title: Communication with patients and colleagues.
abstract: BACKGROUND
  Although patient-centred communication has provided a focus point in health care for many years, patient surveys continuously reveal serious communication problems as experienced by patients, due to poor communication. Likewise, poor inter-collegial communication can cause problems for both health care staff and patients. So, knowing that patient-centred communication and good inter-collegial communication is for the benefit of both health professionals and patients, the relevance of improving health care professionals' communication skills and investigating the effect on both professionals and patients is beyond doubt.
  
  
  OBJECTIVE
  The aim of this study was to investigate whether a training course in communication skills for health care professionals could improve: 1) Health care professionals' self-efficacy in communication with patients and colleagues 2) Health care professionals' evaluation of inter-collegial communication 3) Patients' experience of quality of care,   and to investigate health care professionals' experience of: a) participation in a communication skills training course b) the influence of the course on their ability to communicate with patients and colleagues.
  
  
  METHODS
  The study was carried out in the Department of Orthopaedic Surgery, Kolding Hospital, a part of Lillebaelt Hospital, as an intervention study with baseline measurements and measurements after the intervention. The intervention was an in-house communication skills training course for all health care professionals at the department. The effect was measured partly on the health care professionals' self-efficacy and evaluation of inter-collegial communication, partly on patients' evaluation of quality of information, continuity and care. Data were collected by means of questionnaires and further explored by focus group interviews with health care professionals.
  
  
  RESULTS
  A total of 181 health care professionals were included in the study. The questionnaire was completed by 177 (97.8%) before; 165/169 (97.6%) immediately after and 150/153 (98%) six months after the course. The health care professionals' self-efficacy was significantly increased, both for communication with patients and colleagues. The effect was still present six months after the training course. Also the health care professionals' evaluation of inter-collegial communication showed significant improvements after the course; the effect was more pronounced for inter-professional than for intra-professional communication and more pronounced six months after than immediately after the course. A total of 32 health care professionals participated in the focus group interviews, which showed that, in general, nurses, nursing assistants, medical secretaries and managers principally experienced better control over the patient interview, increased confidence in communication, improved inter-collegial understanding and increased focus on patient-centred communication after the training course. The doctors had an overall negative experience of their participation in the training course, but nevertheless experienced positive changes in their communication after the course.   In the patient survey a total of 3660 patients answered the questionnaire from the 1st of May 2007 untill the 31st of May 2010. The eligible response rates were 67.75% for the baseline measurement and 77.63% for the after measurement. There was a significant increase in patients responding "To a considerable extent" for 15/19 questions; a non-significant increase for 3/19 questions, and a statistically significant decrease for 1/19 question after the training course.
  
  
  CONCLUSIONS
  The study has shown that a communication skills training course can improve health care professionals' self-efficacy in communication with both patients and colleagues and also improve inter-collegial communication. The focus group interviews showed that the most essential experiences of change were more confident communication with patients and colleagues and an increased patient-centredness. Furthermore, the study has shown a significant increase in patient satisfaction concerning information, continuity and care after the training course for health care professionals.
authors.affiliation: Department of Orthopaedic Surgery, Kolding Hospital, Skovvangen 2-8, 6000 Kolding, Denmark. birgitte.noergaard@slb.regionsyddanmark.dk
authors.forename: Birgitte
authors.initials: B
authors.lastname: Nørgaard
mesh_terms: D000328:Adult; D003142:Communication; D016001:Confidence Intervals; D003299:Cooperative Behavior; D003718:Denmark; D005260:Female; D017144:Focus Groups; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D016017:Odds Ratio; D010348:Patient Care Team; D017060:Patient Satisfaction; D010379:Peer Group; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D012044:Regression Analysis; D020377:Self Efficacy; D013997:Time Factors; D014741:Video Recording