Good communications are an integral part of quality healthcare, not alone between patients and medical professionals but also between medical professionals themselves. The Ombudsman is aware of the impetus within the health service towards providing an integrated care pathway for patients on their journey through the system. At the heart of this process is the delivery of the service though teamwork. Communication between health professionals is essential in order to ensure continuity of care and effective treatment for patients. Consequently communication between primary care, secondary care and social and voluntary services, between doctors nurses and other health professionals, should be seen not as a chain, but as a communication net within which any one member may need to communicate with any other. Good management requires that all members of the communication net are as aware as they need to be of who is doing what. An adequate standard of continuing medical care can be achieved only if every member, both medical and non-medical, understands his or her role.
Deficiencies in the communications practices of staff in acute hospitals have been identified in a recent survey of patients in acute hospitals, conducted by the Irish Society for Quality and Safety in Healthcare. The Survey found that approximately one in ten patients were not informed of their condition or treatment in a way that they understood and, at times, were given little opportunity to discuss these matters with members of their healthcare team. One in four respondents reported that they had questions that they would like to have asked members of their healthcare team, but did not, whilst the same number reported that staff discussed medical matters at their bedside whilst ignoring them.
Failures in communications between healthcare professionals and their colleagues, and between professionals and carers, are the source of many complaints. Common problems include the provision of conflicting information, poor record keeping and a lack of involvement in care plans. The benefits of good communications for patients include a better relationship with the professional, higher rates of compliance with treatments and a heightened sense of empowerment in making decisions about their own health.
The benefits for the professionals include a reduction in the incidence of clinical error, being better able to cope with difficult emotional situations, less likely to be the subject of complaint and increased job satisfaction. However, simply recognising this need is not enough; appropriate and effective training should be made available in order that healthcare staff are enabled to develop and refine these skills.
Patients, in general, are vulnerable while in hospital. They may be disoriented, they may be frightened, they may be dependent on others to assist with basic functions for the first time in their adult lives. In other words they have had to surrender control to the medical system whose language they may not understand and that makes them impatient and perhaps a little less receptive than normal. Their relatives may also be on edge and will be resisting their loss of control over the welfare of their loved one. At the same time health professionals are working with many constraints on their priorities and energy; they are also operating in an environment which is familiar to them in terms of its procedures and language. Medical and nursing staff may have their sensitivities blunted to some extent by having to deal with thousands of patients. However, what is routine to them is unique to the patient.
In such conditions there is a particular need to periodically review the manner in which sensitive information is communicated to patients and their families. It is important for all health professionals to appreciate the patient's perspective, to make all exchanges as sensitive, meaningful and humane as possible and to understand that effective communication means more than simply saying something to somebody. The Ombudsman would wish to see a special emphasis placed on the development of improved communication skills as one means of reducing complaints in the sector.