Communication in healthcare: where the information gets lost
There is no shortage of advice on how to conduct a conversation, and it helps little. What fails in healthcare fails not in the conversation but at the handovers in between.
Search for better communication in healthcare and you find recommendations on conducting conversations: listen, phrase things clearly, invite questions. All correct, and all part of every training. If that were the issue, the problem would have been solved long ago.
But it is not the individual conversation. It is that between the doctor who knows something and the person who needs it there are usually several stations — and at each of them part of it is lost.
The first handover: practice to patient
The familiar finding from health services research: a large share of what is said in a consultation cannot be recalled immediately afterwards. That is not carelessness on either side but a property of conversations held under stress.
What helps is not speaking better but leaving something behind. A written summary of the three most important points — what they have, what to do, when to report back — beats any improvement in conversational technique, because it still exists after the conversation.
The second handover: between clinicians
This is where the most expensive losses occur. A report is written, sent, received, read and transferred into another system. Each of those stations can delay, and at least one of them is manual work.
The usual reflex is to write faster. More effective is to reduce the number of stations: a report that lands directly in the target system needs no fax, no matching and no second entry.
The third handover: back to the practice
The least noticed. A patient was in hospital, comes back, and the practice knows what the patient recounts. The report arrives later, sometimes considerably later, and in the meantime decisions are made on an incomplete basis.
This handover can barely be steered from the practice, and that is precisely why it is the best argument for a direct channel between institutions . A short message on the day of discharge replaces no report but bridges the gap in which guessing otherwise happens.
In healthcare, communication rarely fails at the phrasing. It fails because between the knowledge and the need stand three systems and two people.
What actually helps
- 1
Leave something written rather than explaining better
Three points are enough: finding, next step, when to report back. What exists in writing survives the journey home; what was said usually does not.
- 2
Reduce the number of handovers rather than their speed
Every station removed saves more than any station made faster. That applies to reports as much as to queries.
- 3
Offer a channel for queries that needs no appointment
A large share of calls between clinicians is an attempt to reach somebody. A message read when there is time replaces three attempted calls.
None of this is new, and none of it needs a new system. It needs the decision to treat communication not as a question of attitude but as a question of routes — and then to set up the shortest one.
