By C.A. Wolski
Communication—in today’s technological age, it’s what makes the world go ‘round. E-mail, texts, social media, smartphones—these are just a few of the ways that we communicate and miscommunicate on a regular basis.
HTM professionals are primarily tasked with taking care of medical equipment to help clinicians do their jobs, but, perhaps more importantly, they need to be able to clearly communicate with both clinical and administrative staff. Unfortunately, clear communication often is lacking due, in part, to a lack of understanding of how to effectively and clearly communicate with the clinical and administrative side of the healthcare enterprise.
By taking just a few practical steps, biomeds can improve their communication and their value within the organization.
The nature of biomed itself is reflected in the need for clear communication.
“I’ve always thought of biomedical engineering as a ‘boundary spanning’ discipline,” says Matthew Baretich, PE, PhD, founder of Baretich Engineering in Fort Collins, Colo. “It crosses boundaries of biology, medicine, and engineering. As practitioners in the discipline, we need to build bridges of communication.”
And to that point, clear communication will go a long way toward being taken seriously, according to Binseng Wang, ScD, CCE, fAIMBE, fACCE, vice president of clinical engineering program management at Sodexo.“We work in a technical field, but we also have to interact with clinicians and administration. It’s my duty to communicate clearly,” he says. “If these clinicians and administrative professionals don’t understand me, I’ll lose their interest, support, and I’ll be less credible to them. I won’t survive in the organization.”
Wang notes that communication is all about the audience—speaking to a physician about finance or a member of the finance department about clinical matters would be counterproductive.
Tailoring the message to the specific audience is just as important. “All communication with others should be approached from the perspective of knowing where the recipient’s knowledge base lies,” says Gordon Hosoda, chief of biomedical engineering at the VA Portland Health Care System.
“A non-technical medical stakeholder can be a clinically focused medical stakeholder,” Hosoda adds. “Keeping in mind the recipient’s occupational roles, experiences, and operational culture can help a biomed tailor the quantity and depth of information and the selection of words and phrases. This will help ensure that critical information is shared and received.”
For example, Wang uses the idea of evidence-based maintenance when speaking to a clinician, since this concept is analogous to evidence-based medicine. “The difference is that they treat a real, human patient and our patient is a machine,” he says. This approach allows him to find common ground with his clinical colleagues, making communication clearer.
When communicating with non-medical staff, the perspective, naturally, has to be adjusted. “If you’re communicating with the C-suite, for instance, information needs to be tailored in such a way that they can properly understand and assess the situation in the most succinct way possible,” says Hosoda. “From their operational perspective, they have to know a little about everything. Providing balanced technical information of low to moderate depth can help ensure they properly understand the situation. Here it would be detrimental to get them lost in the weeds of details.”
Wang says he tries to be empathetic to whomever he’s speaking with. It was an approach that he developed during his biomedical engineering training when an unforeseen turn of events found him sporting a lab coat and trailing behind neuro-surgery interns instead of in a lab working at a bench.
When he was beginning his M.Eng. program, Wang’s engineering advisor had to take a leave of absence to care for her husband, who had been severely injured in a car accident. Wang was faced with a choice: transfer to another university program 800 miles away or spend the first six months of his studies under the guidance of his clinical advisor. He chose the latter.
“It was the best thing that ever happened to me,” he recalls. “In the five years leading up to my engineering degree, I had never seen how the clinical environment worked.”
One of the most transformative moments in his understanding of the clinical environment and the way physicians communicate occurred during and after a neurosurgical procedure Wang observed (as a neurosurgical “intern” Wang regularly attended surgeries). During the procedure, his neurosurgeon advisor made jokes and spoke with the other physicians and interns in a lighthearted way.
Wang followed the neurosurgeon back to his office after the procedure and saw a different side to this seemingly happy-go-lucky physician. He began to cry, because the patient wasn’t going to make it. This turnabout mystified Wang.
“I called my brother who was training in opthalmology and asked him, ‘What is going on?’ He explained to me that physicians train themselves to emotionally compartmentalize to get through their work,” Wang says. “For me it was kind of a shock.”
This transformative experience also changed the way Wang communicates with non-technical staff. When speaking to a nurse about an equipment problem, for instance, Wang says he tries to approach the issue with empathy. “If a nurse says a piece of equipment is not working, I have to have empathy for her situation,” he says. “I ask her to show me what the problem is. This takes patience and humility.”
Baretich echoes Wang’s view on having empathy for non-technical colleagues, and also advises that clinical engineers take the further step to learn medical terminology so they can share common ground.
“The first thing is to understand the perspective and objectives of non-HTM colleagues. For example, nurses focus on patients, not on machines,” he says. “The second thing is to become familiar with the terminology that our colleagues use in their work. Then, when we attempt to communicate with them, we address their concerns using their language. Sometimes we need to teach them new concepts but, again, we need to respect their context and knowledge base.”
But it’s also important to remember that communication, particularly in a medical setting, is not about niceties, but getting to the point. “Everybody tends to want to know, what’s in it for me (WIIFM), that is, what are the costs, gains, impacts benefits, drawbacks, etc.?” observes Hosoda. “If that information is communicated in a manner that the recipient cannot grasp, then they may not buy in to the costs and gains, or they may have extremely negative reactions to impacts and drawbacks that occur after the fact.”
And it works the other way around as well, Hosoda notes., If the biomed doesn’t get the information he or she needs from the clinician—instead of “what’s broken?” they are given a litany of medical implications related to the disabled machine—the result is still a useless device. In other words, communication is clearly a two-way street, and the biomedical engineers should have it as a goal to facilitate that communication.
Miscommunication can have significant consequences for the patient, according to Aracely Rosales, chief content expert and multilingual director for Health Literacy Innovations. “The danger is in that when [medical personnel] use medical devices and they do not understand or are confused with instructions, errors can happen. If they use equipment in the wrong way, the result could be harm, medical mistakes, death, skewed data or medical results, or more,” she says.
Tailoring your message, having empathy, and a common set of terminology that you share will go a long way to have clear communication and understanding. But sometimes clinical engineers—as with those in any technical profession—take refuge in the comfortable, and that can lead to jargon-filled conversations that cause frustration and cloud clarity.
“Sometimes jargon makes us feel comfortable. Sometimes it makes us feel smart. In fact, it makes us look like uncaring technocrats, which is not a good look,” observes Baretich.
Wang goes a step further, noting that biomedical engineers should avoid explanations that come off as insulting and snobbish—often the result of peppering in lots of jargon. He also advises avoiding dumbing down explanations, which could have the same psychological effect on the clinician—that you’ll come off as condescending.
Jargon is often most prevalent in written communication, particularly the kind of communication that’s seen in an office or professional setting. In fact, in a July 2017 column in Inc. magazine, Glenn Leibowitz gets to the heart of the problem of jargon-filled writing in an overview of Harvard Psychologist Steven Pinker’s (then) latest book The Sense of Style: The Thinking Person’s Guide to Writing in the 21st Century.
The premise of the book is to demystify why so much of writing is incomprehensible. The answer is an over-reliance on jargon, according to columnist Leibowitz, and specifically: “For Pinker, the root cause of so much bad writing is what he calls ‘the Curse of Knowledge,’ which he defines as ‘a difficulty in imagining what it is like for someone else not to know something that you know. The curse of knowledge is the single best explanation I know of why good people write bad prose.’”
The so-called “curse of knowledge” is an advantage when speaking to other experts—it avoids having to engage in long explanations, and gives a shorthand and lexicon to those who share the same experience, interest, and background. According to Leibowitz, Pinker advises expert writers to pepper in brief explanations to make their point clear when writing for a non-expert audience. The example in the Inc. column is the use of the word “Arabidopsis.” Alone it will mean nothing to a non-expert, but write it like this: “Arabidopsis, a flower,” and the meaning is clear.
For his part, Leibowitz summarizes the point thusly: “Whenever I write a sentence that makes me pause and wonder about what it means, I assume that other readers might react in the same way. If a sentence is not clear to me, it might not be clear to others. It’s an approach that I recommend to anyone who is trying to improve his own writing.”
Hosoda sees the use of jargon less as a crutch that invariably leads to obfuscation, than as the collision of different languages. “To me, jargon—and lingo—is phrases and idioms from a particular language,” he says. “If two people are using two different languages—with their included jargon and lingo—nothing will be communicated because neither party has the ‘dictionary’ of the other person’s jargon. A common ground of communication needs to be worked out with common understandings and common definitions.”
Biomedical engineers don’t just have to be able to speak clearly, but they have to write clearly, and this can be just as big a pitfall for clinical engineers. In face-to-face or even telephonic communication, an HTM can get a sense that a clinician doesn’t understand them and they can change tactics. With written communication, without that feedback, it’s easy to go down the jargon rabbit hole.
“It’s critical to write in a way that your audience will understand,” says Wang, echoing Leibowitz’s column. “Make it intuitive and cut out the jargon…and use analogies where necessary to help make your point.”
Involving other non-technical clinical or administrative members to help craft a document—for example, instructions about how to use a piece of equipment—could go a long way toward developing clearer understanding and avoiding significant frustration.
“Involvement of non-HTM colleagues in development of written materials makes good sense—and it’s a good way to build rapport,” says Baretich. “Clarity and simplicity come first; tailoring for specific audiences follows, but only when necessary.”
Rosales goes a step further, advocating jargon-free, simple language in all forms of communication. “Biomed/HTM departments should create health literacy standards and policies for communication to be easy to read and clear. They should make sure all information is free of technical words and jargon, and in all communications—written, verbal, and media, including social media,” she advises.
Hosoda also sees involving as many different stakeholders as possible as a way to get the perspective of the group he’s trying to communicate with. “Overall, I believe it is always good to engage a stakeholder if possible, someone who has ‘skin in the game,’ as it were,” he says. “They can help ensure that information being created for dissemination, instructions, user guides, etc., will have the most effective impact on the recipients. To me, clarity and simplicity is relative to the group you are communicating to. Customer focus and awareness is critical.”
Cultivating Better Listening Skills
It may almost be a cliché, but communication is a two-way street. And while speaking and writing clearly is crucial to clear communication—so is listening. And this requires patience.
“The trap I often fall into is interrupting the speaker with questions,” says Baretich. “I have to remind myself to hear the speaker out and then follow up. And I have to remind myself not to make assumptions and jump to conclusions.”
And while he admits that he sometimes doesn’t listen as carefully as he should, he certainly knows the value of listening as part of the communication process. “The fundamental technique is simply to listen with care and respect,” he says. “You can ask for the colleague to just [walk] you through the situation: What were you trying to accomplish? What did you see or hear or feel?”
Listening allows for a deeper probing of the situation, and ultimately gets to the root cause, and, more importantly, a solution.
Solving the Communication Impasse
While it may seem that communication between biomedical engineers, clinicians, and administrators is simply an exercise in ongoing frustration, Hosoda relates how a commitment to real customer service has helped improve communication throughout the Portland VA.
“One key method we have implemented to manage [troubleshooting] is actually encompassed with our approach to customer service,” he says. “Each of the biomedical engineering support specialists (BESS) can receive direct calls from end users when their equipment needs repair. During this conversation, specific details are obtained as to the operational failure and clinical impact. This allows the BESS to be able to focus quickly and directly on the issue at hand.”
The result has been spectacularly successful, he adds: “Our aim is to be the ‘go to’ group in the medical center when a customer has needs. Even though we periodically field questions or issues that are not related to medical equipment, we still assist the customer to help them get what they need. We have defined ‘customer’ as ‘any person who comes to you with a need.’ This can be both internal to the medical center as well as external.”
While there is no magic formula that will improve communication, the interviewees offered some practical best practices that can certainly help improve communication and build a bridge to understanding and clarity, including:
- Take time to understand the perspective of your audience
- Communicate often with follow up and follow through
- Be “multicultural,” that is, learn the “language” of your audience
- Avoid jargon; use straightforward language that is well organized and easy to read
- Have empathy
- Stick to the facts
- Always listen with sincere interest
And, perhaps, having a dash of humility. Wang noted that he always keeps this dictum of “a much smarter fellow MIT-alumnus” physicist and Nobel Prize Winner Richard Feynman’s in mind when he’s communicating with someone: “If you ever hear yourself saying, ‘I think I understand this,’ that means you don’t.”
But no matter what, biomedical engineers can’t lose sight of the primary goal of communication. “The end goal is for both parties to understand each other’s needs, issues, concerns, and information,” says Hosoda.
L.A.-based freelancer C.A. Wolski is a regular contributor to 24×7 Magazine. Questions and comments can be directed to [email protected].