Ashley Barrett

Transcript

DEREK SMITH:

Hello and welcome to Baylor Connections, a conversation series with the people shaping our future. Each week we go in depth with Baylor Leaders, professors, and more discussing important topics in higher education, research and student life. I'm Derek Smith, and today we are at Talking Communication and Healthcare Settings and more with Ashley Barrett. Dr. Barrett serves as associate professor in Baylor's department of Communication, a two-time Baylor graduate. She joined the faculty of her alma mater in 2013. This year she earned a prestigious NSF career award to study the impact of technology on compassionate communication and healthcare settings. In earning the award, she became the first Baylor faculty member to earn a non-STEM career award from the National Science Foundation. It's been an exciting year for you, for your research and for Baylor with this award. We're glad to have you on the show to talk about it. Thanks so much for joining us.

ASHLEY BARRETT:

Us. Thank you so much for having me. I'm excited for the conversation.

DEREK SMITH:

Well, I'll start off with, I don't know, maybe this is an obvious question, but we're talking about a National Science Foundation award and you're a communication professor. Is that something that's very common outside in higher education?

ASHLEY BARRETT:

I've learned even more so recently after receiving the award that it is not, but there are industrial changes that are occurring and I think in the world of science, especially in the world of healthcare, we are starting to realize how important communication is and we can have the most brilliant science, but if we can't communicate it to a diverse audiences, then we're kind of missing a huge chunk of that process. So I just was at our National Communication Association conference and it was really interesting because I started to notice that there were NSF and NIH professionals who were in our audiences at our panels and they actually stood up at the end in one of my panels and said, "Hey, communication is so important to what we're doing and it's really a part of our future agenda to pay more attention to this." So I can only imagine that communication and another social science disciplines will be better positioned for NSF awards and NIH awards down the road.

DEREK SMITH:

Well, absolutely. And here at Baylor, you're the first. When you were applying for this award and when you received your, were you aware of the sort of historic nature here at Baylor?

ASHLEY BARRETT:

I wasn't. I did, I guess in retrospect, I did my homework and I looked at other NSF awardees across university and I did notice that they were mostly not in, I didn't see any of the social sciences, but I thought maybe I was missing one or maybe I didn't have all of them, or maybe they were just NSF awardees in recent years. But I've come to the realization recently that it's really awesome because it is. It's the first one that we've had in the social sciences at Baylor. But just looking at who the people in my department, and that's just one department specifically, and the grants that they're currently applying to, this is just going to become, I would expect more commonplace in the future.

DEREK SMITH:

Well, let me ask you about that as we visit with Ashley Barrett, you and your colleagues. I spent a lot of time in the Castellaw building. So as a Baylor communication grad, I'm proud of this, but you've a lot of great communication research. I know you can't speak for all of your colleagues, but could you give us just a little bit of a sense of what kind of research is taking place in the Castellaw building these days?

ASHLEY BARRETT:

Yeah. One really amazing thing about communication is the range of really important topics that we're studying. So I was actually the first hire in health communication in our department. Since then, we've hired two additional faculty who study health communication, but in different areas. Our most recent hire is someone who studies health communication, does social science, but also does rhetoric. And so her research, Dr. Kayla Rhidenour, she's looking at how we can pull information from social media sites like Reddit where you're having all these conversations that people are having and they're really frank and honest conversations and they're trying to seek information about health scenarios that they're encountering. Maybe some of those scenarios are stigmatized, maybe some of those conditions are stigmatized and they don't feel comfortable having outright conversations with a professionals first, maybe not their physicians first. And so they're going to these communities to seek help. And so she's really looking at, well, how do we make sure that there's also an official voice in those communities or there's other outlets for people who are going to those communities so that they make sure that they're getting credible information. So she's setting kind of veterans in that scenario. She's doing COVID-19 studies where she's looking at long haulers who have COVID-19 symptoms for a long time and can't figure it out, why they're still encountering those types of conditions and those symptoms. We have someone else on faculty who she does a lot of research surrounding sexual harassment and building campaigns at universities and other larger institutions and making sure that people understand kind of their rights and they're protected and they're safe. And all that really comes down to organizational communication. So she's at that intersection of organizational and health communication as well. So there's a lot, I could keep going on, but what I really value and appreciate in our discipline, and particularly in our department, is the really important conversations and really important topics that we're having. And we're not just having them with other academics. We're having conversations that are really valuable, important for our surrounding communities and communities across the countries because a lot of these conversations have not been had outright and as directly as they should have, and they haven't been strategized as much as they should have. So I think that's really important. We have that really great connection from theory and academia to practitioners and kind of practical implications.

DEREK SMITH:

Well, as we talk about your research, I think we'll see that as you, you're talking with what patients, healthcare practitioners, people who create resources that serve them, which everyone can relate to in some way or another.

ASHLEY BARRETT:

Yes, absolutely. And when I did my dissertation research was looking at the use of electronic health records and this huge transition from using paper records to now with the Affordable Care Act and thinking about digitalizing the healthcare world. We're kind of making this movement slowly but surely. Now we've made it into the electronic health record world. But that was a hard transition. But let me tell you, it was not hard to collect that data because I was talking to physicians and they would talk my ear off about how they liked the opportunity, they didn't or they liked the change. They didn't like the change. And then of course, from a patient perspective as well, now that we have this other entity in the room with you, which is the computer which the physician is paying attention to, how can you make sure that the patient is still getting that attention as well? And they feel like they're getting that attention as well, because it's a bifurcated way of giving your attention. But equal parts are really important. It's just as important as the other, and maybe the patient experience is even more important to really elicit the information that you need about that patient's condition. Because at the end of the day, they are the expert of their own body, so they have to give the information that the physician really needs.

DEREK SMITH:

Where did your interest in this topic, beginning. You said you did your dissertation on this, and you've pursued this as a professional, but for you, where were the roots of this?

ASHLEY BARRETT:

Oh gosh, that's such a great question because it brings me back to my dissertation and wondering what do I want to do? Every PhD student, they're done with their coursework, everything that's been predetermined for them, they've accomplished. And now they're at this point, at this point, kind of at this crux where they have to decide who they are as a scholar and who they want to be. And I think a lot of that transition into electronic health records occurring around the time that I was deciding on what my dissertation was going to be was in retrospect, I can see how powerful that was and how influential that was to me. My PhD was in organizational communication and technology, and I was already interested in healthcare organizations, but I was trying to think to myself, academia can be so siloed and I don't just want to do research that I publish and it sits and collects dust and journals somewhere. I want to do research that matters. And so looking at this kind of new age phenomenon that was occurring, I thought, well, I think we can figure out more about this. And then I had this experience where I went to my ophthalmologist and he is brilliant, he's such a great communicator. And before I saw him, I saw a nurse and she was reading electronic health record. I could tell it was a new process, but I could also tell in that moment how it changed our interactions from the last time I was there and there was not electronic health record. There were very clear check boxes of information that they needed that was new information that they had not asked me before. And some of that information didn't seem completely relevant. They asked, "Are you a smoker?" Well, I'm like, "Oh, well you never asked me that question before. How was that relevant?" So I just got really interested in that process of now we have this other set of criteria, communicative criteria that we need to accomplish in our interaction with our patients, but what does that do to those genuine organic interactions? And those are so important to establish that relationship, to establish that rapport and trust with your physician again, to get your patient to feel comfortable enough to really open up to the physician and to the nurses. So every good research, I think starts with a really personal experience.

DEREK SMITH:

What are some of the questions that you're trying to answer through this grant?

ASHLEY BARRETT:

Yeah, that's a great question. I keep coming back to those and reassessing those. But I think for the most part I'm trying to understand, and I've looked at it previously prior to this grant from a physician and a health provider, a clinician perspective of what do you do now that you have this other set of criteria? And it is even more prominent with some types of physicians than others, which I've learned in my past research, like pediatricians and oncologists, paying attention to the patient in a way that's very compassionate is even more important. And pediatricians for them, they have to pay attention to the child, but they also have to pay attention to the parents because the parents are really the ones who understand what's genuinely wrong with the child. And you can tell emotionally, non-verbally looking at the parent how worried they really are. And that's all information to take in. And so yeah, I'm interested in now that we have this other kind of third party, which is the computer, in the patient medical suite or the interview room, how do you make sure that in time you are filling out the information that you need to, that you're required to right into the EHR and you're doing that sufficiently and to the extent that you need so that when you share these records with other people, they can understand what's occurring. Or when you share this record with yourself in the future, you can understand what occurred with that patient. But simultaneously being able to make that patient feel like they are a human and kind of humanizing that conversation and doing those things where you use verbal and non-verbal immediacy to build rapport. And because I think when you go in and it's in your mind frame that I have to answer these questions on this computer, you can start to lose sight of, "Okay, but I also need to establish rapport with my patient. I also need to ask them how their children are or how their school is going. I also need to show really good non-verbals, great eye contact and body positioning and gestures with my hands and all those things that make a conversation feel like a real genuine conversation. So how do I do those two things simultaneously?" That's one set of questions. And then the other set of questions are, hey, we're all very well aware of this virtual environment, whether it's Zoom or Teams or whatever we're on. It's a different communicative venue with different challenges and different opportunities. But we haven't done a lot of research to figure out what does compassionate empathic communication look like in this particular venue? And what do successful conversations look like online in these virtual visits? And so with the rise of telemedicine specifically, COVID-19 was a catalyst for that. I think that's going to be a conversation that's on the forefront and something that we need to figure out and understand as communication scholars and share with the healthcare world.

DEREK SMITH:

Visiting with Ashley Barrett, associate professor in Baylor's department of Communication here on Baylor Connections. And I think you described this when you were talking a moment ago, but I want to ask you specifically, when we talk about compassionate communication, is that an academic term? Is that a term that we all understand when we hear it? There's a little bit of both.

ASHLEY BARRETT:

It's a little bit of both. If you look at Hillcrest and look at their mission statement, they're going to talk about compassion. That is foundational to their care. But compassionate communication is also theoretically and academically talked about in the communication discipline by a really prominent communication scholar named Catherine Miller, who actually wrote the textbook from my organizational communication class that I teach at Baylor. And so she talks about... Well, first, it wasn't until the 1990s in academia that we started to think about emotion and emotionality in the workplace and how it really impacted our decision making. And it impacted how we interact in the workplace. And so we need to study it, right? Because I think we're a long time, we're like, "No emotion. It doesn't exist in the workplace. It doesn't belong in the workplace." So it wasn't until the 1990s when we started to theoretically think about it and its role in the workplace and part of that conversation, that's the larger umbrella term. Another term that came out of that was compassionate communication. And that's this idea of thinking about emotionality and communication. And particularly it's this idea of noticing, feeling, responding and connecting. So noticing when you're with a patient that they are in need of an emotional response, right? Feeling that is part of that process. Connecting involves both verbal and non-verbal immediacy, strategies, patterns, so enacting those with your patient. And then the final one is connecting. And that is also kind of has two prongs. One prong is cognitive connecting, and that's really perspective taking. So thinking about the situation that the patient is in, how they perceive their environment, what they would need to hear, see, feel, so on and so forth. And then the other one is more emotional, so connecting emotionally. And of course that occurs through empathy.

DEREK SMITH:

So we've all sort of adjusted at least somewhat to this new technology in recent years. And you're looking to see how we are adapting, how we're adjusting, how it's impacting. How do you go about doing that through this grant? How do you collect the data that's going to help you determine what what's next?

ASHLEY BARRETT:

Yeah, that's a great question. So I'm partnering with Waco Family Medicine and Baylor Scott & White Health, and they're both really great entities to work with in this type of research for different reasons. Waco family medicine is smaller, but they are known for practicing really compassionate care and thoughtful care with their patients. A lot of their patients that they're serving are underserved, fall underneath the federal poverty line, don't speak English as their first language. And so I was really interested in working with them, doing interviews with their residents there who are not first years. So they probably don't have a lot of experience in terms of lived experience with the patient and patient interactions, but second and third year residents and kind of talk with them about what have you learned in this process because you've kind of been thrown into the fire. I felt the same way when I started teaching at UT during my PhD program. It's like one semester you're a TA, the next semester you have a class of 50, and here you go. You got to make it work. And you learn so many experiences in executing and doing along the way. So because they have that really important compassionate, empathic orientation with their patients already, and because their patients are an underserved community, which probably have... Research has shown that underserved communities, communities encountering health disparities, have more needs for compassion in their healthcare. So that was with Waco Family Medicine, because that's such a great, they're great for so many reasons. We're engaging in interviews, just kind of asking best practices from the residents. Different year residents. We're also talking to patients and asking them, what is going on here? What did you like about your medical visit? What did you not like about your medical visit? Is there something that you needed from a communication standpoint that you didn't get? And just asking general satisfaction questions as well, but kind of honing in on the communicative element of satisfaction. And then we're also observing the medical visits through video technology. So it kind of goes hand in hand. The same residents who we interview we'll also observe them with their patients, and then we'll ask those exact patients, how did this medical interaction go for you? And looking at that same interaction from those multiple perspectives I think will be really helpful and we'll really get a clear idea for what's going on there. So that's at Waco Family Medicine. And then Baylor Scott & White Health, they run a communication program called Art of Communication, and it's a workshop that they're already offering to their employees, all types of employees, anyone who's interacting with a patient really. And they have two versions. There is an eight hour workshop that you're just kind of signing up to be a part of all day. And then there's a one hour online workshop. So I'm observing those workshops. I'm interviewing the people who are attending those workshops. And then we're also going to add to that workshop by adding a virtual element to it or an online communication element to it, because currently it doesn't have that. And then we're running with those healthcare providers who engage in those workshops to see if they think the second workshop that had the virtual information that had the online lessons is more effective than the previous one.

DEREK SMITH:

What are your hopes as you look at the next five years, what would make this a successful project?

ASHLEY BARRETT:

I was just promoted to associate professor. And so I think part of the process of being assistant is it's that publish or perish. So you kind of have your head down, you're trying to prove your worth, create a scholarly identity, prove your worth in your discipline. And you're just trying to crank out, you're trying to learn the publication process and crank out as many publications as you can. But I think with, that's great because you learn the process, but now I really want to turn my attention outward and use the research that I collect to help communities, to help whoever I can with the information that I've collected. And so I think that that's what this grant is going to enable me and allow me to do. Already the rigorous connections that I've made with Waco Family Medicine and Baylor Scott & White Health are really valuable, and they're going to be long term because I've gone through so many different phases of socialization already with these organizations and gaining access from a legal standpoint, from a communicative standpoint, from a social standpoint. And so I'm really making lifelong connections that are serving communities day to day that I think could benefit by this research.

DEREK SMITH:

You paint a great picture of all this, and I think we can all see why the NSF is interested in this, but to make an even finer point, what does the data show? As we talk about building relationships of trust and compassionate communication, what does the data show about the impact of that, on the outcomes for people and in need of healthcare?

ASHLEY BARRETT:

It's so interesting because for whatever.... Different organizations, healthcare organizations will call it different things, whether it's patient centered communication, relationship oriented, communication, consumer-centric care. I've seen it be called different things, but they all have a common denominator, which is we need to make patients feel like they can open up to us, they can trust us. And like I was kind of mentioning before, if you do establish that trust with your patient, not only will they come into the healthcare facility more, because they do feel like they have that interaction, they feel like they know their providers personally. They'll enjoy those conversations more, they'll feel more organic. But also what has been established in the literature already is that trust leads to more shared decision making, shared decision making leads to patients opting into treatment plans that they'll actually carry out, which leads to better care. It can also lead to a better return of investment for these larger healthcare organizations and hospitals in general. Hospitals have a lot of resource challenges, which I think became really apparent in COVID-19, establishing trust with patients. That means that you can get through conversations a little bit quicker, a little bit more efficiently, and with more high quality. So it can even help with things like getting patients through the hospital system faster. So there are a lot of, building that trust is so important for multiple reasons, but it seems like not only will it increase patient satisfaction, which is of course how some healthcare facilities get medical reimbursements like Medicare, Medicaid reimbursements, but it also helps them with other metrics that are important to them that keep the hospital efficiently running. So I think there's a lot. There's a lot there. It's better for the patient, it's also better for the healthcare organization.

DEREK SMITH:

A lot of stakeholders who can benefit. Well, Ashley, thanks so much for joining us on the program today. Thanks for sharing. Congratulations on the award, and we'll have to talk to you again down the line as you delve further into this to see how things are going.

ASHLEY BARRETT:

Absolutely. I hope it's a good place. There's a lot of prongs in the fire, but it's all positive and really excited and lucky to be at Baylor [inaudible]. I feel so supported in conducting this type of research and going through this process, although it's new for me.

DEREK SMITH:

Yeah, we're exciting to see that happened in your alma mater too. In your alma mater.

ASHLEY BARRETT:

Yeah, exactly.

DEREK SMITH:

That's fantastic. Well, Ashley Barrett, associate Professor in Baylor's, department of Communication, our guest today on Baylor Connections. I'm Derek Smith. A reminder, you can hear this at other programs online, baylor.edu/connections, and you can subscribe to the program on iTunes. Thanks for joining us here on Baylor Connections.