PATIENT SAFETY COURSE

1. 1
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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2. 2
•Understand the importance of EC.
•Learn the basic concept of EC & its barrier.
•Understand how EC can improve Patient Safety.
Learning Objectives

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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)
Why Communication in Healthcare is
Important?

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Level of Communication
Involving Junior Health Care Professionals

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“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?”
Communication Failure…

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EC
Communicate
Receiver
Feedback
Sender
Message
to send
Encode
Message
medium
Decode
Massage
receiver
Basic Communication Concept
Effective Communication (EC)
Loop

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

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• Language
• Attitude
• Knowledge
• Fatigue / Stress
Personal
factor
• Noisy
• Cultural issue
• Weather
• Disruption
Environment
factor
Barrier to an EC

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CLARIFY the problem & gather data / factsCLARIFY the problem & gather data / facts
CONCISELY describe the problemCONCISELY describe the problem
Actively LISTEN to responseActively LISTEN to response
Assert CONCERNS if neededAssert CONCERNS if needed
Steps to EC in Clinical Setting

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Verbal
Clear
Brief and concise
Timely
Respectful
Assertive
Non-verbal
Eye contact
Posture
Dressing
Facial expression
Confident
Effective Communication

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Seek Consultation/ Referring case /
Informing case
Passing over cases
Informing concerns / red flags
Taking consents
Breaking bad news
Communicating error
Situations Requires EC

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Frequently missed
Seek Consultation/Referring Case/Informing Case

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Seek Consultation/Referring Case/Informing Case

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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.
Example of Inappropriate
Communication Between Doctors

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• Introduction & Situation
• Dr Ali, this is Dr. Abu from the ED. I have this 29 year old male En. X complaining of severe
RLQ abdominal pain x3/7 and fever x1/7. Currently admitted to yellow zone with impression
of acute appendicitis
• Background
• He has had this pain since 3 days ago and worsen today. Initially at the umbilical region
and today it is worsen over the RLQ. His fever started today. Otherwise, he had nausea and
loss of appetite during the course of illness. No other urinary symptoms , UGIB and LGIB
symptoms. BO normal. He has been treated by a G.P for presumed gastritis with T.
Ranitidine. No past medical or surgical history.
• Assessment
• 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 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?
“Doctor to Doctor” Communication Using ISBAR
VIDEO

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• 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
Communicating Patient Safety Incident for
Junior Health Care Professional

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