Patient Safety and Communication Breakdown

Good communication is an essential prerequisite for good and safe patient care. To effectively communicate is an everyday life skill and it’s one of the most basic that we all must master in some way.

From a patient safety context, poor health carer communication practices are a worldwide problem which continues to cause global patient harm. The WHO states that communication failures are the leading cause of inadvertent patient harm.

Successive Health Service Ombudsman in England have maintained that communication failures are a leading cause of patient complaints. In 2014-2015 poor communication, including quality and accuracy of information, was a factor in one third of all health care complaints.

NHS Improvement have produced a report about improving the spoken communication of safety critical information in the NHS (National Health Service) in England and it contains some very useful advice. The report maintains an important potential to positively influence health care practices. Throughout the report there are examples and commentary of situations where good and poor communication practices have taken place in a health care context. These examples show the patient safety problems that can occur and are excellent learning tools from which to improve spoken health care communication practices.

The report identifies six challenges with spoken communication in healthcare settings.These challenges must be recognised and guarded against to ensure the safety of patients when there is spoken communication of safety critical information.

The challenges:

(a)          The communication environment

(b)          Information exchange

(c)           Attitude and listening

(d)          Aligning and responding

(e)          Creating the preconditions for effective communication within a team

(f)           Communicating with specific groups

The report begins each key challenge with a statement of the ideal communication setting, what good looks like. A discussion then follows on the issues and problems that have been identified.

The Communication environment

In the ideal communication environment there would be adequate time, privacy and comfort to convey information properly. The perfect environment would be free from distractions or interruptions. Both nurses, doctors and patients would be relaxed and not feeling under pressure.

The report’s findings reveal a situation far removed from this ideal:

Inappropriate environments for communication, time constraints and overworked staff were common themes in our data-set. In many patient accounts, there was a perception that wider system pressures had led to clinicians not being available to communicate, not attending fully to their concerns and (in some cases) unable or unwilling to engage emotionally. In some cases, patients felt that they were a burden, so did not speak up.” (p6)

This report shines a bright light into spoken communication of safety critical information in the NHS . There are many serious failings identified and some of the case study reports reveal harrowing patient experiences. The report points to such problems as excessive use of jargon and acronyms by health care staff. Health carer communication expressing dismissive attitudes, lack of psychological safety in multidisciplinary teams, extended misunderstandings and ‘tribalism’ among professional groups.

This is an excellent report which uncovers a number of acute patient safety failings and also provides a clear road map of communication patient safety challenges. These are however not new findings and have been seen before in numerous reports on patient safety and health quality over the years both in the UK and abroad. What is new is that this report catalogues the errors all in one place and focuses on spoken communication.

John Tingle

John Tingle

Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I teach tort and medical law on the LLB at Nottingham Trent and global patient safety on the LLM in Health Law and Ethics. I have published over 500 articles and a number of leading texts in patient safety and nursing law . I am also a regular contributor to the Harvard Law School, Bill of Health Blog. I am a Visiting Scholar at Harvard Law School in November 2018.My current research interests are in global patient safety, policy and practice particularly in African health care systems.My most recent publication is: Global Patient-Safety Law Policy and Practice edited by John Tingle, Claytion O'neill and Morgan Shimwell, Routledge 2018.

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