By Mary Ellen Filbey, RN, BSN, JD, CPHRM, Coverys Senior Risk Specialist

Communication failures in healthcare―particularly in large hospitals or medical centers―are often inadequately addressed because healthcare providers and institutional leaders simply don’t know where to begin. How do you pinpoint the issue, change institutional culture, or reach every person in a chain of communications?  

I suggest you begin where you have the most control … with yourself.

Five Things You Can Do to Reduce Communication-Related Errors
  1. Don’t assume without confirming. When it comes to provider-to-provider communication failures, don’t assume other members of the team have all the significant patient information they need. Your assumptions, while natural and often correct, should never go unspoken. Consider as part of your practice to ask a fellow provider, “Have you seen these abnormal test results?” or “Are you familiar with Mr. Steven’s significant medical history for …?” or “Before we talk about a new medication for him, may I review his chart with you?”
  2. Clarify. Whether you are the giver or the receiver of information, failing to clarify an order, a statement made verbally, a piece of medical documentation, or a nonverbal gesture can lead to medical errors. When giving information, work to proactively promote understanding by asking questions, such as: “How might this affect your plan moving forward?” or “What about this can I clarify?” Likewise, when receiving information from your colleagues, ensure you’ve understood them fully. Never ignore your doubt―seek clarification.
  3. Listen. Put your thoughts on hold before responding and take time to understand the perceptions of others. Listening effectively involves a degree of humility.
  4. Give what you would hope to receive. At work, as in life, we want to be communicated with in a way that is respectful, timely, clear, complete, and kind. In the healthcare setting, ensuring we give and receive such communication is paramount.
  5. Ensure that your entries in the EMR are accurate and complete. Prior to finalizing your medical record entries, review them as diligently as you would an important article or letter you might write. You are, after all, the author of the medical records you create. When communicating about a patient’s health, your use of the electronic medical record (EMR) is vital. All too often, the EMR lacks complete and accurate documentation, even when communication between providers has been flawless.  
Create a Culture of Communication

Aside from the daily commitments you can make to become a better communicator, you may also be in a position to effect or lead positive cultural change at your organization. Here are a few tips to keep in mind when embarking on systemic changes to communicate your way toward better patient outcomes:
  1. Focus first on areas where risk is highest. A five-year analysis of claims data at Coverys revealed nearly 68 percent of communication-related claims resulted from incidents occurring in the hospital setting, with the top two areas of vulnerability being surgery and emergency departments. Our data also shows that nearly 33 percent of communication-related claims involve doctor-to-doctor communications.  
  2. Be conscious of “fault lines.” When you are engaged in a crucial step in patient care, such as a patient hand-off, think of it as a fault line—a brief but potentially life-altering moment when critical patient information must be communicated accurately, timely, and clearly. Poor communication at a fault line can cause devastating shifts in a patient’s healthcare outcomes.
  3. Build infrastructure. If your organization is vulnerable in the area of communication-related errors, consider implementing communications training and/or building high-reliability teams (HROs/HRUs) with designated safety champions.   
  4. Obtain tools that can help. Consider TeamSTEPPS training for your organization, and make use of the valuable hand-off tools from the Joint Commission.
  5. Stay the course. Know that meaningful and lasting culture change takes time―often three to five years. But the improvements you’ll make along the way can benefit patient health outcomes immediately.
Better Experiences, Better Health Outcomes

Better communication in the healthcare setting matters because patient safety is at stake. A full 8 percent of claims at Coverys across a five-year period involved a primary or secondary communication issue. And it’s estimated that, across the nation, medical errors caused by breakdowns in communication can lead to as many as 1,000 deaths per day and cost trillions of dollars in healthcare costs each year. But those issues can be addressed, and the impact can be profound. According to researchers at UC San Francisco, improving communication between healthcare providers can reduce patient injuries from medical errors by an astounding 30 percent.
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.