Last week, I took a look at the use of scripted conversational devices in hospitals as a way to get doctors and nurses to speak from a standard script when talking to patients and, it's hoped, improve communication with patients. Advocates of scripts — and there are plenty of hospital people who are big fans — say the devices standardize hospital communication and ensure that patients are getting the attention and respect they deserve during their stays. There are a few naysayers, though, who think the scripts aren't as successful as getting clinicians to change their overall behavior, producing the same end result — good patient care and communication — without the hassle of a larger workload due to training, learning and reciting the scripts.
A few readers wrote in with their own thoughts on the subject, which I'd like to share today.
Mary P. Malone of Malone Advisory Services, argues that scripting is an essential, if improvable, part of patient care:
"Having practiced in the area of improving the patient experience for more than 20 years, I am very much a scripting advocate. In my opinion and experience, virtually everyone in health care already has scripts — and not all of them are good ones:
- 'This won't hurt a bit.'
- 'The doctor will be right with you.'
- 'We're short-staffed today.'
- 'It'll be OK, sweetie (or honey).'
- 'They never tell me anything.'
So, yes, we need to improve our scripting, if only to replace some of the scripts we use now. No, scripting isn't about making employees into robots. It is about figuring out what works and delivering that information (script) consistently every single time. I think part of the reluctance to embrace scripting comes from the same place as 'I am not going to practice cookbook medicine.' Of course, tone and non-verbal behaviors are important. And adding one's personality is encouraged. To sum up: Before we say 'scripts are terrible,' let's use them as a tool to remove the 'terrible scripts' we already have."
Fernando Jara, M.D., chairman, emergency medicine at Lincoln Hospital in the Bronx, argues that finding and retaining physicians who communicate well with patients, and working to improve the skills of clinicians who struggle with communication, is a better big-picture strategy:
"Asking a patient 'I want to make sure I understand you correctly' may work in some communities but not all, and certainly not in the South Bronx. Scripted dialogue has no value with physicians that are 'good' listeners, or empathetic, caring and knowledgeable. The answer is not necessarily a scripted dialogue because the 'training' needs to start at medical school. Even then you will still have the occasional rogue physician who has poor bedside manners. Hospitals should have a treatment plan for those physicians that just don't get it. Team-steps and scripted dialogue may help them out, but it is not a cure. Remember, it's not whether or not you say good morning, it's how you say it."
And finally, Paula Lovell, president of Lovell Communications, writes that the decision on whether or not to use scripting comes down to their effectiveness:
"I guess the question is, what kind of improvements in important metrics are made when scripting is applied? If it improves patient satisfaction, that is pretty significant. I think [the Studer Group] has the numbers (results) to back up their recommendations on scripting or at least following certain behaviors enough that they become ingrained and natural. Then it doesn't sound so much like scripting, perhaps."
Email your thoughts on scripting to firstname.lastname@example.org.
Haydn Bush is senior online editor for Hospitals & Health Networks magazine.