Communication Assessment Guide
AHRQ Communication and Optimal Resolution Toolkit
Purpose: To help you identify members of your organization who are effective at delivering disclosure communications.
Who should use this tool? Communication and Optimal Resolution (CANDOR) Implementation Team, Disclosure Lead(s), Disclosure Communicators
How to use this tool: Use the Communication Assessment Guide (CAG) to help you identify effective communicators who can participate in disclosure conversations as Disclosure Leads and/or Disclosure Communicators. The guide includes the Communication Assessment Questionnaire (CAQ) (Appendix 1). The CAQ is a two-part instrument that uses two measures (cognitive complexity and message design logic) to provide a way of assessing an individual's level of communication competence. Once completed, the assessments can be used to provide individualized feedback about each participant's current level of communication competence for further improvement and to identify highly competent communicators. The CAG is structured in the following order and can be used chronologically.
How to Administer the Communication Assessment Questionnaire
Using and Sharing Results from the Communication Assessment Questionnaire
Appendix 1: The Communication Assessment Questionnaire
Appendix 2: Scoring Rubric and Examples
Appendix 3: Results Template
Appendix 4: References
Communication is at the heart of the CANDOR process. Effective communicators who participate in conversations with patients, families, and caregivers following an adverse event must demonstrate the following characteristics and competencies consistently and naturally. Individuals who are effective Disclosure Leads or Communicators will:
- Demonstrate empathy, sincerity, and honesty.
- Demonstrate active listening skills.
- Demonstrate patience during stressful situations.
- Demonstrate tact and diplomacy.
- Demonstrate emotional maturity and self-awareness/intelligence by withstanding anger, criticism, accusations, blame, combative, or defensive behavior without taking criticism personally.
- Adapt non-verbal expressions and body language to the situation.
- Speak without using medical jargon and non-technical language.
- Focus entirely on the patient's and family's interests.
- Understand when to seek additional support and help during a conversation with a patient and/or family.
Individuals who are effective Disclosure Leads or Communicators will be experienced members of the organization who portray a professional demeanor and authority. These individuals should demonstrate:
- Experience in communicating with patients and families about bad news, complaints, and grievances.
- Understanding that s/he speaks for the organization, not an individual unit or department, and thus conveys a "we" message, avoiding criticism or blame of other individuals or departments.
- Sufficient clinical knowledge and experience to answer relevant questions.
- Familiarity with the organization's risk, safety, claims, and quality operations.
- An understanding of the individual and systemic bases of patient harm.
- Genuine professional commitment to the principles of just culture and the CANDOR process.
Most health care team members exhibit some of the skills and competencies listed above. Only those team members who demonstrate all of the skills and competencies should be involved in delivering communication about adverse events to patients, families, and caregivers. Strong communicators are usually easily identifiable; however, some might not yet generally be known.
When identifying effective communicators, the results of the CAQ should be used in conjunction with all other available sources of information about staff members' communication skills, including personal experience, recommendations, performance reviews, professional experience, position within the organization, and patient satisfaction scores. The CAQ is not meant to be used as the sole basis for identifying candidates for Disclosure Leads or Communicators. The number of people selected for this role will depend on the size of the organization and the resources available for training.
The CAQ can be uploaded into an e-survey or by administering paper-based forms. Members of the CANDOR Team can administer this instrument at their discretion when evaluating potential members of the Disclosure Team. The scores are combined for both assessments to yield one final score.
Part I: Role Impression Tasks
The cognitive complexity assessment is the first task, and it requires the participant to think of two people that he or she knows well on a personal level: one liked, and one disliked. The participant must then describe first the liked and then the disliked person in as much detail as possible, ignoring physical characteristics and focusing instead on the person's character, personality, behavior, etc. Participants are instructed to take no more than 5 minutes on each impression. These impressions are then scored in terms of their complexity using a standard scoring procedure. The result is a cognitive complexity score for each participant.7,8
To assess a cognitive complexity score, simply count the number of unique descriptors used in the impressions of the liked and the disliked people. The total number of unique adjectives used, summed across the liked and the disliked impressions, will yield the cognitive complexity score for that person. Sometimes it is not obvious where to draw the boundary, or whether a description should count as one or two concepts. The rule is to err on the side of more rather than fewer concepts; if in doubt, please count the additional concept.
Part II: Role Scenario Tasks
The second part of the CAQ identifies messages that reflect the highest level of communication skill. Message design refers to the process that people use to perceive the relevant goals in a situation and to then convey messages that will achieve those goals.a The type of message design someone employs will show how effectively a person relays his or her intended message.
To make this assessment, ask each participant to read two hypothetical communication scenarios (a group project scenario and a disclosure scenario) and write down exactly what they would say in that situation. Then apply a standardized scoring procedureb to the messages to identify participants with the highest level of communication skill.
Data Preparation and Logistics
To prevent scores on one section of the assessment from influencing scores on another section of the assessment, review and score all responses for Part I separately from Part II. Then score as described below, and enter the scores into the spreadsheet for further analysis.
Reporting Feedback to Participants
Once all of the responses are scored, rank all of the participants from highest to lowest based on their scores for Parts I and II, respectively. A template for sharing responses with participants is found in Appendix 3.
1 Research indicates that there are at least three "message design logics" commonly used by communicators, and these correspond to progressively higher levels of communication competence. From least to most competent, these are the expressive, conventional and rhetorical message design logics.
2 The overall Approach to Scoring the Group Project and Harm Disclosure Situations is very similar to scoring Cognitive Complexity. Count concepts individually, and compare written responses with the examples noted in Appendix 3 and 4 to identify what type of message design logic participants will exhibit.