How communication in health care eases confusion, pain and reduces misdiagnosis
The Consumers Health Forum of Australia (CHF) and the Australian National University’s Institute for Communication in Health Care (ICH) co-hosted a national, interdisciplinary webinar on Friday May 25th 2022 — “The role of health communication in patient safety and quality of care”. Over 170 people from across Australia attended, including medical and nursing academics and clinicians, health care policy experts, health sector managers, health care consumer representatives, public health professionals, linguists and communication specialists.
The webinar showcased current research into organisational and interpersonal communication in key healthcare settings and at care transition points, and aimed to raise awareness of the importance of communication for patient safety and quality of care.
On clinical handover
Professor Diana Slade’s presentation pointed out that over 500,000 people per year in Australia suffer from an avoidable critical incident in hospital, of which it is estimated that over 90% have a communication failure component. Perhaps the most significant site for communication failures in hospitals is during clinical handover- the process whereby health care professionals handover responsibility and accountability of a care for a patient to another clinician or group of clinicians. It is estimated that there are over 50 million shift to shift handovers per year in Australian hospitals, whether this be nursing, medical or allied health. Every one of these handovers represents a chance of miscommunication.
Professor Slade described how the research she conducts with her team is unusual in that it involves detailed observations—immersing themselves in the context in each hospital ward, extensive interviews with clinicians, patients and management and audio/video recording many hours of actual handover interactions. The evidence-based research is then translated into ward level practice improvement recommendations and communication resources and training for best practice.
Her findings showed sustained changes in communication on wards as well as related positive changes to patient outcomes including a reduction in falls, medication errors and hospital-acquired pressure injuries.
Patient advocate Maureen Williams shared core lessons learnt over more than 42 years of being a patient with Addison’s Disease. She reminded participants of the critical role patients play in their own diagnostic journey. Patients who are interrupted early often miss the opportunity to tell their story which can cause vital information to get lost leading to misdiagnosis or even death. For Maureen, ensuring that patients are heard is the most critical aspect of communication in health care, because respectful and proactive patient can use their expertise on themselves to improve healthcare.
Dr Carmel Crock highlighted that a such a fundamental thing as communication can actually be the key to safer, more timely and accurate diagnosis. Communication issues certainly contribute to the unchanging 10% diagnostic error rate. Communication around the complexity and evolving nature of diagnosis, including all its uncertainties, can help clinicians and patients to better navigate this process. Another key aspect of safer care through communication mentioned by Dr Crock was a focus on accurate and timely communication among teams including patients, carers, clinicians and crossing from hospital to primary care.
Dr Dahm’s research showed doctors who spent more time listening to the patient’s story provided more correct diagnoses than doctors who cut the patient short. This is an exciting finding because it shows us that the time doctors spend on history is time well spent. It is crucial for doctors to really listen to their patients and give them time to voice their concerns and discuss their symptoms fully. This way doctors get better information to inform their thinking about the diagnosis, and means they are more likely to get the diagnosis right.
On end of life care and conversation
Prof Mitchell shared her research on end of life and how conversations about dying can be improved. Fifty percent of People aged 65 or older will die in hospital but it is still unclear what dying in hospital and the quality of end of life conversations looks like. Her research suggests that many patients who die in hospitals are not having timely end of life conversations before being admitted to hospital: only 12% of patients having an Advance Care Plan in place and only 40% seeing palliative care teams. Among clinicians, Prof Mitchell’s research found there is a recognition that especially junior clinicians could improved their skills in talking about death and dying. She stressed the need to move to a more holistic approach to the journey of dying process.
The importance of communication and research
Our joint webinar demonstrated the critical role of effective communication for the safety and quality of health care. Research on communication in health care has informed policy and practice change. For example, communication has been enshrined in the Australian National Safety and Quality Health Service (NSQHS) Standards, since their inception. First, incorporated into a standard on clinical handover; later as the current stand-alone standard dedicated to “Communicating for Safety”. The Communicating for Safety standard encompasses effective communication between patients, caregivers and clinicians, multidisciplinary teams and health organisations across high-risk situation including patient identification, transition of care and emergence of critical information.
There have been many excellent international policy initiatives to try to improve healthcare communication but despite these there is little evidence that communication practices are becoming safer. There is also a lack of evidence-based research and data on why and how communication failures are happening.
Additional research and related funding is needed to fully understand the interplay of organisation and interpersonal communication with safe and high quality healthcare. Yet, research funding overall has been decreasing over the last decade and a dedicated place and funding body for health communication research is missing.
Research on communication in health care often falls between cracks of the biggest national funding bodies: the Australian research council (ARC) and the National Health and Medical Research Council (NHMRC). The ARC’s medical research policy means that research including studies on communication cannot be directly linked to improvements in patient or health outcomes.
Research on communication often draws on qualitative data such as interviews with patients and clinicians and recordings of actual clinical interactions, which are often wrongly seen as the lowest ranking evidence in terms of quality. The NHMRC historically has a reputation for favouring what are considered to be more rigorous quantitative studies and clinical trials, over qualitative research. These factors tend to combine to lower the chances of success for Australian government Category-1 funding applications that focus on the relationship between communication and the quality and safety of the patient experience.
Together with the recording of the May webinar, CHF and ICH are today launching a survey on patient experiences of communication in health care via Australia’s Health Panel. Register here to join Australias Health Panel.
The survey will deliver results to inform how communication in health settings affects the care experiences of Australians and also provide information to be discussed at a co-hosted Thought Leadership roundtable co-hosted by CHF and ICH in October this year and facilitated by Dr Norman Swan from the ABC’s Health Report. The need for more dedicated research, action and funding to strengthen and improve communication in health care will be among the crucial issues to be addressed at the Roundtable.
We encourage everyone to complete the survey, and share it with your friends and family.