile while listening and when appropriate to show warmth and compassion.
• Tilt head to indicate interest and attentiveness.
• Pay attention to your hands and align them with the rest of your body language.
• Nod at key moments to convey understanding and agreement.

Use the right verbal cues – to demonstrate listening and understanding. Avoid filler words when speaking to patients/clients, such as “like”, “so” or “um”. Use simple words and sentences, and avoid jargon or complex language that patients/clients may find difficult to grasp. Be concise and to the point, and avoid repetitions and unnecessary details.

Active listening can improve rapport, empathy, and collaboration with patients/clients and their families by:

• Making them feel respected and valued when they see someone is listening to them, taking their concerns seriously, and that their feelings matter.
• Creating a warm, welcoming, open and supportive environment where they feel comfortable talking about their concerns and feelings can make it more likely that they will engage and participate.
• Showing understanding and empathy if they have concerns and validating their feelings and emotions can foster rapport and trust and build positive relationships.
• Being non-judgmental and allowing them to express themselves fully can promote openness and disclosure.

If healthcare and social care professionals adopt active listening techniques, it can create positive relationships, improve patient/client outcomes and increase patient satisfaction. It can also help them communicate effectively with colleagues and other professionals.

Further tips on active listening are on:

• BHF Heart Matters magazine – 10 tips for active listening.
• Verywellmind – Active Listening: Techniques, Benefits, Examples.

Empathy and Compassion

Active listening and empathy go hand-in-hand in effective communication, e.g. recognising people’s feelings, paying attention to the emotion behind their words and being aware that meanings can often depend on mood, feelings and context.

When a person has empathy, they can:

• Emotionally understand and share the feelings, thoughts and personal experiences of others.
• See things from other people’s perspectives and put aside judgements.
• Imagine themselves in someone else’s position.
• Listen to others with compassion and communicate understanding.

Compassion goes beyond empathy, and NHS Professionals define it as:

“How care is given through relationships based on empathy, respect and dignity. It can also be described as intelligent kindness and is central to how people perceive their care”.

Empathy and compassion are hugely relevant in healthcare and social care settings for the following reasons:

• Fosters trust – when patients/clients use healthcare and social care services, they want to feel valued, respected, understood and supported. If they feel listened to and cared for, it can build trust and strengthen relationships.
• Reduces anxiety – patients/clients can feel anxious, uncertain and fearful, especially when they have health challenges. Demonstrating empathy and compassion can help alleviate their concerns and worries and improve patient-provider interactions.
• Leads to better health outcomes – research demonstrates that empathy and compassion can improve the health and well-being of patients/clients and lead to better health outcomes, as they are more likely to follow medical advice and adhere to treatment plans (Barker et al, 2023). According to the University of Leicester, empathetic care can reduce pain, medication use, and the number/length of hospital admissions.
• Reduced errors – if healthcare and social care professionals listen empathetically to patients’/clients’ needs and concerns, it can lead to better collaboration, shared decision-making and fewer mistakes.
• Lead to higher patient/client satisfaction – if patients/clients feel cared for, supported, respected, valued and understood, they are more likely to be satisfied with their healthcare and social care provision and engage in their own care.
• Improved relationships with colleagues – healthcare and social care can be a challenging and demanding sector to work in. Therefore, empathy and compassion can help colleagues support one another and work better as a team.

The Health Foundation has a video on compassion, dignity and respect in healthcare here, and it includes some patient stories of how compassion made a difference when they were in the hospital.

Healthcare and social care professionals should demonstrate empathy and compassion in their settings, and some examples of the strategies they can adopt are as follows:

• Actively listen, pay attention to what patients/clients are saying, and demonstrate a genuine interest.
• Encourage patients/clients to communicate openly, express their concerns and ask questions.
• Use reassuring responses, e.g. “I understand how you feel” or “I can imagine how challenging this must be for you”.
• Use empathetic non-verbal cues, such as a warm smile (where appropriate), open body posture, eye contact or a comforting touch (with permission).
• Be patient and non-judgmental, and avoid making assumptions to create a safe and supportive atmosphere.
• Validate their emotions and feelings using empathetic responses, such as “It’s okay to feel that way”.
• Tailor communication styles to each patient/client. Some may need more reassurance than others.

Some examples of how empathetic communication can enhance the quality of care and support provided are as follows:

• Understanding and alleviating patient/client fears, anxieties, and experiences can make them feel more comfortable, less embarrassed and more likely to seek help and disclose information. It can help healthcare and social care professionals provide more tailor-made and personalised care and services (Moudatsou et al, 2020).
• Explaining diagnoses, care, treatments, and support calmly, clearly and kindly makes it more likely that patients/clients will follow medical advice and engage in care and treatment plans. If they are more involved in their own care and support, it is likely to improve their health outcomes.
• Validating patients’/clients’ feelings and emotions can help them feel understood, valued and respected, fostering trust and increasing their satisfaction when accessing services. If patients/clients are happy with the service, they will continue to access the care and support they need.

Clear and Concise Communication

Information and messages are understood, and misunderstandings and confusion are avoided when communication is clear. Concise communication is getting straight to the point and using fewer words, which can help people understand the information they are receiving.

Clear and concise communication is important in healthcare and social care for the following reasons:

• It avoids miscommunications and misunderstandings that can lead to confusion, conflict and mistakes.
• It builds trusting relationships with patients/clients and their families.
• It helps patients/clients, colleagues, and other healthcare and social care professionals understand the information given to them.
• It ensures everyone is on the same page, which fosters efficiency and promotes higher-quality care.

According to the Patient Information Forum, complex and jargon-heavy materials can lead to increased hospitalisation visits, failure to take medicines correctly and a lack of trust in healthcare. Therefore, it is essential to communicate clearly and concisely in healthcare and social care settings, and here are some tips:

• Avoid jargon, acronyms, abbreviations and technical terms, as they are difficult for patients/clients to understand. Tailor language to meet each patient/client.
• Be mindful of non-verbal communication. Maintain eye contact and adopt welcoming and compassionate body language.
• Think carefully about the choice of words and remember less is more. Avoid unnecessary words and repetition, and flowery language.
• Use plain language that can be understood the first time it is seen or heard, i.e. keep it simple, use short sentences and avoid rambling.
• Speak at a pace the patient/client can understand.
• Ask patients/clients questions to confirm they have understood the information given to them.
• Look at various ways of presenting information, especially when communicating in writing. Consider visual ways of getting the message across and use a glossary or explain immediately if a complex word needs to be used.
• Be mindful of patients/clients who communicate in different ways, e.g. those with autism and dementia may require various forms of communication to help them understand.

Verifying understanding and seeking clarification is essential in ensuring effective communication, as miscommunication and misunderstandings can lead to confusion, costly mistakes, patient/client dissatisfaction, poor health outcomes and even harm. Unclear communication can significantly erode patient/client trust in healthcare and social care provision, resulting in them avoiding services.

Further information:

• Alzheimer’s Society – How to communicate with a person with dementia.
• CPD Online College – Effective Communication for Care Professionals | Strategies.
• CPD Online College – The 7 Cs of Communication.
• National Autistic Society – Understanding and developing communication.
• The BMJ – Improving your communication skills.

Non-verbal Communication

Communication does not just involve spoken language and the use of words, but it also encompasses non-verbal communication, which includes:

• Facial expressions – show emotions and reactions, which can span various cultures. For example, a smile can convey happiness and make someone feel welcome and comfortable, while a frown can signify displeasure.
• Gestures – use of hand and arm signals, e.g. waving, thumbs up and pointing. Gestures can differ between cultures.
• Eye contact – conveys interest, trust and attention. For example, maintaining eye contact can signify engagement and interest and looking elsewhere suggests disinterest and boredom.
• Body language – involves posture, stance and movement. For example, crossing arms can signal defensiveness and leaning forward when someone is talking can indicate interest.
• Paralanguage – using tone, pitch, volume and voice, e.g. a raised voice can signify anger, and a soft tone can demonstrate care and compassion.
• Touch – communicates emotions and intentions, e.g. a pat on the back, a hug or a handshake. Culture dictates what is appropriate regarding touch.
• Personal space – this is the distance maintained between one another. Standing too close to someone can invade their space and make them uncomfortable.
• Appearance – our clothing, jewellery, grooming and body art can convey information and influence people’s impressions of us.

Non-verbal communication cues are significant as they can convey information to others and have an essential role in our interactions. According to the British Council, 93% of communication is non-verbal and 7% verbal. In non-verbal communication, 55% is body language. Therefore, we say a lot without even opening our mouths.

In healthcare and social care interactions, being mindful of non-verbal communication cues is essential, as it can mean the difference between maintaining professionalism and overstepping boundaries. It is also crucial in conveying empathy and reassurance and creating a comfortable and trusting environment.

Healthcare and social care staff should also know how to interpret and respond to non-verbal cues from patients/clients. Their response will depend on each individual and situation, and they should:

• Respond empathetically and compassionately to the non-verbal cues they observe.
• Be mindful of different cultures and medical conditions when interpreting and responding to non-verbal cues, as they can signify something else.
• Adjust the response to each individual and what they say, how they behave, their situation and their non-verbal cues.
• Always get consent before touching a patient/client, even if they initiated.

It is important to not rely solely on non-verbal communication cues, as they can sometimes indicate something else, e.g. a person with crossed arms may be cold and not defensive. Healthcare and social care professionals should use these cues with verbal cues and other sources where necessary (Health Service Executive).

Cultural Competence

The UK is diverse and multicultural, with people from different backgrounds, races, ethnicities, cultures, beliefs, values and religions. Patients/clients and their families will all have varying needs and preferences. Therefore, healthcare and social care workers must be sensitive to these differences and develop cultural competence.

According to NHS North Kensington Major Incident Response:

“Cultural competence describes a set of aligned and transparent skills, attitudes and principles that acknowledge, respect and work together as a system towards optimal interactions between individuals and the various cultural and ethnic groups within a community.”

Cultural competence is vital for communicating effectively within healthcare and social care settings and enhancing trust, engagement, and satisfaction among patients/clients from diverse backgrounds as it:

• Promotes active listening and allows communication styles to align with patient/clients’ cultural norms, which can build trust and encourage dialogue.
• Enables healthcare and social care staff to understand and tailor care and support to patient/client needs, preferences, beliefs and wishes, and fosters a positive environment built on trust and collaboration.
• Helps overcome barriers to healthcare and social care, such as cultural norms, beliefs and language, encouraging patients/clients to access the services they need and improving health equity.
• Makes patients/clients feel more comfortable, understood, valued and respected so they are more likely to share information, openly communicate and actively participate in their healthcare and social care.
• Creates a positive experience for patients/clients if their cultural needs and preferences are acknowledged, which can increase engagement and satisfaction in the service provided.

Some examples of strategies for culturally competent communication are as follows:

• Never assume that a patient/client has certain beliefs, needs or wishes. Self-reflect, recognise and challenge own assumptions and biases.
• Understand patients’/clients’ backgrounds, traditions, religions, beliefs and language preferences to provide person-centred care. Ask them about their needs and wishes by using open questions.
• Learn basic phrases in other languages, such as greetings, to help build rapport.
• Use professional interpretation services, where available, to overcome language barriers. Avoid using family members who may misunderstand or not relay important information.
• Use visual aids, such as drawings, diagrams and posters, or demonstrate to help clarify information and increase understanding.
• Undertake cultural training to learn more about cultural competence.
• Collaborate with local cultural groups and community organisations to increase understanding about the communities accessing services.

Healthcare and social care staff should respect people’s values, beliefs and cultural identities. Even small efforts can help build trust, enhance communication and foster collaboration.

Further information

• Care Quality Commission – Culturally appropriate care.
• co.uk – The Importance Of Cultural Competence In Nursing.
• UK Council for Psychotherapy – Understanding cultural competence in mental healthcare.

Conflict Resolution

Conflicts can happen in most workplaces, but they can occur more frequently in healthcare and social care due to the stressful, challenging and emotive nature of these settings and the multidisciplinary teams involved (Kelly & Al-Rawi, 2020). Everyone has differing needs, so conflicts are inevitable from time to time. They can arise between:

• Healthcare and social care staff, e.g. due to personality incompatibilities, differences of opinion, and power struggles.
• Patients/clients/families and healthcare and social staff, e.g. having certain expectations regarding their care and treatment and poor perceived service.

Communication breakdowns are also an issue in healthcare and social care and can lead to conflict. They occur when there is a lack of communication due to a failure in exchanging information. It can result in patients/clients not receiving vital information or misunderstanding it, leading to dissatisfaction.

With the high demands for healthcare and social care services and longer waits for appointments, it is not surprising that patients are getting more frustrated. Unfortunately, these frustrations are often directed towards healthcare and social care staff. Conflicts and communication breakdowns can lead to staff being verbally abused and even physically assaulted. Therefore, anyone working in the sector needs to understand how to manage conflict and resolve communication breakdowns in their settings to foster a positive environment. Some examples of strategies include:

• Understanding why conflicts can arise, e.g. a lack of information, conflicting information, or incompatible belief systems.
• Trying to discuss the issue in a neutral location and away from others.
• Adopting active listening techniques and listening intently to patients/clients can show them you are taking their concerns seriously and want to help.
• Clarifying what the issue is and trying to seek common ground.
• Showing empathy and compassion to demonstrate to patients/clients that their emotions and feelings are taken seriously.
• Working with patients/clients and their families to find a way forward and seeking advice from senior personnel if the conflict is irresolvable.

If the conflict is not preventable and things begin to escalate, several de-escalation techniques can prevent a tense situation from worsening, such as:

• Assess the person’s emotional state, e.g. frustrated, angry or under the influence of substances, such as drugs or alcohol.
• Actively listen to them to understand their concerns and get to the cause of the issue or triggers.
• Adopt open body language and maintain eye contact.
• Do not raise your voice, even if they are shouting. Speak softly, calmly and lower your voice volume.
• Reassure them to alleviate their worries and tell them what you will do and when. However, do not make promises, but keep them informed of the progress.
• Provide them with choices where possible, which can help to make them feel more in control.
• Request assistance from managers, supervisors or colleagues, where needed, to help manage the situation.

Conflict resolution is vital to seek a peaceful solution to conflict. When done effectively, it can improve:

• Teamwork – those working in a team can learn to communicate more effectively when they address conflicts openly and constructively, which can also build trust, as each member feels heard and respected. It also promotes shared responsibility, collaboration and reduced blame when the team works together to find solutions to provide the best possible care.
• Collaboration – healthcare and social care staff must work together to deliver high-quality, person-centred care to improve outcomes for patients/clients. Effective conflict resolution can improve staff well-being and team dynamics.
• Patient/client outcomes – when teams manage conflicts, they are on the same page regarding patient/client care and treatment decisions. It helps them work together better, reducing mistakes and improving patient/client outcomes. It also helps them communicate more effectively with patients/clients, which can improve adherence to treatment plans and increase satisfaction with the service.

Technology and Communication

Technology is developing rapidly and is now widely used in healthcare and social care settings, and its use is increasing. It can include various technologies, tools, systems and services, such as health apps, wearable technology, artificial intelligence and social media.

It has an essential role in enhancing communication in healthcare and social care settings, as it improves access and increases efficiency, e.g. electronic records have mostly replaced paper, which allows staff to access patient/client information/records more quickly. It also streamlines communication processes, allows for remote communication between providers and patients/clients and can improve services through data analysis.

Since the COVID-19 pandemic, technology, particularly digital tools, has become increasingly important in enhancing access to healthcare and social care services and improving communication. Some examples include:

• Electronic health records (EHRs) – patient/client information is stored electronically and shared across various healthcare and social care providers, which can avoid duplication and enhance coordination and collaboration
• Telehealth services and telemedicine – involves providing healthcare and social care at a distance (remotely) rather than face to face, e.g. remote consultations, either by phone or video calling. It can make services more accessible to vulnerable and marginalised communities and those in rural areas.
• Digital communication platforms – can include emails, instant messaging, videos, text messages, live platforms, websites, social media, etc. These can enhance the speed at which patients/clients receive and respond to information.

It is important to note that some may have digital barriers, particularly those who are in poverty, homeless people, older people and migrant populations (British Medical Association). Therefore, healthcare and social care providers should use communication forms and methods that meet patient/client needs and preferences, i.e. if someone does not have access to technology, lacks basic skills or prefers not to use it, they should use other means of communication.

While technology has many benefits regarding communication in healthcare and social care, there are risks, particularly regarding privacy, confidentiality, and security:

• Privacy is essential to uphold patients/clients and their family’s dignity and respect.
• Confidentiality is critical, as patient/client personal data must be protected by law. They also expect their data and information to be kept confidential.
• Security is vital to protect patient/client data from being stolen, as there is a risk of cyber attacks and data theft.

Healthcare and social care staff must be mindful when having private conversations with others to ensure they are not overheard by anyone, even when talking with others remotely. They must uphold privacy, security and confidentiality when using technology and sending messages and information digitally. They should always follow their employer’s policies and procedures and the standards of regulatory bodies.

Further information:

• Department of Health and Social Care Media Centre – How we are delivering innovation in health and social care services.
• Neve et al (2020). Digital health in primary care: risks and recommendations. British Journal of General Practice.
• Skills for Care – Using technology in social care.
• The King’s Fund – Shaping The Future Of Digital Technology In Health And Care.

Conclusion

Good communication, i.e. verbal, non-verbal, visual, written, formal or informal, is crucial to delivering messages and information in a way patients/clients understand. If communication is poor, it can lead to confusion, misunderstandings, miscommunication, patient/client dissatisfaction and even harm.

Effective communication is crucial to understanding patient/client needs and preferences and providing person-centred care and support in healthcare and social care settings. If it is also empathetic and compassionate, it helps build rapport and trust and fosters positive relationships between staff, patients/clients, their families/caregivers, and other healthcare and social care professionals.

When communication is effective, it also enhances teamwork and collaboration between colleagues and multidisciplinary teams where everyone is on the same page regarding patient/client care, treatment and support. It can lead to better health outcomes for patients/clients and enhance their satisfaction with healthcare and social care services.

There are numerous forms and methods of communication and many strategies and techniques to improve interactions with patients/clients. Healthcare and social care professionals must tailor their communication styles to each patient/client and use the forms and methods they prefer to increase engagement and reduce conflict. They should also develop and refine their communication skills to meet the evolving needs of patients/clients and their families.