The importance of communication

A new CRICO Strategies CBS report identifies malpractice risks in communication failures, which are a factor in 30 percent of all medical malpractice claims. What can we learn from this? HRMR investigates.

While communication failures are varied, the implications are real: unsafe patient care. The new CRICO Strategies Comparative Benchmarking System (CBS) report, Malpractice Risks in Communication Failures, analyzed national medical malpractice claims and found that 30 percent of all claims involve a communication failure. These claims involve communication breakdowns where acts, figures, or findings got lost between the individuals who had that information and those who needed it—across the spectrum of healthcare services and settings.

With a special focus on general medicine, obstetrics, nursing, and surgery, the report shines light on miscommunication and identifies specific opportunities to improve skills and systems to mitigate those risks.

Mined from the CRICO Strategies CBS, the report highlights communication failures within selected services of general medicine, obstetrics, nursing, and surgery cases.

“An important takeaway from this analysis is that when a claim has provider-provider communication failures, it is more likely to result in payment than cases with provider-patient communication issues,” says Mark Reynolds, president of CRICO.

“The data in this report look at specific drivers of those breakdowns which offers organizations actionable intelligence to implement solutions to mitigate those risks.”

The CRICO Strategies CBS database currently holds more than 320,000 medical malpractice cases from more than 400 hospitals nationwide and provides a unique insight into what goes wrong, and why. Participating organizations contribute their claims to the ever-growing pool of data and are awarded with analysis that offers insight to specific risk vulnerabilities. Armed with this data, healthcare providers and leaders have a clear line of sight on how to change specific clinical systems or clinician behaviors and reduce those dominant risks.

“Communication difficulties are not isolated to providers lacking ‘people skills’ or patients with language or comprehension deficits,” says Heather Riah, assistant vice president of CRICO Strategies.

“Every mode and system by which patients and caregivers share health-related information is vulnerable to failure. Our report helps identify and mitigate those risks.”

Causes of communication breakdown

The key drivers of the communication breakdowns studied in the report vary widely.
“Each creates a different kind of void and has its own consequences—hence the importance of the data,” says Dana Siegal, director, patient safety strategies for CRICO Strategies.

“Information developed, or determined, by one provider (documented assessments, interpreting or reviewing test results, consultative reports) and successfully passed on to another, is critical to the diagnostic process."

“In some cases inconsistent tracking systems or misdirected electronic reports lead to a lack of awareness of missing test results or consultative recommendations. In other cases it may be the failure of providers to be complete in the clinical information they exchange or intend to exchange.
“Time pressures and distractions often lead to abbreviated conversations and/or short, sometimes incomplete documentation.”

Others drivers include language or educational barriers with patients and families, hierarchical and culture issues that suppress speaking up and, in some cases, the basic human factor of misunderstanding the intent, content or urgency of a communication.

One of the most prevalent, and costly, claim types is caused by diagnostic failures—and this is driven, in great part, by voids in the communication of information vital to the diagnostic process, and often dependent on multiple providers involved in coordinating the care of a single patient.

“Information developed, or determined, by one provider (documented assessments, interpreting or reviewing test results, consultative reports) and successfully passed on to another, is critical to the diagnostic process. When that communication falters or fails, there can be a delay in the diagnosis, creating the potential for harm to both patient and provider,” says Siegal.

Using the data

We cannot fix what we cannot see—and the level of detail in the data used in the CRICO Strategies report adds great clarity to the specific vulnerabilities that are experienced in real clinical scenarios.

“With that knowledge, we can build solutions that we know can have an impact on improving outcomes,” says Siegal.

In order to fix the problem, you need to make sure you understand it—in this case, the specific factors leading to communication breakdown in your organization. Siegal emphasizes that it is important for a physician practice or hospital organization to use its own data to understand the issues and seek relevant solutions.

“Is medical care delayed because providers are not receiving reports and results, or not communicating next steps to their patients? If so, solutions that focus on closing the loop on test results and referral follow-up are essential.

“Is there a disconnect between patient expectations and actual outcomes in surgical services causing patient complaints, or worse, claims of mismanaged surgical care? A stronger focus on patient conversations for expectation-setting and informed consent may be in order.”

Other issues to address may include language barriers—in which case, an interpreter may be needed—and the need for better or new educational materials. If there are concerns about staff and providers feeling comfortable speaking up or sharing safety concerns, it might be advisable to look to the staff satisfaction and culture of safety survey to determine if team training programs may offer much-needed communication skills.

The findings from the CRICO Strategies CBS report can act as a pointer to where some of the problems may lie in your organization, and also make a strong and persuasive case for communication issues being a key focus of any enterprise risk management and patient safety efforts.
“The great value of the report lies in the quantitative analysis that shines a direct spotlight on the very real issues of communication that contribute to adverse events and patient harm,” says Siegal.

“It validates the issues we in risk management and patient safety have been focusing on for quite some time and allows us to rally the attention, resources and engagement we need to create successful solutions that make a difference for our patients and providers.”