Enhancing Patient-doctor Communication in Healthcare Delivery

Oluchi Chibuzor highlights the need to teach about empathy and work-related challenges for a better healthcare delivery process in the country

A research on, “Association of Perceived Medical Errors With Resident Distress and Empathy: A Prospective Longitudinal Study,” by Colin West, reveals that medical errors are common among internal medicine residents and are associated with substantial personal distress.

The research argued that personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.

It further noted that medical errors and patient safety are important concern for patients and physicians, while stating that medical errors are associated with feelings of distress in physicians, “but little is known about the magnitude and direction of these associations.”

The research opined that as medical doctors possess varying levels of empathy relative to their sociodemographic characteristics, specialty of choice and level of expertise.

The research revealed that clinical empathy is the competence of a physician to understand the patient’s situation, perspective, feelings and act on that understanding in a helpful therapeutic way. 

Acording to the research, “One thing is clear to medical practitioners is that empathy is the backbone of patient-physician communication in clinical care, even though  it can be innate, learnt or acquired in the course of the medical career.

“However, on the part of the physician it is essential during interpersonal communication to understand the perceptions and needs of the patient, empower the patient to cope more effectively and resolve the patient’s problems. It is believed that effective consultations and interactions between a patient and a physician plays a vital role in patients’ perception of the quality of care received.”

Interestingly, a PwC survey of Nigerians found that more than 90 per cent of respondents associated advanced healthcare delivered in Nigeria with ‘low quality’. 

The PwC report stated that this perception has been established over many years, adding that each new report of poor clinical care has reinforced the belief among the population that Nigerian healthcare is somewhat substandard and should be avoided whenever an alternative can be found.

It further explained there are also negative perceptions arising from confusing the hospitality function such as aesthetics, ambience of hospital, courtesy of staff with the clinical function-effectiveness of care provided of hospitals.

Championing Empathy 

The views of late Prof. Emmanuel Elebute in the medical field remains to be admired considering his exploits in the health sector in the country.  

In his view, empathy, which is also lacking in practices as most providers do not see their patients as people anymore but as statistics.

He believed strongly in the need for healthcare providers to be empathetic which would ultimately improve patient outcomes, while ensuring that Society for Quality in Health in Nigeria (SQHN) standards for accreditation had a chapter on empathy. 

This was the first standards for Hospital Accreditation with a chapter on Empathy and Professor Elebute remained a giant and exemplar of excellence in Healthcare who wished and strived for Access, Quality and Patient Safety in healthcare in Nigeria. 

Recognising his role in the industry, former Minister for state on Health, Dr. Muhammad Ali Pate, remarked that during late Prof. Elebute’s service in the civil service, he encouraged them to focus on improving the quality of health care in Nigeria.

“Our engagements with him then informed the clinical governance initiative we started that led to a National Quality Strategy to be developed in the Federal Ministry of Health. We also engaged safe care to work with PSHAN for quality collaboratives in Primary Health Centers in Lagos State,” he stated.

Driving Patients’ Safety 

In 2003, Elebute, and a group of healthcare professionals came together to promote the idea of a Non-Government Organisation (NGO) being registered to drive the quality and patient safety initiative and take the discussion of quality in healthcare to a wider platform.

The Society for Quality in Healthcare in Nigeria (SQHN) was subsequently incorporated in May 2006 as a not-for-profit organisation which has multi-disciplinary involvement and governed by a constitution, with its focus to bring about a wider understanding and acceptance of quality in Healthcare towards improved patient outcomes and reduction in healthcare delivery costs. 

It is also a platform to share best practice and successful strategies and since inception it has equipped about 7,000 Nigerian healthcare practitioners with basic and advanced quality and patient safety improvement skills.

In line with this mission, SQHN actively began the development of local healthcare facility standards in 2014 to guide and support healthcare facilities in Nigeria in their collective and individual journeys towards quality care delivery, excellent patient experience, and patient safety. 

SQHN standards are specifically designed to improve the overall quality of the health sector by providing standardised assessment of the structures and processes necessary to achieve quality outcomes in a manner that promotes benchmarking and internal organisation improvement of healthcare facilities. 

The SQHN accreditation provides a basis for measurement of the performance expectations, structures or processes that must be in place for any healthcare organisation to provide safe and high quality care, treatment and service while minimising variation. 

Patient’s Safety and Quality Care

Speaking at the first memorial lecture of late professor Emmanuel Elebute, Pate noted that there was widespread evidence from many low- and middle-income countries showing that many individuals who seek care fail to receive appropriate treatments.

Delivering the first Emmaneul Adebayo Elebute memorial lecture with the theme on ‘Reimagining the Future of Healthcare in Africa-A Healthcare Quality Perspective’, Pate said quality should be embedded within all pre-service health workforce training and continuing professional education, with a team-based and multi-disciplinary approach. 

He emphasised that measurement of quality, tracking and continuous improvement must be at the top of mind for health professionals and managers in our health systems. Such training should include large doses of interpersonal elements and teamwork.

“Using digital technology can improve diagnostics, integration and continuity of care, as well as enable patients to be more active participants in the production of health. Provider payment mechanisms that measure and reward quality will set the right incentives for public and private providers,” he maintained.

In view of this the SQHN also agreed to set up the first Late Professor Emmanuel Elebute  prize award that would help in deepening the culture of patient’s safety across the teaching hospitals in the country.

According to him, failure to appropriately treat patients may result from poor provider knowledge, poor access to medicines and vaccines or from the inability of health systems to properly notify and follow up with individuals to provide adequate and timely treatments.

Entrenching Patient’s Safety

The Board Secretary, SQHN, Dr. Abayomi Sule, said: “We have used this lecture to commemorate professor’s lifestyle and contribution to access quality and financial risk protection in Nigeria. But in terms of quality, his notion was that quality is not what you leave to the doctor , private sector , government or even the patient alone; but something all of us should be involved with. All stakeholders that are involved with quality inclusive of all the health care workers, patients and come together to better understand what quality is and how we can better understand improving quality of care.”

According to him, healthcare workers need to be more conscious that quality is not just about themselves or patient care is not about doing or following a particular protocol but making sure that they empathise with patients and adapt in ways that are respectful of the patient as well.

Sule further said: “Quality in health care is quite comprehensive and for us at SQHCN we are devoted to training advocacy and committed to accreditation; it means we have a set of standards which we share with hospitals to meet those standards .

“These standards have themselves been audited and vetted by the international society for Quality in Health Care and so those standards help organisations in Nigeria particularly to benchmark where they are in global requirements. 

“We don’t just give them the standards, we hold them in hand; we have our consultants who help them through what we call practicum-activities. We go to hospitals to support them with both private and government sectors.”