Dr. Hiwa K. SaaedSchool of PharmacyUniversity of Sulaimani2014-15ref. Communication Skills in Pharmacy practice, Chapter 4, p 43-53

Barriers to Communication

Barriers to Communication

• Overview• Introduction• Environmental Barriers

Discovering Potential Environmental barriers

• Personal BarriersPotential pharmacist-related personal barriersPatient-related personal barriers

• Administrative Barriers• Time Barriers• Summary

www.wchsolutions.com

Barriers to communication

What are barriers to communication that exist in any work setting?

Take a few moments to write down some of…. your thoughts…

Sender barrier:Encoding barrierCommunication

channel barrierNoise barrier

Receiver barrier:Decoding barrierFeedback barrierPerception barrier

Barriers to Effective Communication

Barriers can disrupt the accurate transmission of information. These barriers take different forms:

Barriers to effective Communication

include: Physical (environmental), Psychological (personal), administrative or time conflict.

Such conflicts prevent effective communication from being established.

Physical/ Channel Barrier

Physical/ Environmental barriers • The venue, (place, space): lack of privacy furniture• The effect of noise:•Physical factors:

light, temp, ergonomics, numbers, distance, voice & visual quality

Space• Closed office doors, • barrier screens • and separate areas for people of different status results in

creating a barrier to effective communication.

Place

The place or the location where a communication process takes place can degenerate into a barrier to effective communication.

Noise

Crowded, noisy prescription areas also inhibit one-to-one communication in many practice settings.

Noise may have its origin from an external source or may exist even in the communication loop.

Discovering Environmental barriers

One approach might be to view things from the other person’s perspective. • What images do others have when they enter your practice site? • How easy is it for them to access you to have a meaningful dialogue? • How many steps does it take you to reach a private area within your

practice site?

Paying attention to the amount of privacy can help create an atmosphere that causes both parties to communicate more effectively.

Potential Environmental Barriers

The next time you enter a community pharmacy, check for the following:• Is the pharmacist visible?• Is it easy to get the pharmacist’s attention?• Does it appear that the pharmacist wants to talk to patients?• Is the prescription area conducive to private conversation?• Do you have to speak to the pharmacist through a third

party?• Is there a lot of background noise or other distractions?

Personal Barriers Potential Pharmacist-Related Personal

Barriers

• Low self-confidence• Shyness• Dysfunctional internal monologue• Lack of objectivity• Cultural differences• Discomfort in sensitive situations• Negative perceptions about the

value of patient interaction

Potential Pharmacist-Related Personal Barriers• Lack of confidence, if you believe that • you do not have the ability to communicate well.• or are rather shy,

you may avoid talking with others. •Negative experiences: what might happen • if you get into a heated argument with a patient who appears to be

unreasonable and rude? Would you be excited to talk to the next patient? Probably not. • if you felt you were taken advantage of by a colleague when you agreed

to do something that you really didn’t want to do? Would you feel like avoiding this individual in the future?

Probably, the negative experiences may influence your • personal desire to communicate• Self-esteem regarding interactions with others

PHARMACIST-RELATED PERSONAL BARRIERS-Emotional Barrier

• Another potential personal barrier involves emotional objectivity. • Although physical and emotional issues are often related to

each other, you should separate your role in treating both. • It may be appropriate for you to assist with physical issues,

but probably not patient emotional needs. • You should remain empathetic towards your patients, but

not get so involved that you carry their emotional burdens with you. • It is probably more appropriate to refer patients to

professionals who can assist them with these issues.

PHARMACIST-RELATED PERSONAL BARRIERS/ Cultural barriersFor example, in some cultures it is not proper to engage in eye contact during communication. Other barriers related to culture include the following:• Definitions of illness (some patients may not perceive

themselves to be ill).• Perceptions of what to do when ill (some cultures stress self-

reliance rather than seeking help):• Health-related habits or customs (eating habits).• Health-seeking behavior (some cultures place more reliance on folk

medicine)• Perceptions of health care providers (based on possible

distrust of the health care system or past negative experiences).

PHARMACIST-RELATED PERSONAL BARRIERS-other

Other personal barriers exist in:• Situations: where you may not be completely sure how to respond;For example, you may not know exactly what to say when a cancer patient expresses a fear of dying. • The pharmacist’s personal perception of the value of patient

communication. Many pharmacists believe that talking with patients is not a high-priority activity.

PATIENT-RELATED PERSONAL BARRIERS-patient perceptions

Patient perceptions If patients perceive you

as not being knowledgeable or trustworthy, that you do not want to talk with them,

On the other hand, if patients perceive you as being knowledgeable and have had positive experiences in the

past, they will tend to seek out information.

• Impersonal: Another patient perception that hinders communication is their belief that the health care system is impersonal. Some patients sense that health care providers are not concerned about them as individuals but rather as cases or disease states.

PATIENT-RELATED PERSONAL BARRIERS• Patient perceptions of their medical conditions :• Some may believe that their condition is a relatively minor one

requiring no further discussion with you. • In contrast, some patients may be overly anxious about their

condition and therefore will avoid talking about it because they feel so vulnerable.

• Some patients may feel that their physicians would have already told them all the important information about their condition and their medication. Therefore, there is no need to talk with you. • In addition, many patients think that all the important information is

stated on the prescription label or in the patient education leaflet. • You may need to convince some patients that they need to learn more

about their medications and that the few moments spent with you will be valuable to them later on.

Perceptual Barriers

We all see the world differently !We all have our own preferences, values, attitudes, origins and life experiences that act as ‘filters’ on our experiences of people, events and information.

20

Administrative barriers

•management: may view the lack of money compensated for communication as a reason not to communicate. More money is made by prescribing medication, not caring for patients.• Time barriers are interlinked with administrative barriers

because management is responsible for staffing levels as well as allocation of work duties. • Time limits are very common when it comes to pharmacists

and patients. Time restraints are often excuses not to counsel, though it often does not take very long.

Time Barriers

Choosing an inappropriate time to initiate conversation may lead to communication failure. For example, a woman who just came from a physician’s office after waiting for 3 hours with two sick children may not be interested in talking with you or anyone else. The most important thing on her mind is to go home, get her kids to bed, and then relax. She is probably not in the best frame of mind to sit down and have a meaningful conversation about her children’s medications.

Time Barriers• By the same token, you may not be in the best frame of mind to

interact with others. You may be dealing with multiple issues: a physician is waiting on the phone, a large number of prescriptions need to be filled in the next hour, and you have not eaten lunch so you are starving. You may feel that this is not a convenient time to talk to others, such as the mother in the above example.

A possible solution might be • to give the mother basic information to get the therapy started. • Another strategy is to have written information that can reinforce a

short message during busy situations. • “highlighting” related information within the written information to

emphasize key points before the patient leaves the pharmacy.

Summary

• Messages become helpful to others only when they are accurately received and understood. • If messages are distorted or are incorrect, they actually may be harmful

to patient care and interpersonal relationships. • Failure to communicate may lead to negative patient outcomes. • Barriers, may lead to distortion of messages and misunderstandings

between you and others. • you must be assertive about your need to communicate with others,

but at the same time be aware of their needs as well. • In any situation, you should assess nonverbal messages from health

care providers or patients for assurances that communication is well timed (Do they appear to be listening to you? Are they comprehending what you are saying?). At the same time, you must be aware of situations where people are trying to talk with you, but you are not listening appropriately.

REVIEW CASE STUDY 4.1A pediatrician phoned two different antibiotic prescriptions into a pharmacy—one for Brian Bentley and one for Brandon Bentley. Unfortunately, the pharmacy assistant did not recognize that two different names were given and did not realize that they were twins. She subsequently typed both prescriptions for Brian (Brandon sounded like Brian to her). The father picked up both prescriptions and gave them both to Brian. Unfortunately, the parents did not discover the error until the next day. They immediately called the pharmacy to address the issue. Both the assistant and pharmacist on duty apologized to the Bentleys; fortunately, Brian was not injured by taking a few doses of both antibiotics.1. Name three things that help facilitate communication in this

setting.2. Describe three things that help facilitate communication in this

ambulatory care clinic.

Review Questions

1. What is the first step in removing environmental and personal barriers to communication?

2. What are at least three patient barriers that inhibit communication?

3. How can the current nature of pharmacy practice inhibit good communication?