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.
There is science behind the art of communication. 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 a 5-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 health professionals 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.
Some organizations find it helpful for Dr. Makoul to present the CAT to health professionals before implementation. Once results are in, CAT reports provide systematic feedback of individual 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. Dr. Makoul provides online resources to facilitate improvement; health professionals with scores below a threshold of 70% ‘excellent’ on the CAT items can 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 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.
