RESULTS OF AIDET BASED COMMUNICATION PRACTICE AMONG NURSES, MIDWIVES, AND MEDICAL TECHNICIANS AT VINMEC SMART CITY HOSPITAL IN 2025

3.2. Implementation of the AIDET model in communication

Figure 3.1: Completion rate of each component of the AIDET model (n=326)

Comments: In 326 observations, most of the components of the AIDET model were performed at a very high rate, ranging from 92.6% to 99.7%. The "Acknowledge" component achieved the highest rate (99.7%), followed by "Explanation" with 99.4% and "Thank you" with 98.8%. The "Duration Notification" component reached 97.5%. Meanwhile, "Introduce" had the lowest rate (92.6%). Overall, the full compliance with all 5 components of the AIDET model reached 91.7%.

Figure 3.2: Causes of incomplete components of the AIDET model

Comments: In the observations that did not fully complete each component of the AIDET model, the most common cause was "Forgetting or not introducing the name, not introducing yourself" in the Introduction component, accounting for 7.1%. Next, in the Duration component, 1.8% of cases did not notify the waiting time for results or did not specify the specific time. The Thank you component had 1.5% of cases that did not show thanks, while the Explanation component only recorded 0.6% of cases that did not explain the process clearly. Notably, the Acknowledge component is fully implemented in all observations, there is no case of missing a greeting.

3.3. Factors related to the implementation of communication according to the AIDET model

Table 3.2: Relationship between the characteristics of the research object and the implementation of AIDET

 Comments: The analysis of factors associated with the full implementation of the AIDET communication model reveals several statistically significant correlations:

Occupational group: The rate of full AIDET completion among nurses and midwives (93.3%) was significantly higher than that of medical technicians (84.2%). Nurses and midwives were more likely to adhere to the complete 5-step model compared to the technician group (OR=2.6; 95%CI: 1.1–6.2; p=0.029).

Departments: Staff in clinical departments demonstrated a higher compliance rate (93.3%) compared to those in diagnostic support departments (84.2%). This difference was statistically significant (OR=2.6; 95%CI: 1.1–6.2; p=0.024).

Working Shifts: There was a prominent difference in performance between shifts⁵. Healthcare workers on afternoon and night shifts had a much higher completion rate (98.2%) than those on the morning shift (88.5%). The probability of full compliance during afternoon/night shifts was 6.9 times higher than during the morning shift (OR=6.9; 95%CI: 1.6–29.9; p=0.002).

Communication situation: Although the "Reception – Admission – Discharge" group had a higher completion rate (93.6%) compared to the "Diagnosis – Testing – Treatment" group (88.7%), this finding did not reach statistical significance (p=0.123).

IV. DISCUSSION

4.1. Characteristics of the research object

The study recorded 326 observations of communication activities of medical staff, of which nurses and midwives accounted for 82.5%, reflecting the typical human resource characteristics of general hospitals in Vietnam, where the nursing force plays a leading role in care,  monitor and communicate regularly with the patient and the patient's family members [7, 16]. The distribution by department/department shows that Pediatrics (18.1%), Medical Examination – Internal Medicine (17.5%) and Obstetrics (16.6%) account for a high proportion. These are specialties with a large frequency of direct contact, requiring continuous, clear and standard communication to ensure patient safety and improve the care experience, in line with the assessment of domestic studies on the characteristics of communication in clinical departments with high interaction intensity [4, 8].

In terms of observation time, the majority of communication was recorded on the morning shift (66.6%), which is the time frame when many medical examination, treatment, procedures and interventions are concentrated. Studies at provincial and central hospitals in Vietnam show that morning shifts are often accompanied by high work pressure, which can easily affect the quality of communication if there is no standardized process [16]. Therefore, it is important to strengthen and maintain the practice of communication according to the AIDET model in the morning shift to ensure uniformity and service quality in the condition of high workload.

These results are consistent with the Studer Group's report on the implementation of the AIDET model in clinical settings, in which nurses and frontline staff in clinical departments were identified as focus groups that should prioritize the application and monitoring of communication practices [19, 20]. At the same time, Ali and his colleagues' research also noted that nurses account for more than 80% of the workforce that communicates directly with patients, playing a key role in shaping patient experience and satisfaction [9].

4.2. Implementation level of components of the AIDET model

The research results show that the level of compliance with the components of the AIDET model is very high, especially at the steps of Acknowledge (99.7%), Explanation (99.4%) and Thank you (98.8%). These are the components associated with basic communication behaviors such as greeting, explaining processes and showing respect, which are regularly integrated into nursing training and standards of conduct in healthcare facilities in Vietnam [7, 16]. Many domestic studies also confirm that clear explanations and friendly communication attitudes of medical staff are closely related to patient satisfaction and sense of security [4, 7].

However, the Introduce step only reached 92.6% and was the component with the highest non-compliance rate (7.1%). This result shows that although health workers are well aware of the AIDET model, there are still certain limitations to the full and consistent implementation of each step. Some studies in Vietnam show that medical staff often tend to skip the step of introducing themselves in familiar contexts, especially for patients undergoing long-term treatment, or when the workload is high [3, 6].

This is also consistent with the findings of Shaw and colleagues in the UK, where the Introduce step is often overlooked in clinical practice, although it is a key factor in establishing professional roles and responsibilities and building trusting relationships between healthcare workers and patients [18]. According to the Studer Group, failure to clearly introduce identities and roles can cause patients to feel out of control, reduce trust levels, and affect the assessment of the care experience, even when other communication steps are adequately implemented [19, 20].

4.3. Factors related to the implementation of AIDET

Analysis of relevant factors showed that the nursing group was more likely to complete the AIDET model fully than the technician group (OR = 2.6; p = 0.029). This result can be explained by the characteristics of the professional role of nurses, when they are the force directly involved in comprehensive care, continuous monitoring and maintaining regular communication relationships with patients and family members. Meanwhile, technicians mainly perform subclinical technical activities, short contact times, and are procedural, resulting in a greater emphasis on the technical aspect rather than communication [11, 16]. The results are consistent with research by Chen et al. in China, in which occupation was identified as one of the strongest predictors of compliance with communication standards, especially standardized communication models such as AIDET [11]. In Vietnam, studies by Han Thi Thanh and Phan Thi Hong Tuyen also recorded a significantly higher rate of adequate implementation of AIDET by nurses compared to other groups of healthcare workers, showing the consistency of the current research results [5, 6].

In addition, the faculty/office is also a significant factor influencing the implementation of AIDET. Staff working in clinical departments had higher rates of full AIDET completion than support and subclinical departments (93.3% vs. 84.2%), with statistically significant differences (OR = 2.6; p = 0.024). This reflects the difference in the intensity and nature of communication, as clinical staff often have to build and maintain long-term interactive relationships with patients, thereby forming a habit of fully practicing standard communication steps [8, 17]. In contrast, in support and diagnostic imaging departments, the pressures of the number of shifts, the need for rapid rotations, and short contact times can cause staff to prioritize the completion of professional tasks, leading to the abbreviation or omission of some components of AIDET. This phenomenon has also been documented in Hwang et al.'s study, where time pressure and high workload reduce the ability to fully perform normative communication behaviors [13].

Shift work time was a prominent relevant factor in this study. Employees working the afternoon and night shifts were more likely to complete the full AIDET than the morning shift (98.2% vs. 88.5%), with statistically significant differences (OR = 6.9; 95%CI: 1.6–29.9; p = 0.002). This result shows that the morning shift – the time when many medical examinations, procedures, hospital admissions and interdisciplinary coordination activities are concentrated – is the period with the highest work pressure, thereby negatively affecting the quality of communication. This is consistent with previous studies, in which time pressure and workload were seen as major barriers to maintaining patient-centered communication [13, 16].

In contrast, the study did not record a statistically significant difference between types of communication situations (reception – hospitalization – discharge versus diagnosis – testing – procedures – treatment – medication – vaccination) with full implementation of AIDET (p = 0.123). This shows that when the AIDET model has been implemented and standardized throughout the hospital, healthcare workers tend to maintain relatively stable communication behavior, regardless of the context or type of interaction. These results reinforce the view that AIDET is a flexible communication framework that can be effectively applied in a variety of clinical situations [19, 20].

4.4. Significance of the study

The results of this study confirm the feasibility and effectiveness of the application of the AIDET communication model in hospital settings, especially in private healthcare facilities and smart hospitals. The high level of compliance in most components of the model indicates that healthcare workers have adopted and applied the principles of standardized communication relatively well in their daily practice. This is in line with the general trend of modern hospitals, in which communication is considered an important indicator reflecting the quality of service and patient experience [22].

Firstly, self-introduction should be emphasized as a mandatory standard, regardless of whether the employee and patient are familiar or not. Several studies indicate that referrals increase feelings of safety, trust, and enhance the overall assessment of service quality [14, 18].

Secondly, it is necessary to consider adjusting the allocation of human resources and work processes in the morning shift, when work pressure is high, in order to create conditions for employees to fully carry out communication steps. Solutions may include increasing support staffing, reallocating appointments, or adopting concise but effective communication tools.

Thirdly, for departments with low completion rates such as Medical Examination – Internal Medicine, it is necessary to strengthen training and direct supervision mechanisms. The study by Ali et al. showed that immediate feedback after observation significantly improved compliance with the communication model within 3 months [9].

Finally, the integration of AIDET into the periodic training program, which combines regular monitoring and two-way feedback between staff, patient feedback, and management, will help maintain and improve the quality of communication in the long term. In the context of smart hospitals moving towards a uniform and personalized experience, standardized communication is not only a skill but also a strategic component in health service quality management.

4.5. Limitations of the study

This study has some limitations that need to be considered when interpreting the results. First of all, the cross-sectional descriptive design only reflects the current situation at a time, and does not allow to assess the trend of change or the causal relationship between related factors. In particular, the study used direct observation to evaluate the implementation of the AIDET model, so it is difficult to avoid the Hawthorne effect, where healthcare workers are able to adjust their communication behavior in a more positive direction due to the perception that they are being monitored.

Although the team tried to mitigate this effect by not announcing the observation time in advance and performing observations on various shifts, the ability to fully control the Hawthorne effect was still limited. In addition, the study was conducted in one hospital, with a given sample size, so the ability to generalize the results to other medical facilities should be carefully considered.

V. CONCLUSIONS AND RECOMMENDATIONS

The study results demonstrate a high level of adherence to the AIDET communication model at Vinmec Smart City Hospital, with 91.7% of total observations successfully fulfilling all five stages. Notably, the components of Acknowledge, Explanation, and Thank You exhibited exceptional compliance rates of 99.7%, 99.4%, and 98.8%, respectively. In contrast, the Introduce step was identified as the least performed component, with a rate of 92.6%.

            Statistical analysis reveals that AIDET completion rates varied significantly across occupational groups, departments, and working shifts. Specifically, the nursing and midwifery group demonstrated a significantly higher compliance rate compared to medical technicians (93.3% vs. 84.2%; p < 0.05). Primary areas for improvement include consistent self-introduction, clear notification of expected duration, and the formal expression of gratitude, underscoring the necessity for standardized communication reinforcement within specific units.

            Consequently, it is recommended that the hospital sustains and enhances the efficacy of AIDET implementation through periodic, scenario-based training and intensified monitoring with real-time feedback tailored to each department and shift⁷. Priority should be given to medical technical teams and units exhibiting lower compliance⁸. Furthermore, integrating AIDET criteria into the hospital’s quality management framework and professional performance evaluations will be crucial to ensuring the uniformity and long-term sustainability of communication standards throughout the institution⁹.

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Nguyen Thi Lien¹, Nguyen Ngoc Anh¹, Phan Thi Thu Hien¹, Nguyen Thi Khuyen¹, Nguyen Thi Khanh Van¹, Nguyen Thi Thu Hien¹,
Nguyen Thi Kim Thoa¹, Pham Nhat Quang¹, Pham Van Thanh¹, Tran Thi Thu²

1. Vinmec Smarst City Hospital; 2. Vinmec Times City Hospital.

     Correspondence author: Nguyen Thi Lien: Email: v.liennt1@vinmec.com; Phone: 0932356639