COMMUNICATION
Health Professional communication with patients is a key driver of Likelihood-to-Recommend and, thus, Net Promoter Score. Moreover, in every reporting period since 2007, the HCAHPS composite measures of ‘Communication with Nurses’ and ‘Communication with Doctors’ have been the #1 and #2 key drivers of Hospital Rating. However, being told to simply 'improve communication' is frustrating.
Communication is a fundamental clinical skill that can be measured and improved. The Communication Assessment Tool (CAT) – developed by Dr. Gregory Makoul – is a reliable, valid, evidence-based instrument designed to gauge patient perceptions of communication with health professionals; it has been used across clinical settings in many countries. The CAT’s 14-items highlight essential communication tasks, all measured on a5-point scale (poor-fair-good-very good-excellent). Psychometric testing during scale development and subsequent real-world use support reporting only % excellent.
This approach is well received by clinicians because it provides tangible, actionable results and serves as a diagnostic to prioritize areas for improvement via tailored training. To enhance accessibility, the CAT is written at a 4th-grade reading level and available in several languages. There are versions for providers, nurses, and teams(e.g., ED) as well as a self-assessment. The CAT can be administered periodically in ambulatory settings and/or during the 2nd full day of hospitalization for inpatients. It will likely be helpful for Dr. Makoul to present the CAT to an organization’s leaders and clinicians before implementation.
CAT reports can be delivered to clinicians – with appropriate context and expectation setting – to provide systematic feedback of their own results in comparison to group results; leaders of clinical services receive roll-up reports. The individual reports highlight strengths as well as areas for improvement. To facilitate online access to improvement resources, Health professionals with scores below a threshold of 70% ‘excellent’ on the CAT items will be invited to a small-group training session led by Dr. Makoul. His training sessions and 1:1 coaching relationships yield marked and sustained improvements. This supportive and largely self-directed approach bolsters provider skill and confidence – and scores – reducing burnout while improving the experience and delivery of care.
Original scale-development article: Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Education and Counseling. 2007;67:333-342.
Related consensus statement: Makoul G, Noble L, Gulbrandsen P, van Dulmen S; Consensus Working Group. Reinforcing the humanity in healthcare: The Glasgow Consensus Statement on effective communication in clinical encounters. Patient Education and Counseling. 2024;122:108158.
