Claire O’Regan, Clinical Risk Adviser, and Ann Duffy, Senior Clinical Risk Manager, examine communication in healthcare and how it can be improved.

Open, clear and honest communication between health and social care providers and patients/service users, as well as effective inter-professional communication, is a critical element of effective, safe and professional health and social care delivery.

Is poor communication a problem?

Communication is a recognised skill which requires improvement. Review of closed claims by the Clinical Risk Unit of the State Claims Agency shows that deficits in written and verbal communication feature frequently as contributory factors to adverse outcomes. Service-delivery issues relate to sub-optimal documentation and handover within and between teams. Patient-related issues include:

• Inadequate or incomplete consent for interventions
• Inadequate or incomplete Open Disclosure after adverse events/incidents
• Inadequate or incomplete handling of complaints

The Medical Protection Society (MPS) reports that 70% of litigation in healthcare is related to poor communication.

The society emphasises the importance of continuity of care, adequate transition of care, clear lines of communication with colleagues and clear lines of responsibility.¹ The Medical Council annual report 2018 stated 161 complaints had been received about poor communication with patients. This represents 56.09% of all complaints received.²

Breakdown in communication was the leading root cause of sentinel events reported to the Joint Commission in the USA between 1995 and 2006.³

According to Vincent and Amalberti (2016), ‘poor communication across different settings is frequently implicated in studies of adverse events in hospital and in inquiries into major care failures in the community’.⁴

Communicating effectively and compassionately with patients/service users is an integral aspect of delivering care. Communication is a two way dialogue. Listening to a patient or service user’s concerns, queries or feedback allows for a respectful partnership at a time when he/she can feel vulnerable, in an environment which may be alien to them. When explanations are clear, patients/service users have more confidence and trust in their health and social care provider. The avoidance of jargon, abbreviations and acronyms helps with providing clear explanations.

Complaints can arise and escalate when the patient/service user is unclear about their care pathway. This can be compounded if they perceive the style and delivery of communication as abrupt, dismissive, rushed or unprofessional. In the words of Maya Angelou: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

How can communication be improved?

Document well

Clear, concise, accurate, timely and legible documentation is required and expected when treating a patient. While there are valid reasons to make an entry to a clinical record retrospectively, any such entry should be clearly marked as retrospective and the rationale explained. Clear documentation, as described, can assist the defence of a claim, should one arise.

Use tools such as ISBAR and Huddles

The National Clinical Effectiveness Committee (NCEC) published its first clinical guideline in February 20135 – the National Early Warning Score – which incorporated the ISBAR communication tool, to facilitate a structured format for the handover of clinical care (Identification, Situation, Background, Assessment, and Recommendation). This tool was since augmented to R3 to include Risk and Read-back. Huddles provide a multi-disciplinary structured opportunity for handover of care, ensuring attendance of all staff.

Be aware of human factors

The application of human factors and attention to non-technical skills is recognised as essential to effective and safe health and social care delivery. There is increasing evidence that team-based initiatives and training in human factors is associated with significant reductions in adverse events and improvements in patient outcomes.6 Non-technical skills include: situational awareness, decision making, communication and teamwork, and leadership.

Improve your skills through training

The National Patient Experience Survey (a joint initiative by HIQA, the HSE and the Department of Health) identified the development and improvement of communication and consultation skills as a key priority. A National Healthcare Communication Group reviewed patient comments in the national surveys, which led to the development of a National Healthcare Communication Programme.7 This programme is a joint collaboration between the HSE and EACH (International Association for Communication in Healthcare). The programme ‘is designed to support healthcare staff to learn, develop and maintain their communication skills with patients, their families and with colleagues’.

Attend the SCA’s National Quality, Clinical Risk & Patient Safety Conference

This year’s conference takes place on Tuesday, 19 November 2019 and will explore the theme of communication in the health and social care sector.

References available on request.