Background 1-4

  • Productive health outcomes are achieved by involving patients in treatment and management decisions of their condition
  • Helping patients can be challenging
  • Clinicians should be mindful that patients have significant personal, social, emotional and financial conditions affecting their lives
  • Skilled communication takes time to learn and practice to be effective

An evidenced approach 1–4

  • Evidenced behaviour change intervention skills with origins in health psychology, can be used and applied to the rural and remote context. See Resource 1.
  • Continued development and practice of effective communication skills can help patients modify their health behaviours

1. What is effective communication? 1–4

  • Core skills and processes to successfully help others
  • A way to work with and support individuals to help them achieve their goals within their broader socioeconomic and cultural environment
  • Equips clinicians to respond to the needs of individuals and families

2. Clinician qualities 2–7

  • The personal qualities that clinicians bring to a relationship (or partnership) with patients and their family include:
    • being respectful by accepting and valuing patient decisions and views
    • being genuine, sincere, reliable and honest without judgement or defensiveness
    • having humility, by understanding own limitations, and being flexible to accept and learn that patients know what is best for themselves
    • being empathic, by seeing, understanding, experiencing and feeling the world from a patient's point of view and setting aside their own biases, views and anxieties
    • being enthusiastic, warm, and encouraging and maintaining a positive outlook
    • having personal integrity, by having the maturity to listen and accept the feelings, ideas and views of their patients
    • being constructive and sensitive when providing feedback and to recognise the impact of their own feelings and views on the process of helping
    • using knowledge, experience and technical expertise

3. Clinician skills 2–4,6,7

  • The observable behaviours and communication methods clinicians use to effectively express the above clinician qualities, while interacting with patients and families are:
    • listening closely. Being attentive without distraction
    • communicating clearly and summarising accurately
    • showing empathy and being receptive to the patient's life experiences
    • actively negotiating, seeking, clarifying and exchanging ideas and priorities with patients
    • being encouraging and build patient confidence by admiring and praising their efforts
    • being focused and prioritising
    • helping patients to change ideas, feelings and behaviours
"The most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them"

Ralph Nichols (1910 - 2001)

4. Characteristics of our patients and families 2–4,6,7

  • Patients and families engage with health services for many reasons. Our ability to help them will depend on our ability to form an effective partnership
  • Patient and family characteristics can include:
    • cultural diversity, rights, views, values and expectations of First Nations and culturally diverse people
    • nature of problem(s)
    • barriers to engagement
    • motivation to change
    • attitudes and beliefs about services
    • expectations of outcome
    • socioeconomic circumstances
    • key needs and strengths

5. Characteristics of our service 1–4,8–10

  • Forming partnerships with our patients is:
    • a key Queensland Health investment strategy action towards closing the gap in health outcomes for Aboriginal and Torres Strait Islander Queenslanders by 2033 by "embedding cultural capability in the planning, design and delivery of health services by enhancing the knowledge, skills and behaviours of the health workforce in culturally responsive patient care"
    • a Queensland Aboriginal and Torres Strait Islander Health Equity strategy to "Improve communication with health consumers and patients by using language and terminology that community understand" and to "Deliver value-based care that personalises and engages Aboriginal and Torres Strait Islander health consumers and patients in decision-making about their care"
    • a Queensland Health service strategy to "engage consumers and communities about their health, and promote and influence healthier choices and protective behaviours"
  • The key characteristics of our service and our communities are:
    • diversity of cultures
    • reflective practice, supervision and support
    • skilled, knowledgeable and competent staff
    • drive and enthusiasm of clinicians, managers and teams
    • attitudes and beliefs about service provision
    • expectations of change and outcome
    • organisational culture, structure, stability, openness and flexibility, value of and access to meet user needs
    • resources available and their use

6. Constructs 2,3

  • Constructs are a person's lifelong experiences that shape the way we view, make sense of, and react to our day to day interactions. They include:
    • culture
    • community
    • family, friends and parents
    • child and generational trauma
    • social media
    • education and schooling
  • Constructs are:
    • thoughts and feelings attached to our actions and behaviours
    • continuously shaped and influenced by subsequent experiences throughout our lives
    • functional, helping us to feel safe and secure in the world
Patient constructs influence their willingness and ability to engage and respond to the help available. Clinician constructs affect perceptions of patient strengths and difficulties. Helping patients sometimes involves 'loosening' or challenging unhelpful constructs; ours and theirs

7. Collaboration 1–7

  • The partnership (or relationship) requires the clinician and patient to:
    • communicate openly and clearly
    • engage constructively in the helping process
    • develop and maintain genuine connectedness
    • recognise complementary expertise and roles
    • share decisions
    • trust and respect one another
    • be supportive, open, honest, influential, connected and purposeful
  • A partnership is not an expert, dependent, friendship, adversarial or avoidant relationship
Do no harm
While we may not always be able to 'make things better', we certainly shouldn't make them worse!

8. Helping1–5,7

  • The process of helping includes:
    • exploring the situation(s) to get a clear picture
    • a shared understanding of the patient's strengths and needs resulting in an agreed set of priorities for change
    • setting SMART (specific, measurable, achievable, relevant, time-limited) goals to ensure clear outcomes
    • planning clear and realistic strategies to ensure goals can be met
    • supporting patients to implement plans with sufficient skills, expertise, enthusiasm and confidence
    • reviewing outcomes and exploring the nature/usefulness of the partnership and, if necessary, altering it to ensure progress
    • ending the partnership, with clear future strategies to ensure sustainability, once outcomes have been reached and supports are in place
  • These tasks:
    • are undertaken together in partnership, with the patient taking the lead
    • enable clinicians and patients to explore and develop a shared understanding of the patient's ecology
    • lead to negotiation of goals and a plan that is supported and reviewed over an agreed period of time

9. Change 1,2,5

  • In partnership, clinicians and patients work together to achieve meaningful change and outcomes
  • Three related processes that underpin change are:
    • spontaneous change: occurs through the process of exploration and understanding, as patients' capacity for change is stimulated by feeling heard by clinicians
    • guided change: occurs through the loosening of unhelpful constructs and the strengthening of constructs more likely to help patients achieve their goals and outcomes
    • planned change: occurs through the systematic use of goal setting, planning and implementation to bring about specific change
  • There will be times when safety is at risk and change has to happen. It is important to work hard to navigate such situations respectfully, openly and in partnership

10. Outcomes 1–4

  • Effective behaviour modification aims to provide patients with the ability to:
    • develop strengths and abilities to be more effective in helping themselves
    • identify, clarify and manage their problems
    • change knowledge, feelings and understanding of themselves and their situation
    • view and experience themselves in accurate, helpful and constructive ways
    • develop involved and consistent personal skills
    • develop effective social support and community involvement
    • foster resilience by predicting potential future problems
  • The outcomes for clinicians are to:
    • do no harm
    • encourage and maintain patient engagement and participation
    • help patients to achieve change and improve outcomes
    • implement effective, mutually agreed actions that address patient difficulties
    • improve the quality and effectiveness of service delivery
Engaging our patients isn't always about 'making things better'. Sometimes things can't change in the way we'd like. In this case it's about making the best of a situation while maintaining a respectful partnership despite actions that need to be taken i.e. patient beliefs or behaviours that impinge on safety

11. Where to from here?

  • A first step is to develop and practice the skills and knowledge to communicate with our patients
  • Understand the patients and population your service targets. For those in rural and remote areas of Australia this would include undertaking a cultural awareness program tailored to your population
  • Although speaking with patients can be easy, speaking with patients in a meaningful, constructive manner to effect behavioural change can be difficult
  • The skills and ability to purposefully engage patients to make positive changes takes time, experience and training
  • Engage your local health service for communication, engagement and counselling training

12. References

13. Resources

  1. There are numerous counselling, communication, engagement and partnerships programs available nationally. See your local jurisdiction for training options nationally e.g. the Family Partnership Model

Last updated: November 2024

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