![]() 508–509) According to Lingard et al., communication failures occur not only when the content of a message is flawed, but also when the context of the communication is characterized by errors of occasion (the physical or temporal circumstances of the message are flawed), purpose (the goals, either implicit or explicit, are not reached), or audience (the right people are not involved in the communication exchange). 1, 10 Three rhetorical principles are particularly relevant to the study of communication in health care: (1) all communication has intended as well as actual effects, (2) all communication is motivated by the need to identify with an audience to “overcome differences and achieve the common ground required for a productive exchange,” and (3) rhetoric places the message (content) in relation to context (audience, occasion, and purpose). Lingard et al.’s rhetorical framework (the study of the relationship between communication and its effects) may provide a useful basis for identifying and classifying communication failures. Without information about the various types of communication failures that occur and the effect of different types of failures on patient outcomes, our efforts to learn from failures and reduce communication-related adverse events are limited. 9 Second, limited work has been done on characterizing communication failures and describing their different types. Yet this definition of communication has not been widely adopted in health care. ![]() 8 However, communication also involves the development of shared understanding, as suggested by the word’s Latin root, communicate, meaning to share or make common. Current recommendations and tools to prevent failures, such as communication protocols and checklists, assume that communication is a unidimensional activity and defined as information exchange. First, the concept of communication as adopted by health care researchers may be too narrowly defined. 3- 7ĭespite decades of research focusing on improving patient safety, adverse outcomes related to communication failures persist in part for two reasons. Sentinel event reviews identify communication failures as contributing to more than half of these “never events,” 2 and communication failures have been linked to significant adverse outcomes, including delays in care, surgical errors, falls, extended and inappropriate hospitalizations, serious injury, and death. Communication failures (that is, ineffective or insufficient communication) 1 between health care providers, such as physicians and nurses, pose a significant threat to the quality of care and safety of hospitalized patients.
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