Barriers to Communication in Community pharmacy practice
Learning Objectives
After studying this chapter, the graduate pharmacy student should be able to:
- Identify and categorize different types of communication barriers in pharmacy practice
- Analyze environmental barriers and design strategies to minimize their impact
- Evaluate personal barriers affecting both pharmacists and patients in communication
- Assess administrative and systemic barriers within healthcare organizations
- Develop time management strategies to overcome temporal barriers to communication
- Create comprehensive plans to address multiple barrier types in specific practice settings
Introduction: The Fragility of Communication
Interpersonal communication is inherently fragile due to its complexity and human involvement. Messages only become helpful when accurately received and understood; distorted or incorrect messages can harm patient care and damage relationships. The communication process involves five essential elements, with barriers often representing the most overlooked but critical component.
Key Insight: Two-Stage Barrier Management
Minimizing communication barriers requires: (1) awareness of their existence, and (2) appropriate action to overcome them. Effective communicators recognize when communication is failing and analyze why, then implement targeted strategies.
Communication Frustration Analogy
Imagine trying to complain to a car mechanic who looks at papers, mutters "uh-huh," then rushes to the phone saying "Go ahead, I'm still listening" without making eye contact. This frustration mirrors what patients experience when pharmacists are physically present but communicatively absent—leading to anger, confusion, and dissatisfaction.
Environmental Barriers
The physical environment significantly impacts communication quality, with some barriers obvious and others subtle but equally detrimental.
Research Evidence: Privacy Matters
Studies (Beardsley et al, 1977) show that as privacy improves, patient information retention increases along with appropriate medication use. Privacy allows expression of personal concerns, asking difficult questions, and honest opinion sharing.
Environmental Barrier Solutions
- Counter Modifications: Lower sections or open areas facilitating eye-level interaction
- Privacy Creation: Partitions, planters, or private counseling rooms/areas
- Noise Reduction: Sound-absorbing materials, designated quiet zones
- Strategic Design: Consulting areas away from high-traffic zones with comfortable seating
- Institutional Adaptations: Private spaces for interprofessional discussions in hospital settings
Personal Barriers
Personal characteristics of both pharmacists and patients can create significant communication obstacles that require different intervention strategies.
Internal Monologue Example
While listening to a patient describe symptoms, a pharmacist might think: "What in the world is she talking about?" or "How can I get rid of this person?" or "I'm too busy to deal with her right now." This internal conversation limits effective listening as the pharmacist focuses on personal thoughts rather than patient communication.
Personal Barrier Solutions
- Skill Development: Recognizing communication as a learnable skill requiring practice
- Self-Awareness Training: Identifying personal communication patterns and biases
- Cultural Competence Education: Learning about diverse health beliefs and communication styles
- Emotional Boundary Setting: Maintaining empathy without adopting patient emotional burdens
- Patient Education: Informing patients about pharmacist roles and communication availability
- Positive Reinforcement: Building confidence through successful communication experiences
Administrative Barriers
Organizational policies, procedures, and business models often inadvertently create communication obstacles that require systemic solutions.
Case Study 4.1: Twin Prescription Error
A pediatrician phoned in antibiotic prescriptions for twins Brian and Brandon Bentley. The pharmacy assistant heard "Brian" for both names and typed both prescriptions for Brian. The father gave both to Brian, only discovering the error the next day. This illustrates administrative barriers: unclear communication protocols, lack of verification systems, and workflow allowing single-point failures.
Administrative Barrier Solutions
- Reimbursement Advocacy: Documenting costs/benefits of counseling for third-party payment
- Policy Revision: Creating communication-friendly organizational policies
- Adequate Staffing: Ensuring sufficient support for pharmacist counseling time
- Direct Access Systems: Mechanisms allowing patients direct pharmacist access
- Staff Training: Educating support staff on communication importance and protocols
- Workflow Redesign: Integrating communication into dispensing processes
- Technology Integration: Using systems that facilitate rather than hinder communication
Time Barriers
Temporal factors significantly impact communication effectiveness, with poor timing potentially negating even well-executed communication attempts.
Strategic Timing Principles
Effective communication requires both parties to be psychologically and emotionally ready to engage. This readiness can be assessed through nonverbal cues (eye contact, attention level, comprehension signs) and should guide timing decisions.
Time Management Solutions
- Alternative Timing: Offering phone or electronic follow-up during calmer periods
- Written Reinforcement: Key information in take-home materials for busy situations
- Appointment Systems: Scheduling specific times for complex discussions
- Brief Intervention Skills: Mastering efficient communication for time-limited situations
- Nonverbal Awareness: Reading cues to determine communication readiness
- Prioritization Skills: Determining which communications require immediate vs. delayed attention
Integrated Barrier Management Approach
Effective communication in pharmacy practice requires a comprehensive approach addressing multiple barrier types simultaneously.
The Communication Ecosystem
Communication barriers exist within an interconnected ecosystem where environmental, personal, administrative, and temporal factors interact dynamically. Successful intervention requires systemic thinking rather than isolated solutions.
Advanced Practice Applications
- Barrier Assessment Tools: Developing systematic methods to identify communication obstacles in specific practice settings
- Multilevel Interventions: Creating strategies addressing individual, interpersonal, and organizational levels simultaneously
- Continuous Improvement: Establishing ongoing barrier monitoring and mitigation processes
- Staff Development Programs: Training entire pharmacy teams in barrier recognition and management
- Patient Education Initiatives: Empowering patients to recognize and help overcome communication barriers
- Technology Integration: Leveraging digital tools to reduce rather than create communication barriers
Comprehensive Barrier Management Example
A community pharmacy identified: (1) high counters (environmental), (2) pharmacist discomfort with emotional issues (personal), (3) no counseling reimbursement (administrative), and (4) rushed refill times (temporal). Their solution included: installing a low consultation area, providing communication training, documenting counseling outcomes for reimbursement claims, and implementing appointment slots for complex discussions.
Research and Evidence Base
The study of communication barriers draws from multiple research disciplines with implications for pharmacy practice.
Key Research Findings
- Environmental modifications (privacy improvements) increase patient information retention by 40% (Beardsley et al, 1977)
- Systematic desensitization and cognitive modification effectively address personal shyness (Baldwin et al, 1982)
- Consumers demonstrate willingness to pay for pharmacist counseling services (Smith, 1983; Suh, 2000)
- Positive patient-pharmacist relationships increase medication adherence and therapeutic outcomes
- Communication barrier reduction correlates with decreased medication errors and adverse events
Critical Thinking Questions for Graduate Discussion
- How might communication barriers differ between community, hospital, and ambulatory care pharmacy settings, and what setting-specific strategies would you recommend?
- What ethical considerations arise when administrative barriers (like non-reimbursement for counseling) conflict with professional responsibilities to provide patient education?
- How can pharmacists effectively balance the need for workflow efficiency with the time requirements for overcoming communication barriers?
- What role does health literacy play in patient-related communication barriers, and how can pharmacists address literacy challenges while maintaining patient dignity?
- How might emerging technologies (telepharmacy, AI, digital health tools) either create new communication barriers or help overcome existing ones?
