Transcript
Melanie Barlow: Hello, welcome everyone to the next episode of Reframing Conversations. Today it's great pleasure. We have Professor Bernadette Watson with us today. And she is an honorary professor at the Department of English and Communication at the Hong Kong Polytechnic University, an honorary professor of psychology at the University of Queensland.
Melanie Barlow: And she has an international reputation and is world leader in the field of language and social psychology and health communication research. She has, I looked you up on Google Scholar, Bernadette, you have over a hundred peer reviewed papers.
Melanie Barlow: and And I can personally attest, she is award winning PhD supervisor extraordinaire, who has just written a book called Miscommunication in Healthcare, care Solving a Wicked Problem.
Melanie Barlow: which we're going to discuss today. So hi, Bernadette.
Bernadette Watson: hi mel hi haida and uh it's lovely that you've invited me to do this podcast i'm very excited and thank you for that very generous introduction.
Melanie Barlow: Pleasure. Well, we'll jump straight in. I'm going to go after it. What I'm really interested in after years of research in language and social psychology and health communication,
Melanie Barlow: Why did you feel that this book was needed to be written like right now?
Bernadette Watson: I guess there are two answers to that. One, i was approached by one of the series editors, Howard Giles, and asked if I would like to write a book on health communication.
Bernadette Watson: And I thought, well for the 30 years that I've been doing research, a lot has now come together. And it was a very good time to write a book that wasn't just on one particular topic in healthcare, but covered the the range of research areas and contexts that looked at over the last 30 years. So it felt the right time to do it and the interest was there from the Peter Lang Publishing.
Bernadette Watson: And yeah, I took the challenge.
Melanie Barlow: Excellent. Small challenge.
Bernadette Watson: Slight challenge.
Dr H: we We often think of miscommunication as like simply using the wrong words. And so how does your book, Miscommunication in Healthcare, challenge that assumption?
Bernadette Watson: Well, you're quite right, it can be used in the wrong words, but communication is much bigger than just words. That's the first thing. And people sometimes find that they they are not able to explain clearly what they want to say, or maybe they don't want to explain clearly what they what they have to say, for whatever reasons that I go into in the book.
Bernadette Watson: And also it's quite possible that people misunderstand. You know, you you might think you've heard X, I might think I've said Y. So it's it's not just the words, it's also how you perceive someone. so If you're talking to a nurse or a doctor's talking to a nurse, there are certain identities there that come into play. It's not Susan the nurse and Fred the doctor. It's actually Susan as a professional nurse and the doctor as a professional doctor. And they don't always speak the same language.
Bernadette Watson: They have different jargon, different ways of approaching health care. And so there can be misunderstandings. At the same time, and this is why it's difficult, people work in the hospital are overworked.
Bernadette Watson: They have lots of time pressures on them. They're often fatigued.
Melanie Barlow: Thank you.
Bernadette Watson: So they may not communicate because they're just tired. too busy, which is a terrible thing to say. But I have known doctors say to me that at the end of a shift, when they've got to hand over, they are exhausted. And they think to themselves, do I really want to give all this information? I'm just so tired, I need to go home. And they can justify that by saying, I'll give the basic information, and it's up to the person coming in,
Bernadette Watson: to really understand the needs of this patient. Well, that's not ideal, but these are the sorts of things. It's very, very complex. These are sorts of things that go on. And it's, again, it's not just words. It might be the way someone looks at someone, the way someone dresses. They can communicate volumes. And that can be quite confronting sometimes to people.
Melanie Barlow: There's a lot going on, isn't there, vengeance than just saying the words.
Bernadette Watson: Yes. Hmm. Hmm.
Melanie Barlow: There is so much out there in healthcare saying, well, just speak up. You know, when we go to training that just teaches, tries to teach people just speak up.
Melanie Barlow: We have leaders of organisations saying, please speak up. Yet it's incredibly difficult to do and often...
Melanie Barlow: People choose silence over speaking up. Why do you think speaking up is still difficult in healthcare?
Bernadette Watson: I don't think there's any one reason and I think your own research Mel has touched on a lot of what's going on. First of all, it can be in the hierarchical situation of of the hospital where there's doctors at the top of the pecking order and nurses further down and others in between, it can be quite confronting.
Bernadette Watson: to set to check someone, to say something to someone when you think something has gone wrong or is about to go wrong. You want to be very sure that you are not wrong because if you're wrong, what will the response be by the person who's listened to you? They may be rude. They may put you in your place and you think, I'm never going to do that again. even though the patient's care should be utmost.
Bernadette Watson: So it's a case of not wanting to look incompetent, not wanting to get it wrong, not wanting to annoy perhaps the the person who's in charge because maybe you're a junior doctor wanting to get into that specialty and asking this particular specialist a question about, are you sure that's the right thing?
Bernadette Watson: then that might just be your path not to get into that specialty. You know that from your own experience, Mel.
Melanie Barlow: you
Bernadette Watson: Also, it's not just about the speaking up. People need, the person who's been spoken to needs to think about the message. And this is, of course, something that you study all the time. And people are not trained to understand why someone might speak up. and how threatening it might be for them. People are very comfortable in their little status areas and they may think nothing of telling someone to be quiet, you're wrong, rather than say, well, thank you for that, but actually, no, we can talk about it later.
Melanie Barlow: Thank you.
Bernadette Watson: So there needs to be a lot of training about how do I deal with someone who speaks up to me? what What should my reaction be? And of course, it depends too on the critical nature of the Speaking up, is it a life threatening thing? Is it just a procedural thing? i mean, so again, it's very, very broad and diverse. But the hierarchies and the power structure that exist across the world in health care really don't lend themselves to junior people being willing to speak up on behalf of their their patients.
Melanie Barlow: Thank you. You were saying before about respect. Do you think in this intergroup communication, the groups may have a different definition or idea of what respect is?
Melanie Barlow: Do you think that is also getting in the way? Like someone might say, well, they disrespected me, but from the other person's perspective, they thought they were respectful based on how they're socialised?
Bernadette Watson: yeah.
Melanie Barlow: Yeah.
Bernadette Watson: Well, that's right. I mean, you only know what you perceive. You don't know what someone else is feeling. You can never know what anyone else is feeling. you can see how they act.
Bernadette Watson: One of the worst things you can ever say to anyone is, you're so lazy or you're you're angry or telling them how they're feeling. You don't know, never jump in You can say something like, because of your behavior, it seems that you might be angry, but you can't tell someone they're angry. And so how I perceive someone and how they perceive me is very much the eye of that that person. And it's quite often the case that people misunderstand someone else. So
Bernadette Watson: A doctor might think they have a certain way of behaving and people should recognize that they're the doctor and this is how you should speak to them. And if someone doesn't do that for whatever reason, they may see that as disrespectful. Whereas in actual fact, it may not be disrespectful at all. It might be someone thinking, I need to say something now. But the person is not used to being questioned. So...
Bernadette Watson: it's very much, again, in the eyes of the beholder. And so sometimes a doctor might be horrified if they felt that they disrespected someone.
Bernadette Watson: They didn't mean to, but this is how they needed to act in the moment, you know. And we know that doctors actually are quite tough, and they don't mind people being quite tough to them, speaking, you know, do this, do that, do something else. Whereas nurses we've seen tend to be a little bit more sensitive. And that's fine. That's part of the way they've been trained. And again, that brings us back to they're all trained in separate silos, if you like, even with the interprofessional communication training that is happening, it's not translating to the hospitals.
Bernadette Watson: And it's been proven very costly, I think, for the universities to keep it up.
Dr H: Thank you.
Bernadette Watson: So yes, it's it's a case of what I see as something how it happened may not be how the other person see saw how it played out at all. Who's right?
Bernadette Watson: Well, you know, yeah you've got to be aware that people are different.
Melanie Barlow: you
Bernadette Watson: Everyone's unique. And that's what I mean about respect. you You mustn't impose your standards and your ideas on someone. because you think you're right.
Bernadette Watson: You have to speak to each person as if they were, as if they are indeed an individual. Now, I know that's a bit of a challenge, but don't treat people as stereotypes.
Bernadette Watson: That's what I mean. Oh, here comes a nurse.
Melanie Barlow: Great.
Bernadette Watson: Here comes that doctor. You know, it's, that's not helpful.
Melanie Barlow: Yeah.
Bernadette Watson: You must see people in the moment.
Melanie Barlow: right
Dr H: This makes me think a little bit about psychological safety, Mel and Bernadette.
Bernadette Watson: okay
Dr H: I'm just wondering what role does psychological safety play in effective team conversations?
Bernadette Watson: It plays a big role. And I've just been running some research at a hospital and we did a psychological safety measure with them. And nobody felt unsafe in this department.
Bernadette Watson: but doctors felt significantly safer than nurses. And that means, what do I mean by that? Being comfortable in the team, feeling that you could question something, you could make an assertion, you could decide to to say something that really might make a bit of a difference and be a bit out there. And you know that you wouldn't be thought badly of for doing it.
Bernadette Watson: Nurses don't feel that sort of comfort zone in this particular study. Doctors did. So it's a matter of, again, working, getting the team to feel psychologically safe.
Bernadette Watson: But teams in hospitals often aren't, they're not always the same teams. They change.
Melanie Barlow: Thank you.
Bernadette Watson: Teamwork is something that isn't necessarily pretty very well understood in hospitals because you have different emergency teams coming together, different surgical teams coming together. They don't work together continuously and get to know each other in their foibles. So it's a question of looking at what is it that would make this environment safer and risk noting that
Bernadette Watson: If anyone doesn't feel safe, then that needs to be addressed. So in this study, why didn't the nurses feel as safe? What is it that's going on? You need to dig deeper there once you've found there is a discrepancy.
Melanie Barlow: Thank you. i'm So your book addresses intercultural misunderstandings in healthcare.
Bernadette Watson: Mm-hmm.
Melanie Barlow: care What do you think then are the most overlooked challenges in cross-cultural communication? And when we say cultural,
Melanie Barlow: What do you mean in this context?
Bernadette Watson: that's it was a very difficult chapter to write actually because i wanted to get across that you have different ethnicities you have minority groups also in the health system you've got their own culture so intercultural differences within a hospital with their own uh ways of doing things their norms their standards and you put all that in the mix you really do have a very complex situation. But to unpack it a little bit, first of all, we have to understand that more and more people from other cultures, ethnicities are coming to live around the world. Sometimes they may not actually want to be where they are. They found themselves there. And that is very stressful.
Bernadette Watson: Added to that, language may not be, the native language may not be their number one language. So they're coming to a country, perhaps they don't really want to be there, they're not feeling very comfortable about being there, and then they have to work out something about the health system.
Bernadette Watson: And that's challenging enough. Anyone who's lived over overseas for a little while and has to go and find a doctor or something knows it's difficult. You don't speak the language, and also you're disadvantaged.
Bernadette Watson: because youre yeah you you really are at the socioeconomic level of just trying to make ends meet. That's problematic.
Bernadette Watson: So you've got that problem, actual accessing care and understanding how the system works. You've also got the fact that... People try, i think the best intention in the world, to to accept that some people from different countries have different cultures, different standards, different values. But in so doing, they can actually stereotype that person and put, oh, all people from this country are like this.
Bernadette Watson: And that's not right either. Again, it's getting back to the individual. Every... People may have a certain way of generally behaving, but everyone is individual. Also, people have different understanding about what it is to be ill.
Bernadette Watson: So some people see illness as something that's holistic, it's throughout the whole body, and they don't understand that in the West, we tend to think more of symptoms and diagnosis of particular condition.
Bernadette Watson: They may want to take their... alternative medicines. So there's a difference there's a disconnect between beliefs, between the health professional and the patient.
Bernadette Watson: The other thing, of course, is interpreters. a
Melanie Barlow: I
Bernadette Watson: we have You go to hospital, if you can't speak the language of the doctor, then you probably need an interpreter. Do you get one? You may not get a professionally trained one.
Bernadette Watson: At best, you may have someone who works in the hospital who actually can speak your language or it's a family member. And of course, you can imagine the ramifications of how inappropriate that could be if a family member is being asked to translate what the doctor's saying and then what patient's saying back. We really haven't got our heads around getting interpreters in place.
Bernadette Watson: And it's something that needs to be addressed. Again, it's money. It costs a lot of money to do these things. But at the end of the day, if people get good health care because people understand what's being said to them,
Bernadette Watson: And that's going to make a big difference. The other thing too is that doctors are coming from other countries and they don't necessarily work very well with doctors from the host nation.
Bernadette Watson: They have different ways of working. and They're not right or wrong, they're just different and people find it hard to understand and work with these foreign doctors, overseas doctors. So there's lots of challenges there as well. so Again, it's not just one thing.
Bernadette Watson: There's lots and lots of issues that need to be discussed.
Melanie Barlow: Yeah, there's a lot to unpack there.
Bernadette Watson: oh
Melanie Barlow: I can see why that chapter was challenging.
Bernadette Watson: Yes, it was.
Melanie Barlow: So where do you see communication improvement initiatives go awry?
Bernadette Watson: Well, one of the things is that often people come in with an intervention. Now, that intervention, we don't know where it's come from. Sometimes it's consultants come in and they impose it, they think will be a good idea.
Bernadette Watson: Whether it's a good idea or not, it's extra work for the staff. They've got a new checklist. They've got a new acronym that they're trying to learn. And they've when you go to hospitals, you know that across a district, a doctor coming in from this hospital may use an acronym that they don't use in that hospital. And so people don't really know. So that complicates things. But giving people extra things to do in the guise of this will be more efficient, you'll be able to work better, isn't necessarily helpful.
Bernadette Watson: There's this belief that health professionals are not always good communicators. And I don't think that's true. I think they usually are good communicators. They've just got a lot going on. They're under the pump.
Bernadette Watson: And the system around them, the structure that puts the hospital together, for example, doesn't help them. They're short-staffed, all those things again. We go around in circles with these things. that Communication doesn't always come through the computer when it's needed about something about a patient's needs. So mis misinformation happens then. It's a case of I think sitting down and finding out from the staff what's going right and what's going wrong.
Bernadette Watson: And it's that notion of what's going right that isn't asked. It's always what's going wrong. If we were to sit back and try and listen to people telling us when something went well, we might be able to use that information and impose it somewhere else. but we're always looking for how we can fix things that are going badly. I'd like to see more emphasis on what's gone well and what are people's strengths and how they've managed to get around a problem because you can have two teams with the same resources.
Bernadette Watson: One team will make it work and the other one won't because of the dynamics in the team and how they work together. So you need, why is this team working so well?
Bernadette Watson: and this one isn't. You need to look at what's going right to inform what's going wrong, not just trying to fix everything because it's gone wrong.
Melanie Barlow: Thank you.
Bernadette Watson: So I think burden on people because they've been given new instruments, new tasks, more things to do, and they really haven't managed to fix and adapt to the last lot of changes.
Bernadette Watson: And yeah, I think basically just recognizing that You want people on the ground looking at what needs to be done, not people from outside imposing ideas on what would be good.
Bernadette Watson: You really need collaborative effort from within.
Melanie Barlow: Thank you.
Dr H: This makes me think a little bit about some of the AI technologies that we have. And so I'm often thinking about, know, there's so many opportunities and and challenges and risks with that.
Dr H: In terms of healthcare care communication, what are some of the opportunities and risks that we have with AI these days?
Bernadette Watson: Well, I mean, it's the ongoing topic of something I'm starting now to to look at closely. My first impressions are that it can do so much good. you know but So GPs more and more are using AI scribes to actually make notes about what the patient's saying. And they're saying this can actually help them think perhaps outside the box about what might be going wrong for the patient.
Bernadette Watson: on the downside of course is it secure you've got to really make sure that confidentiality is is there and some of these platforms may not be as secure and we've seen examples of that as one would wish so there's a marvelous potential there for ai to come in as a sort of third ear you know and and work out what's what's going on also AI can be very good for screening people.
Bernadette Watson: If you need to go to see a doctor and it's becoming more and more difficult now to see doctors, it's not so bad in Australia, but i know in the UK, forget it.
Bernadette Watson: If you want to see a doctor, you wait two, three weeks.
Melanie Barlow: Thank you.
Bernadette Watson: So having a screening device that might sort of triage patients is is a good idea, but you have to be clear that, Communication's two-way. And so what the patient says is what the AI will understand. the patient isn't articulating themselves very well, then the best AI in the world won't assist. And people find it hard sometimes to describe their symptoms. So there's always going to be a place, I think, for humans, but we just need to have tools that AI can.
Bernadette Watson: can that can be used. But at this stage, it's it's still very, I think, uncertain how it's going to play out. But I certainly believe it's it's got a place.
Melanie Barlow: Watch this space, I guess.
Bernadette Watson: you.
Melanie Barlow: yeah So Bernadette, if there was one thing that you wanted readers to take away from your book, what would it be and why?
Bernadette Watson: I think it would be that, you know, the title, Solving a Wicked Problem. So what is a wicked problem? It means there's no one answer. There's no one discipline that can fix it.
Melanie Barlow: Oh, my.
Bernadette Watson: I, as a health psychologist, social psychologist, knowing quite a lot about healthcare, my approach can't fix it.
Bernadette Watson: But... I have insights that may be useful and other people coming in with different skills and disciplines can perhaps use those. So you need a collaborative approach to understand how many different angles there are to the problem and what can be done. I do think though, pardon me, that I mentioned respect earlier, respect and positivity.
Bernadette Watson: are things that are lacking. You know, we are quick, the met the media are very quick to blame people when something goes wrong and highlight people's failings.
Bernadette Watson: I really think if we could have a system whereby people are congratulated for when they do a good job, and that's the nurses and doctors in the hospitals, anyone, just rather than just accepting, well, nothing went wrong, so we say nothing,
Melanie Barlow: Thank you.
Bernadette Watson: rather it's much nicer to say and I thought more effective to say we did well we got through that and we all worked well and good outcome what's happened to the good outcomes why should they just be a given and it's just when it goes wrong that you start looking for people to blame and looking at the system I think we need to make people feel better about themselves so if we had a more positive environment that was respectful that wouldn't cost much money And it would actually change maybe the dynamics slightly, but you need far more than that. I mean, it's a bit like, how do you solve street crime?
Bernadette Watson: There's no one answer, is there? There's lots of things, you know, bring in more police, have curfews, all sorts of things you can suggest, but one thing won't work. It's got to be a collaborative effort and seeing things in the big picture. And people have got to want to to make it happen. Healthcare is underfunded. No one's willing to give enough money to healthcare. care It's tragic, the amount that is spent in other areas, but is not invested into people's wealth or our well-being and health.
Bernadette Watson: So you've got to have champions within the hospital system up the chain who want to see a difference and they've got to be advocates for change and perhaps also promote a more positive environment in the in the hospitals where they work.
Melanie Barlow: Fabulous. That would be a great takeaway for any reader.
Bernadette Watson: Yes.
Melanie Barlow: So miscommunication in healthcare solving a wicked problem. Where can people buy it?
Bernadette Watson: You can certainly get it of online. I mean, Amazon is is selling it and Booktopia, I believe, are selling it. a can never remember it's Book Depository or Booktopia. One that went out and the other one kind came in. So in Australia, you can certainly get it on online there. I'm going to be having for Brisbane people of a book launch on the 19th of August. And you can certainly get the book.
Bernadette Watson: there at the Avid bookshop in West End.
Melanie Barlow: An autographed?
Bernadette Watson: If people want me to sign it, I'm happy to sign it, although, you know, my writing isn't that neat. And also, it's possible there may be some kind of discount for people who don't buy it on the night, but they attend the book launch, but that's all in the air. But basically, yeah my cousin...
Bernadette Watson: who is quite an elderly gentleman, managed to buy one in the UK online. He said it arrived. Chris got an email from saying arrived. So if he can do it, anyone can do it.
Melanie Barlow: Thank you.
Bernadette Watson: But I do want to say that it's not just a textbook. That's the thing. It's not just about health communication students learning about a particular aspect of, or a theory of communication. It's every chapter is very applied. So health professionals can read it and relate to it, or I hope they can. And they can't, they need to tell me because I, you know, I need to get it right. But certainly the three people of which you are one male at the end of the book who wrote about the theoretical perspective, uh,
Bernadette Watson: They were being practical and it's about seeing your day-to-day environment and how you might do things slightly differently.
Bernadette Watson: So it's not just a textbook for sitting in at uni and reading about health communication. It's a practical guide as well for people who are actually working in healthcare. care
Melanie Barlow: And you had a patient contribute as well, didn't you?
Bernadette Watson: Yes, I did. I had a very good friend who who sadly is a quadriplegic now. It happened overnight. So it was a big, big change for her. And she relayed to me her experiences of being in a spinal unit and rehabilitation for 18 months. And some of the things that, again, it wouldn't have cost money to change her quality of care.
Bernadette Watson: It just needed people realizing that just because this woman, and she's a very independent, strongly spoken woman, just because she seems like she's okay, paralyzed from the neck down, but she's got an iPad, we can leave her alone all day, where so other people can't be left alone. She needed to get out and have some air. She needed to be taken out onto the veranda, you know, but she, who was going to take her? Again, short-staffed. It's not just one thing.
Bernadette Watson: But the big thing too is, and an insight that I was really excited about when I finished the book, was that Julie, my friend, had been having problems with her ventilator. And in the book I say that, you know, she's been going back, has to stay overnight while they test out the ventilator.
Bernadette Watson: And often the key doctors aren't there because it's nighttime. And people don't know... the the equipment and she four or five times she was going back, going back and also taking a bed away from someone who might need it because it was on the ward.
Bernadette Watson: And she came up with a solution that meant she could go during the day and all the the health professionals who were required were there. She made this suggestion about using the sleep clinic, which isn't used during the day. And they said, oh,
Bernadette Watson: that's a good idea you know so there was that didn't cost money that's freeing up a resource but you see that's thinking outside the box one person can make a difference as i say try if you don't think one small person can make a difference try sleeping with a mosquito at night it really stops you sleeping but it's only a tiny mosquito
Melanie Barlow: Thank you, Bernadette. Hi, to Dr. H. Any last words, thoughts? It's been a fantastic conversation.
Dr H: It's been fantastic conversation. Yes, thank you so much. That was really interesting and really appreciate the different stories and and the key concepts that you're raising for us that are really important when we're reframing conversations.
Bernadette Watson: Well, thank you for giving me the opportunity. And I may not have answered the questions or ideas as fully as I would like, but I'll get used to doing this and it does get more and more easy to to share.
Bernadette Watson: Thank you.
Melanie Barlow: Thank you. See you.
Bernadette Watson: Bye now.
