“It’s all about communication!” The world of medicine has changed by leaps and bounds over recent decades. Computers are part of our daily lives, and technological advances have significantly improved our ability to diagnose and treat diseases that were once thought incurable. Despite this incredible progress, healthcare providers continue to commit far too many medical errors. And unfortunately, many of these mistakes are simply caused by “poor communication.”
Malpractice litigation is often caused by communication failures. A 2015 report by CRICO, a division of The Risk Management Foundation of the Harvard Medical Institutions, Inc., found that: “Communication failures were linked to 1,744 deaths in five years … and communication was a factor in 30% of 23,658 cases ﬁled from 2009-2013.” These communication failures occurred throughout the healthcare system. According to the CRICO study, 48% of the communication breakdowns happened in ambulatory settings, 44% in hospital inpatient environments, and 8% in emergency departments.
Evaluation of these malpractice cases revealed that frequent communication breakdowns included:
- Miscommunication of the patient’s condition (26%)
- Inadequate informed consent (13%)
- Poor documentation (12%)
- Unsympathetic response to patient complaints (11%)
- Failure to read the medical record (7%)
In addition, breakdowns related to inadequate patient education regarding medications were noted in 5% of cases.
Results of the CRICO report provide significant take-home messages:
- Malpractice litigation cases involving breakdowns in communication more frequently resulted in financial payments to plaintiffs than other types of cases.
- Payouts to plaintiffs were higher for cases involving communication errors than for other types of cases.
- Cases caused by errors in provider-provider communication more frequently resulted in plaintiff payouts than for cases involving provider-patient communication breakdowns.
- Payouts to plaintiffs were higher for cases involving provider-provider communication mistakes than for cases caused by provider-patient communication errors.
The authors of the CRICO study suggested three ways to improve communication and potentially avoid litigation:
- The first is to have and display “empathy” for the patient’s situation. Providers must consider emotional aspects when delivering diagnoses, treatment plans, and complex scientific subjects. Keep in mind that compassion plays a major role in efficient communication.
- The second suggestion made for improving communication is to create an “Effective Consent Process.” Some organizations are creating legal, yet “patient friendly” consent forms. As part of the consent process, providers should discuss expectations, outcomes, the effect of obesity or smoking, the possible use of blood products, the presence of sales representatives in the operating room, the use of anesthesia, and the use of photography. All conversations need to be clearly documented in the medical record.
- The third recommendation is to develop a family/friend “in-room tablet communication portal” for Intensive Care Units. The portal could provide information on the patient’s care, procedures, and medical devices being used. The tablet would allow the posting of questions to be answered by providers.
Data from The Joint Commission consistently reveals that poor communication is a leading cause of medical mistakes that result in patient harm. In fact, during the years 2014 and 2015, communication was the third most frequent “root cause” of all sentinel events reviewed.
Any discussion concerning the need to improve communication in healthcare settings would be incomplete without including the role of federal healthcare reform legislation. The Patient Protection and Affordable Care Act (ACA) established the Value-Based Purchasing Program (VBP), which reimburses providers based on performance regarding specific domains of patient care. In particular, the “Patient Experience of Care Domain” evaluates and compares hospitals on the topic of patient satisfaction.
A random number of patients discharged from hospitals are asked to complete the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, better known simply as HCAHPS. The survey asks specific questions, many of which are related to the patient’s satisfaction concerning communication with providers. For example, some of the questions are concerned with: communication with doctors, communication with nurses, responsiveness of staff, providing communication about medications, and preparing the patient with adequate discharge information.
Medical errors continue to plague our healthcare system. Many of these mistakes cause significant patient harm and often result in malpractice litigation. Communication breakdowns rather than a lack of provider skill and or medical training are responsible for far too many adverse events. For these unfortunate cases, it is truly “all about communication!”
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- CRICO Strategies. “Malpractice Risks in Communication Failures.” 2015 Annual Benchmarking Report. https://www.rmf.harvard.edu/~/media/0A5FF3ED1C8B40CFAF178BB965488FA9.ashx.
- The Joint Commission. “Sentinel Event Data - Root Causes by Event Type.” http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2015.pdf.
- Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/HospitalQualityInits/HospitalHCAHPS.htm.
- The Lake Superior Quality Innovation Network. “Understanding Value-Based Purchasing.” CMS Quality Improvement Organization Program. http://www.stratishealth.org/documents/FY2017-VBP-fact-sheet.pdf