Doctors performing surgery.

The Need to Go Back to Basics in Patient Safety

By John Tingle and Amanda Cattini

In the hustle and bustle of our daily professional lives, it is sometimes all too easy to forget about the basics. In terms of health care practice and patient safety, these underpinning basic, foundational concepts include the need for proper patient communication strategies.

The consequences of failures in patient communication can be devastating. There is a need to go back to this basic issue at regular intervals.

Look back, refresh, and reset

A root cause of some Never Events errors in the National Health Service (NHS), such as those involving wrong site surgery (surgical procedures being performed on the wrong patient, or the wrong limb), is poor patient and health care provider communication. When analyzing monthly data, it is evident that some Never Events are morphing into Common Never Events. It is clear that communication is one of the basic tenets of patient safety that health care staff need to regularly revisit.

A litigation link?

Poor patient communication by nurses and doctors could also lead to formal complaints and litigation. Good communication strategies may help head off these outcomes.

In “Understanding the drivers of litigation in health services,” Yvonne Birks, Fiona Aspinal, and Karen Bloor discuss poor patient communication and litigation:

“Strong evidence supporting a direct association between improved communication and reductions in litigation was limited, however some of the qualitative reports provided powerful observations around how communication may have an important role in moderating the sometimes-challenging relationships that occur when the views of professionals and families are not well-aligned.”

Some NHS advice

NHS England and NHS Improvement have produced some useful core principles guidance on patient communication within the context on COVID-19.

The advice is categorized by several principles, which include “Personalised,” “Clear language,” and “Shared decision-making (SDM).”

“Clear language

Language should be clear, accessible and easy to understand. This should apply to written and verbal communication with patients…Sometimes, technical terms are needed but these should be explained, or avoided when possible. Try to avoid language that may deter patient involvement in discussions about their care or reduce their choice.”

These are just some recent publications which offer perspectives on patient communication. There does not seem to be shortage of good and helpful literature on this issue. A difficulty remains, however, of capturing the thinking in these many papers and distilling key themes and practices down through to a busy workforce.

A global service industry

Patient safety has become a growing global service industry consisting of many stakeholders. This is a good thing in that we have global recognition of this important discipline. At the same time, however, busy health care staff must cope with what many would call a tsunami of advice, regulations, policy, and so on.

The Care Quality Commission (CQC), the independent regulator of health and social care in England has stated on the question of updating and the volume of information being received by hospitals (trusts) and other health organizations:

“The current patient safety landscape is confused and complex, with no clear understanding of how it is organised or who is responsible for what tasks. Throughout our review we heard how trusts receive multiple messages from various national bodies. This adds pressure on trusts who often feel overwhelmed with the volume of guidance, and makes it difficult for them to prioritise what needs to be done.”

Compounding the problem

This deluge of advice compounds the problem. As the literature and techniques change in a developing field, such as patient safety, it can prove difficult for busy health care providers to keep up to date. A natural reaction in a resource- and time-constrained working environment, such as the NHS in England, is to focus on the latest research and findings.

That is all well and good, but we argue that there are also times that we need to reflect, refresh, reset on the basics of patient safety. Looking back on the basic tenets of patient safety, such as patient communication strategies, will hopefully work to protect patients, respect their autonomy, and minimize the risk of adverse health care events occurring, as well as the risk of resulting complaints and litigation.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly 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 have published over 500 articles and a number of leading texts in patient safety and nursing law. 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, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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