On scope and scale: looking back and planning forward

It is my honor and pleasure to assume the position of Editor-in-Chief for the Journal of Communication in Healthcare: Strategies, Media & Engagement in Global Health (JCIH). As a contributor and editorial board member since the Journal's inception in 2008, I have personally witnessed its growth and expanding reach. I owe sincere gratitude to Mario Nacinovich, Founding Editor, and Renata Schiavo, past Editor-in-Chief and Editor Emerita, both of whom have guided the journal through its first decade and shaped its impact on the field of healthcare communication. They have also been colleagues and mentors, from whom I have learned a great deal.

In thinking about the direction the Journal should take as we enter the second decade, it is important to consider both scope—the breadth of topics that fall under communication in healthcare—and scale—from the intimate dyadic interaction between patient and provider to mass communication in public health and global health messaging. As a clinician in an academic realm, I experience the scope and scale of healthcare communication in my daily life. I thought it would be fruitful to reflect on, explore and understand how communication permeates all aspects of my own work and how it relates to the broader field of healthcare.

As a faculty pediatrician at Weill Cornell Medicine, I practice in both outpatient and inpatient settings. In our general clinic, my patients range from healthy children to patients with complex chronic illness, from infants needing vaccines and routine prevention to those with acute, potentially life-threatening infections, from well adjusted school-aged children to high-risk adolescents and LGBT youths. Being in New York, our clinic serves patients from the indigent to the affluent, recent immigrants to savvy urbanites. We routinely use interpreter services (telephonic or live) and counsel patients with varying degrees of health literacy levels. My panel of patients and families includes those that lack the most basic knowledge as well as those that come armed with printouts from their latest visit with Dr. Google, those that adhere to all recommendations as well as those that refuse influenza vaccines and recommendations on weight loss.

I communicate with a team of registrars, nursing staff and consulting specialists, as well as ‘write’ prescriptions through our electronic health records (EHR). We encourage patients to sign up for our digital patient portal, where they can request prescription refills, make appointments and ask non-urgent questions. Some of our consultants offer second-opinion evaluations through a telehealth platform. While families in the clinic wait to be seen, Child Life Specialists engage children with books and through arts and crafts projects. Our team of social workers frequently steps in to register patients for insurance coverage, arrange for home-based therapies, and coordinate transportation for wheelchair-bound patients. Community health workers and care coordinators complete our interdisciplinary team to implement a patient- and family-centered medical home model [1,2]: through home visits and at weekly care coordination meetings.

When I cross over to the inpatient side, I start off the day with ‘morning rounds,’ when our team of providers discuss and examine hospitalized patients at the bedside. During rounds, I supervise a team of residents and interns, physician assistants, medical students, physician assistant students and nursing students. We employ the family-centered care format [3–5] where we discuss medical issues in front of families, while balancing different perspectives (e.g., patient/family, provider), teaching learners of different levels of training, coordinating diagnostic tests/procedures and negotiating treatment options, educating families, and handling uncertainty in diagnosis or prognosis. We occasionally request consults from subspecialists (e.g., pediatric pulmonologists, nephrologists, geneticists) for additional recommendations; such interactions required brief, focused communication that convey a sense of urgency. I also collaborate with a nurse, clinical librarian and clinical pharmacist to review new and existing patients. Clinical librarians facilitate our search for the best evidence to diagnose or treat medical conditions [6]; at the same time, we tailor the information to the level of the patients and families to ensure comprehension. Clinical librarians also search for and share patient-friendly education materials with families to help improve understanding, adherence and follow-ups.

Giving bad news occurs more frequently than we would like, and role modeling bedside manners to learners at times becomes a juggling act. Occasionally, we confront families suspected of child abuse or neglect, or have to apologize for medical errors resulting from either a personal or systems etiology. We hold interdisciplinary family meetings to ensure all providers from different services agree about next steps in care, which require careful and thorough communication across disciplines. In addition to an EHR system, more urgent communication is accomplished through an individual voice activated system called Vocera® (https://www.vocera.com), and we have recently rolled out another platform called Mobile Heartbeat® (https://www.mobileheartbeat.com) that incorporates both voice calling and texting. An increasing number of nursing and physician staff is pairing their smart phones to Mobile ®Heartbeat (tagged by the IT team for security and patient privacy) to stay connected even after they leave the inpatient ward and after hours.

Digital devices and applications enable us to remain connected 24–7. We use our tagged smart phones to send electronic prescriptions for patients after checking lab values on the same devices. Patient portals make it possible for patients to schedule appointments online, check labs, request medication refills, communicate with medical staff, and in some cases, read actual physician notes [7] at all hours of the day. In my email inbox, I routinely receive notifications and LISTSERV messages about influenza statistics from the department of health, alerts about Legionnaire's disease spread through rooftop water towers [8], medical breakthroughs on specific medical conditions, newly approved treatments from pharmaceutical companies, and product promotions from commercial manufacturers. I participate in webinars on clinical as well as medical education topics, delivered right to my personal device of choice. A modern day physician is never truly ‘logged off.’

When I step away from clinical responsibilities, I put on an educator's hat, which requires a different communication skillset. My educational efforts have focused on humanism in medicine and involved experiential learning in addition to knowledge acquisition [9,10]. I value creativity in medical education and have introduced innovative curricula for students, physicians in training and practicing doctors. One recent example leverages a close partnership with our Family Advisory Council (FAC) to teach family-centered care. During this session, FAC members (generally parents who have had children hospitalized at our institution and now join the organization to give back by improving patient experiences and providing education to learners from different departments), co-facilitate the discussion with me on the management of a toddler with a life-threatening condition using a video-clip, role-play exercises and reflection. Involvement by parents in the session has lent authenticity to the training. Additionally, I am involved in global health education through exchange programs for students in Asian and Europe. I have served as faculty and curriculum director for the Evidence-Based Practice Section of the New York Academy of Medicine, which hosts an annual training conference that integrates evidence-based practice with patient preferences (http://ebmny.org/index.html).

My academic homes, organizations that help foster my professional development [11], include the American Academy on Communication in Healthcare (http://www.aachonline.org), EACH International Association for Communication in Healthcare (http://www.each.eu), Council On Medical Student Education in Pediatrics (http://comsep.org), and AMEE An International Association for Medical Education (https://amee.org). They have enabled me to remain connected to my professional community and updated on best practice in curriculum, research, policy and collaborative opportunities. My involvement with these organizations has taught me that research and practice go hand in hand, that interventions need to demonstrate outcomes, that scholarship demands rigor. And fundamentally, research and scholarship form foundations for policy and culture change.

In all aspects of my professional life, communication plays a pivotal role. As I move from outpatient to inpatient settings, from clinician to educator roles, I am reminded of the wide-ranging scope of healthcare communication: building trust through empathy and non-verbal skills, discussing medication adherence, negotiating treatment options, counseling about health prevention, role-modeling for physicians and nurses in training, engaging in interdisciplinary collaboration, adapting the latest evidence in the literature to patient preference, assessing the impact of mental health, exploring sources of healthcare disparities, advocating for the underserved, etc. Similarly, I experience the large scale of healthcare communication: from individual patient-provider interaction to community engagement, from collaborating with local health department on public health issues to responding to global disease outbreaks, from counseling individual patients to mass communication through traditional and social media.

Mario and Renata have articulated how the Journal needs to respond to the ever-expanding scope of healthcare communication in their inaugural editorials [12,13] and during their tenures. I am broadening this further by adding other topics: education, ethics, end of life conversations, communication theory and research methods, LGBT health, reflective practice and narrative medicine, interprofessional communication, shared decision making, policy and advocacy, etc. These are not simply hot topics, but issues that arise in response to social and societal changes to which our scholarly communities must respond.

Expanding the scope while maintaining the level of excellence of our Journal requires building on the solid foundation that is our panel of expert peer reviewers. I am grateful that my colleagues in various fields, including nursing, pharmacy, social linguistics, medical education, the deaf culture, etc. have accepted our invitation to join the panel and help uphold our high standard of rigor and scholarship. With our expanded panel, we promise to continue to be accountable to our authors/contributors regarding length of time from submission to publication, timeliness of reviews, and quality of feedback. Similarly, I am grateful for our active and distinguished Editorial Board, whose diversity reflects the scale and scope of healthcare communication I discussed above. We will continue to recruit board members to reflect our expanding readership and evolving field. We will continue to engage them as contributors to Special Issues, Inside Commentaries and Book Reviews.

Finally, we want to maintain current partnerships, including with the American Public Health Association (https://apha.org/) and the World Health Organization (http://www.who.int/), which Renata initiated, and establish new ones as well. The idea of an active, engaging community focused on healthcare communication will continue to be a focus for us. And I invite you to count this community as one of your academic homes.

As the journal continues to grow and expand in scope, we need to stay grounded, to keep our eyes on the prize. Our promise to our contributors and readers will remain:

• Focus on outcomes of healthcare communication on the level of individual health, community well-being, and social policy

• Maintain a high level of rigor and scholarship in order to increase impact on the field

• Ensure the inclusion of multiple perspectives for advancement of diverse interests and communities

My learning curve has been quite steep during this transition period. To this I owe immense gratitude to our Senior Assistant Editor, Radhika Ramesh, who has been so helpful in keeping me on task, providing useful pointers, and ensuring continuity of workflow. The staff at Taylor & Francis Group, both veteran and new, have been incredibly patient as collaborators and guides. In particular, Zoe Golbsbury, Assistant Editor for Allied & Public Health Journals, and Simon Smith, Editorial Systems Coordinator, have made my transition smooth and wrinkle-free.

Here's to further productive collaborations!

In this issue

The seven articles in this issue nicely illustrate the large scope and scale of healthcare communication discussed in my inaugural Editorial. The collection includes one systematic review and six original research papers, two of which were published online. One research paper examines an educational intervention, while another is a methods paper looking at the validity of an innovative measure of health literacy. Four originate in the US, one in the UK, one in India and one in South Africa.

On one end of the scale, ‘Role of education and communication interventions in promoting micronutrient status in India - what research in the last two decades informs’ tackles a public health messaging issue to offer insight and challenges on this topic. On the other, ‘Creating a new context for dialogue and reflection within a residency program: the development of a blog’ describes the use of an online blog for residents to reflect, a communication task on the smallest scale, on their own videotaped clinical encounters and those of their peers. Incidentally, this paper recalls my own for the Journal's inaugural issue, ‘Using videotaped objective structured clinical examination as a tool for reflection on communication skills’ [14], but leverages new technology to meet the needs of today's learners.

Three papers lie between these two ends of the spectrum: ‘College students and HIV testing: cognitive, emotional self-efficacy, motivational and communication factors’ and ‘Everyday life information seeking: sex-based associations with where men and women receive information about sexual violence’ examine how young adults seek information on sex-related topics that are difficult to discuss, but have large impacts on their behavior, life choices and future. A third, ‘Mechanisms of influence for weight loss in popular women's health media: a content analysis of health and fitness magazines’ looks at how popular media influences consumer perception, specifically on a topic that has become a huge international public health issue.

The two remaining papers touch on humanism in medicine, a focus of my educational efforts. ‘Development of an item bank of health literacy questions appropriate for limited literacy public sector patients in South Africa’ not only addresses health literacy, a topic central to health equity and patient empowerment, but also does so by examining the validity of an innovative instrument adapted for an underserved population. Finally, ‘Perceived acquisition, development and delivery of empathy in musculoskeletal physiotherapy encounters’ discusses a most fundamental element of the relational aspect of healthcare encounters.

Addendum: Our Special Issue, “The role of communication in advancing mental health,” will be postponed until March 2018.

Disclosure: Dr. Jirasevijinda does not have financial interests in the commercial products discussed in this piece. Nor does he have any conflicts of interest of disclosure.