When it comes to health checks, no news is not good news

CervicalCheck tragedy shows risks in communication failures not widely appreciated

Photograph: iStock

Photograph: iStock

 

There is a huge frustration as well as anger out there at the CervicalCheck debacle that may have cost some women their lives. Other women have been put through unnecessary trauma when they suffered years of delay before being told they were part of an audit process because of concerns about the validity of their smear results.

But there is a major learning point for all of us in the midst of the tragedy.

It’s a generally held aphorism that “no news is good news”. In fact the opposite should hold when it comes to healthcare. If you have had a recent scan, blood test or other kind of medical investigation, the best policy to adopt is “no news is bad news”.

Why? Because, as the CervicalCheck scandal has illustrated, communication in healthcare carries an insidious risk: the process of communication is seen as a mundane administrative task rather than the safety critical process it really is.

Writing in the Journal of the Royal Society of Medicine, patient safety expert Carl Macrae points to certain assumptions that influence both the behaviour of health professionals and the design and implementation of communication processes that lie at the heart of why communication systems in health so often breakdown.

Hearing nothing does not mean that nothing is wrong

“These assumptions can influence the most basic aspects of communication, such as what is viewed as an acceptable communicative practice, when and if confirmatory messages are sought or expected, and which information is considered critical and which is not,” he says.

One of the most basic assumptions of any high-reliability practice is that no news is most certainly not good news.

What everyone of us in the healthcare equation, not least patients, need to adopt as their default position is: hearing nothing does not mean that nothing is wrong.

Macrae recalls a commercial pilot turned air-accident investigator telling him bluntly years ago: “no news means your radio has probably failed”. In turn his advice to us is simple: in the handling of important test results – the absence of a confirmation message should be perceived as a sign that the communication system itself has broken down.

“The assumption that no news is bad news – and that communication processes are fragile, prone to failure and need strong systems of internal checks and balances – have been essential features of safety-critical industries for decades. So why are these assumptions not yet systematically embedded in all areas of healthcare?” Macrae wonders.

Risks

Rather than making a conscious trade-off between safety and cost, it seems many of the risks associated with failures of communication are not widely appreciated in the first place. Assumptions that “no news is good news” can hide the problem itself.

Ultimately, safe systems of communication are built on the deep assumptions and default positions that collectively shape practice.These assumptions determine what is paid attention to, what is valued, what is ignored and how systems are designed and implemented.

The patient safety office of the Department of Health must sink its teeth into this problem without delay. It is so urgent as to warrant it dropping other worthy initiatives it may be pursuing and focus all of its resources in developing robust rules of communication for test results, which the Health Service Executive must implement.

In the meantime, beware messages from hospitals and clinics such as: “If you don’t hear from us, assume everything is okay.”

Make it your business to say no thank you, I’d prefer if you contacted me when the results come back. Ask what the expected time-scale for this is and make a note in your diary to ring the practice or clinic on the day after you see this note- if you haven’t heard from the nurse or doctor by then.

It’s tedious and may seem counterintuitive in this era of multiple online communication platforms – but it could save your life.

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