Effective Communication (EC) To

Improve Patient Safety

Patient Safety Unit
Quality in Medical Care Section
Ministry of Health Malaysia
@ Secretariat, Patient Safety Council Malaysia

In Collaboration with :
Patient Safety Module Technical Committee

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 Learning Objectives

• Understand the importance of EC.

• Learn the basic concept of EC & its barrier.

• Understand how EC can improve Patient Safety.

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 Why Communication in Healthcare is
Important?

Communication is a root cause of nearly 70% the event

reported to the JCHAO from 1995 - 2005

Failure to communicate safety concern and poor

collaboration led to incidents such as medication error,
diagnostic error and wrong surgeries
(Joint Commission on Accreditation of Healthcare Organizations, JCHAO)

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 Level of Communication
Involving Junior Health Care Professionals

Medical Officers Nurses / Sisters /

Matrons

Specialists Medical Assistant

Consultants / Other Supporting

HODs Patients & Families Medical Staffs

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 Communication Failure…
“Hmm..is the dose 50mg or 500mg?…oh well…I’ll just give either one. Someone will
correct me. I don’t want to look stupid in front of the M.O”

“That’s not En. Ramli’s X-ray but I’m too scared to tell the specialist because I will
get scolded”

“I remembered the surgeon left a gauze in the patient’s abdomen but I guess he
remembers it. Anyway, it’s not my problem”

Specialist : “ Start the patient on T. Carbimazole 20mg OD “

H.O : “Did he say Carbamazepine or Carbimazole?”

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 Effective Communication (EC)
Basic Communication Concept
Loop
Commu
nicate

Messag
Message Massage
e to Encode medium Decode receiver
send

Sender
EC Receive
r

Feedba
ck

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Ways of Communicating
Despite having various
modalities of
communication, we still
have problem to
• Case notes communicate
• Documents effectively
• Photos
•
•
Presentation
Body language and dressing
WHY???
• Social media (Whatsapp/FB)

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 Barrier to an EC

•Language
Personal •Attitude
factor •Knowledge
•Fatigue / Stress

Enviro •Noisy
nment •Cultural issue
•Weather

factor
•Disruption

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Steps to EC in Clinical Setting

Assert CONCERNS if needed

Actively LISTEN to response

CONCISELY describe the problem

CLARIFY the problem & gather data / facts

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 Effective Communication

Verbal R
Non-verbal
A
L E
Clear

N C Eye contact

Brief and concise

U Posture

Timely
IF Dressing

Respectful
S K Facial expression

A
Assertive Confident

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Situations Requires EC
Seek Consultation/ Referring case / Informing
case

Passing over cases

Informing concerns / red flags

Taking consents

Breaking bad news

Communicating error

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Seek Consultation/Referring Case/Informing Case
Get person’s
attention
Reach Express
Patient
decision Safety concern
Assertion
Model

Frequently missed Propose State

action problem

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Seek Consultation/Referring Case/Informing Case
Introduction •Your name & role
Situation •What is happening with the patient?

ISB Background •What is the clinical background

AR
Assessment •What do I think the problem is?

Recommendation •What action would I recommend?

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 Example of Inappropriate
Communication Between Doctors

Doctor, I have a 29-year-old male in our ED. He has had abdominal pain for 3
days and was being treated by G.P previously. Since he wasn’t getting any better,
his wife drove him here from Chini to Pekan with their two kids. He waited in
the ED for an hour and a half before we saw him. He was then started on IV drip
for half hours in the ED while waiting for blood investigation. The G.P treated
him with T. Ranitidine for the past two days. I would like you to review this
patient now as we think this is an appendicitis.

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 “Doctor to Doctor” Communication Using ISBAR
• Introduction & Situation
• Dr Ali, this is Dr. Abu from the ED. I have this 29 year old male En. X complaining of severe RLQ

o
abdominal pain x3/7 and fever x1/7. Currently admitted to yellow zone with impression of acute appendicitis

e
• Background

id
• He has had this pain since 3 days ago and worsen today. Initially at the umbilical region and today it is

v
worsen over the RLQ. His fever started today. Otherwise, he had nausea and loss of appetite during the course

r t
of illness. No other urinary symptoms , UGIB and LGIB symptoms. BO normal. He has been treated by a G.P

VIDEO
e
for presumed gastritis with T. Ranitidine. No past medical or surgical history.

s
• Assessment

in
• Generally the patient had mild dehydration. His HR = 104, BP = 110/75, Temp = 38.5. His abdomen is soft,
tender over the RLQ with +ve rebound tenderness. Other systemic examination was normal. FBC came back

To
as leukocytosis (WBC: 16 ) with neutrophil predominance. UFEME : normal . BUSE : normal.
• Recommendation
• We have kept him nil by mouth and started him on IV drip NS maintenance. Kindly review him for further
management. Do you have any inquiry regarding the patient?

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 Communicating Patient Safety Incident for
Junior Health Care Professional
• Incident need to be communicated through proper channel e.g. Incident
Reporting System
• It should not be kept silent
• Your immediate boss must know soonest possible
• Do not handle this matter on your own.
• Involve senior officer in charge in managing this matter, especially when
communicating with patient / family members in this difficult situation
• Show empathy to patient & family members
• Document the communication that take place

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 Take Home Messages

“Treat people the way you want to be treated. Talk to people the way
you want to be talked to...”

Communication is vital in Patient Safety!

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 Acknowledgement

Dr. Nor ‘Aishah bt Abu Bakar

YBhg. Dato’ Dr Zamyn Zuki Tan Sri Dato’ Mohd Zuki
Dr. Mohd Suffian bin Mohd Dzakwan
Dr. Saari Mohamad Yatim
Dr. Khairulina Haireen bt Khalid
En. Arun A/L Adi
Dr. Ahmad Muzammil bin Abu Bakar

Pn. Maznah Abd Wahab

Pn. Sharmila Mat Zain

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