by Chris Hilburn-Trenkle
As a social worker, Lisa de Saxe Zerden is no stranger to communication.
The University of North Carolina at Chapel Hill School of Social Work associate professor has more than a decade of experience communicating as a social worker in the behavioral health field.
Zerden, who is also the deputy director for the UNC Behavioral Health Workforce Research Center, recently utilized her expertise to co-author a publication that could serve as a guidepost for effective communication among health care professionals across the state.
Zerden and Associate Provost for Interprofessional Health Initiatives Meg Zomorodi, a professor at UNC School of Nursing, co-authored “Fostering Psychological Safety: Building Team-Based Care Communication Skills,” for the May 2024 special edition of the North Carolina Medical Journal.
We spoke with Zerden to learn more about the paper, the obstacles facing effective communication in the health care system and more.
In your words, what was the purpose of this paper?
The North Carolina Medical Journal wanted to do a special issue on team-based care and what that looks like, and UNC really took the lead on most of those articles. A really important piece of team-based care is communication. We can talk about clinical care, we can talk about patient outcomes, but in order for those things to happen we have to think about the intangibles of communication. I was asked to write a piece on effective team communication, which I was happy to do. It’s a good thing that social workers know how to do — think about communication and communicating things to people, between people.
When you talk about effective communication in the health care system and the importance of it, as you laid out in the article, what are you looking for specifically?
I think communication in the health system requires different mediums, different approaches to communication. What we love about integrated models where you have behavioral health and physical health providers and medical systems working together and patients and their families, you can have that interaction, that in-person conversation which can happen organically. You can also have communication through chats and electronic help messaging, which Covid really accelerated. You have to have communication in huddles, or a warm handoff that happens in the clinic halls. You’re not going to address the patient’s needs by one of those methods, it’s going to take a combination of all those methods, so just being deliberate and thoughtful about when and how and where you communicate can improve care, and also relationships between the providers themselves.
What takeaways do you feel like you gathered from writing this paper that could be most significant for health care professionals and patients across the state?
We take for granted communication. It just happens, it’s something that we don’t really think about, but it is really an essential tool for collaborative care, so I want folks to take away that you have to be purposeful, you have to be intentional with your words. It makes a really big difference to patients and families. Also, how teams connect and how they feel cohesive and safe together. We take it for granted, but it’s a really essential ingredient, and I’m glad we had a quick sidebar to discuss that and talk about why it’s so important and how you can think about soliciting that feedback or seeking that feedback so you can continually improve communication and be aware of how you’re communicating, if you’re communicating well, if you need to make improvements. Hopefully, readers will think, ‘Gosh, how do I check in with the people I work with’ or ‘How do I ask for feedback on how I’m talking.’
How have you seen effective communication dealing with other health care providers across the state of North Carolina?
What’s been so exciting about my work is you can address some of these issues at the micro level — patient to provider or provider to provider. You can think about how the clinic functions on an organizational level, or you can think about the policy implications or those broader systems, like ‘How do we communicate an electronic health record? How do we take that data and do something positive with it?’ So, I see it on all levels, but really what I think is so important about communication is that we often speak in silos. We treat people in silos, we speak in silos and there’s no good in social workers [just] speaking to social workers. We have to find a way to communicate with the pharmacist and the nurse and the physician. I think it’s a really great way to learn how to speak about your profession and what your profession brings to other disciplines. I think that’s what’s been really effective and really fun about the work that I do.
Do you think you’ve seen that improvement with health care providers also?
I feel like the tide has turned in a really positive way. Just last week I was at the dental school giving a lecture on why dental hygienists and dentists, why in their education in training they need to talk about substance use and patients’ social needs.
I don’t think even a few years ago they would have invited a social worker to come and speak to the dental professors, but there’s just so much more recognition that health and health outcomes are really happening outside the clinic and they’re happening outside that patient’s interaction. They’re happening in the community; they’re happening in people’s real lives outside the clinic. And so, I think it’s such a great opportunity for all these professionals from all different types of backgrounds to work together.
Are there any other improvements that you would like to see among health care professionals, or for health care professionals working with social workers or patients across the state?
The one thing that’s tricky with how payment works right now, we’ve talked about moving towards a value-based payment model. Right now, we’re not quite there. Payment is tricky. Who’s billing for the encounter, who’s billing for the behavioral health intervention? And when you’re working as a team, the billing structure and who’s getting reimbursed for that is quite complicated. For social work we’re sometimes billing — it’s called Incident To — underneath the physician in some cases. It becomes difficult to discern what revenue the social worker is bringing in or what costs we’re saving the system by having our involvement.
[I would mention] The complexities around billing, the complexities around payment. I think we still have a long way to go in order to make all of these different parts feel like they’re being productive and useful. We need that data to increase the evidence that this is a really helpful way to work across teams.You mentioned the advancements and developments of these new integrated models of care, as well as more hybrid-remote work because of the pandemic. How do you manage these challenges that come with communications with all these different updates that we’re seeing in the field?
We have a paper in a revise and resubmit status [examining those challenges and shifts]. Covid really affected everything we were working towards in terms of having people co-located, putting people in the same clinic, it almost blew apart with Covid, because people are now working at home, people are not physically in the same space.
That really has been a radical shift. So, thinking about how we provide integrated care that we’ve worked so hard to get going and get off the ground in these new models where we’re not physically in the same space. We have some examples of folks doing this through intentional team meetings or in a Zoom huddle before a clinic begins, or having dedicated office hours or check-in. It’s created challenges to the traditional way of doing integrated care, which was starting to take off, but now we have to figure out a way to re-calibrate with hybrid flexible work environments.
Do you have any plans to follow up with further focus on the paper or the areas of communication in general?
This one was just a broader think piece, but I think communication shows up in a lot of our work. The theme of communication and teams working well and functioning well together is going to be a continued element of our future work, because as I said it’s essential. If you can’t communicate, you’re not going to be an effective team, across all industries, but particularly in health care where you have so many different needs. Some of it is transportation, some of it is diabetes management, sometimes it’s a clinical need. You have to figure out a way to pull all that information together and be in concert together.
