Contributions to the Australian Communicating for Safety standard

Recently I contributed as a Subject Matter Expert on communication at the Australian Commission on Safety and Quality in Health Care. It was great to see how the standards draw on a wide range of expertise.

Here are some of the comments and papers that I raised in the discussions:

Healthcare in asymmetrical. This is not a bad thing - it's how we allow for people to provide care to us. This is found in how we have conversations in healthcare. However, that functional asymmetry can become dysfunctional and so it is the responsibility of those within the system to avoid that. This idea of functional asymmetry comes from this paper and I discuss this responsibility here.

Personalised feedback is the only type of training that has sufficient evidence for improvement of communication. While other forms of training can help set the foundations for analysing communication in order to give and apply feedback, if there is no such coaching, there is a limit to improvement. This comes from this Cochrane review.

I raised that there was insufficient use of evidence and an over-reliance on vibes and myths in current feedback and training. This is partly because the complexity of communication is not sufficiently appreciated and so engaging with relevant expertise is not done. We discuss that here.

This included challenging the assumption that face-to-face conversation was inherently better. I have previously posted about some of the myths and like to direct people to Elizabeth Stokoe's posts.

The basics of communication are often overlooked, so I paraphrased Jonathan Silverman, co-author of the Calgary-Cambridge Guide, who said that we need to learn how to drive the Ford Focus before we learn to drive the Ferrari. Part of the issue here is that there are so much incorrect information about how conversations actually unfold that the basics aren't always well taught even if they are included. Here's a paper describing a curriculum that includes some of the science of conversation.

Standards are not about prescribing how to do things, but there still is a reductionism when choosing what to include. I raised the importance of have a transparent and frequently reviewed process of standardisation for organisations implementing systems. This comment is explained in my paper on objectivity and complexity, which is based on my plenary talk at ICCH2024.

What I didn't end up raising, was that a team of experts identified core considerations in healthcare communication specifically relevant to those in Australia & Aotearoa New Zealand.