Poor communication in hospitals is putting Australians at risk. Researchers are fighting back

The fine line between life and death in a hospital can hinge on a few words left unsaid.

Imagine a doctor discontinuing a medication used to control a patient’s heart rhythm without alerting the nurse.

Or a nurse failing to mention that a patient was experiencing abdominal pain before surgery.

These are not hypotheticals, but real, documented cases where miscommunication proved fatal.

In Australia alone, around 500,000 people are harmed in public hospitals each year due to similar, avoidable incidents.

“In approximately 90 per cent of cases, poor communication is at the heart of it,” says Professor Diana Slade, Director of the ANU Institute for Communication in Health Care (ICH).

“The financial cost of avoidable patient harm in Australia is estimated to be approximately two billion dollars a year.”

According to Slade, this problem is only intensifying.

As the population ages and chronic conditions continue to stretch the health system to its limits, evidence on why and how communication failures happen remains limited.

This gap led her to establish ICH in 2017.

Created by the ANU College of Arts and Social Sciences, with support from the then ANU College of Health and Medicine, ICH is dedicated to interdisciplinary, translational research that brings together expertise in linguistics, health and communication studies to improve communicative practices in clinical care.

The Institute has also played a leading role in advancing this work globally through the establishment of the International Consortium for Healthcare Communication (IC4CH), with six partner organisations around the world.

“At ICH and IC4CH, linguists, who offer an outsider perspective on language and communication, work alongside health professionals, who bring the insider perspective,” Slade says.

“You can’t really do healthcare except through language.”

“The financial cost of avoidable patient harm in Australia is estimated to be approximately two billion dollars a year.”

Nearly a decade since its founding, ICH have significantly helped improve the safety and quality of healthcare both in Australia and internationally.

“We have what we believe to be the largest database internationally of recorded hospital interactions, consisting of both clinician-patient and clinician-clinician interactions,” Slade says.  

“We have observed and recorded thousands of hours of naturally-occurring conversations between doctors, nurses and patients.”

This rich body of evidence allows them to identify where communication breaks down – ultimately informing policy and clinical practice.

Today, ICH is turning its attention to two national priorities: end-of-life care and enhancing patients’ health literacy and self-management in chronic care.

Dying feeling cared for

Most humans spend their entire lives avoiding the thought of death.

Even in hospitals, end-of-life discussions often happen too late – when patients with life-limiting illnesses can no longer take part in decisions about their care.

Liza Goncharov, Deputy Director of ICH, explains the factors behind this delay.

“It’s emotionally and psychologically demanding on clinicians to share bad news with patients. You never know how they’re going to react,” she says.

“But there’s also uncertainty. In developed countries, death often follows a long journey with chronic illness. Until a patient is imminently dying, it’s very hard to know how much time they have left.”

The nature of the healthcare system itself, with its central focus on saving lives, compounds the problem. 

“With the exception of palliative care specialists and geriatricians, most doctors are driven by the idea of curing and don’t really consider things might go the other way until very late,” Goncharov says.

“Effective end-of-life communication allows patients to make all the preparations they need, having their family around in the way that they want.”

“For them it’s like trying to turn around a very large ship that’s been moving in one direction.”

ICH is currently exploring how better communication can give Australians enough time and space to prepare for death on their own terms.

“When you know you’re going to die, there’s a big difference between dying comfortably, feeling cared for and safe, versus not,” says Goncharov.

After conducting two pilot projects the team is now following the journeys of patients with advanced heart failure at a major metropolitan teaching hospital in Sydney. They have recorded and analysed 16 patient journeys with over 300 interactions between patients and clinicians, to develop an evidence-based intervention to improve communication in end-of-life care.

“Most people think end-of-life communication is awful, stressful, and harrowing. But when it’s done well, although people are still understandably upset and scared, it can actually feel reassuring and comforting,” Goncharov says.

“Effective end-of-life communication allows patients to make all the preparations they need, having their family around in the way that they want.”

Small conversations, big impact

At the recent National Youth Health Conference, ICH Senior Research Fellow Dr Neda Karimi was approached by a young attendee after her talk.

“Thank you for doing research in this area,” they told her. “I felt heard.”

Karimi had just presented in Sydney about an understudied issue: the communication needs of adolescents and young adults in health care.

Nearly one in two Australian teenagers lives with a chronic disease, but many of them don’t have the communication skills needed to understand their conditions and seek appropriate care.

“Communication plays an important role in enhancing or hindering a patient’s health literacy and their confidence and control over their own health” says Karimi, who is also currently managing an ICH-led study to foster health literacy and self-care skills in adults with chronic heart failure.

“Think of health literacy as a relational capacity: a person’s ability to obtain, evaluate, and share health information and a provider’s ability to make health information accessible and support discussion, together enabling informed decisions.”

As young people transition into adulthood, they become responsible for managing their own health, but many struggle to do so alongside the broader challenges of that transition.

“It’s the responsibility of the health system to help patients develop their health literacy,” Karimi says.

“Clinicians play a critical role here – they must provide support and create a space where it feels safe to communicate.”

But these challenges are not shared equally.

“A growing body of evidence shows people from underserved populations have lower health literacy, but we don’t know enough about the mechanisms through which this inequality is reproduced,” she says.

“For example, research shows that young people with a higher education degree are better at coping with chronic disease and moving on with their lives.”

For Karimi, addressing this socioeconomic inequality is key to Australia’s future.

“It’s about building a more resilient, health literate population,” she says.

Compassion under pressure

Elizabeth Fewster, a Research Officer at ICH, still remembers the first time she collected data in a hospital setting.

“I met a lot of patients who were going through an incredibly difficult time,” she says.

“When you stop and listen to patients, you realise there’s so much more going on in their lives, in addition to managing their health problems.”

For ICH researchers, working so closely with patients is a huge privilege.

“Initially I was worried about being a burden to them, but I was amazed to find most patients appreciate having someone listen to their stories,” Goncharov says.

It’s this deeply human dimension of healthcare that ICH sees as essential.

“Our research has shown, across multiple healthcare settings, how clinical conversations can be so much more effective when clinicians and teams work together to engage closely with patients, and how this can be achieved even amidst constant interruption and system constraints,” says Associate Professor Alison Moore, Manager of ICH.

Reflecting on a decade of work, Slade says the establishment of ICH and IC4CH is an exciting development for healthcare communication research globally.

“We believe that working together across borders and disciplines will give us the unity and strength to realise our collective vision of creating a future in which healthcare is safe, compassionate and supportive for patients, carers and clinicians.”

Find out more in the ANU Institute for Communication in Health Care (ICH) 10 Years in Review.