Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

Communication Architecture Design for Real-Time Networked Control Systems

Networked control over data networks has received increasing attention in recent years. Among many problems in networked control systems (NCSs) is the need to reduce control latency and jitter and to deal with packet dropouts. This paper introduces our recent progress on a queuing communication architecture for real-time NCS applications, and simple strategies for dealing with packet dropouts. Case studies for a middle-scale process or multiple small-scale processes are presented for TCP/IP based real-time NCSs. Variations of network architecture design are modelled, simulated, and analysed for evaluation of control latency and jitter performance. It is shown that a simple bandwidth upgrade or adding hierarchy does not necessarily bring benefits for performance improvement of control latency and jitter. A co-design of network and control is necessary to maximise the real-time control performance of NCSs

Integrated Marketing Communication (IMC): New Discipline with an Old Learning Approach: A Syllabi Analysis

Marketing communications as a discipline has changed significantly in both theory and practice over the past decade. But has our teaching of IMC kept pace with the discipline changes? The purpose of this paper is to explore how far the evolving concepts of IMC are reaching university learners. By doing this, the paper offers an approach to assessing how well marketing curricula are fulfilling their purpose. The course outlines (syllabi) for all IMC courses in 30 universities in Australia and five universities in New Zealand were analyzed. The findings suggest that most of what is taught in the units is not IMC. It is not directed by the key constructs of IMC, nor by the research informing the discipline. Rather, it appears to have evolved little from traditional promotion management units and is close in content and structure to many introductory advertising courses. This paper suggests several possible explanations for this, including: (1) a tacit rejection of IMC as a valid concept; (2) a lack of information about what IMC is and what it is not; and (3) a scarcity of teaching and learning materials that are clearly focused on key constructs and research issues of IMC.

Building an organizational change communication theory

The difficulty of communicating during organizational change has intensified with the prevalence of continuously changing organizations (Buchanan, Claydon & Doyle, 1999). The difficulty faced by managers is compounded by the lack of studies examining organizational communication within a context of organizational change (Eisenberg, Andrews, Murphy, & Laine-Timmerman, 1999; Lewis & Seibold, 1996). Not surprisingly then, is there a paucity of organizational change theory to guide further research and practitioners. This paper addresses the lack of organizational change communication research and contributes to theoretical development of communication during organizational change. A model of change communication during continuous change is presented from the analysis of two longitudinal empirical studies. Central constructs of the model are the monologic change communication, the dialogic change communication and the background talk of change. Further Van de Ven and Poole's (1995) Process Theories of Change are extended to consider the sequencing of the three constructs. The findings suggest that the sequencing of the dominant change communication approaches is informed by an alignment of individual communication competences and organizational change communication expectations.