Criterios de evaluación

Communication and openness is another dimension noted in the literature as having an effect on patient safety. Baker et al. (2004) argued that the most reliable organisations pay attention to human factors such as, supporting teamwork, open communications and reporting events. For example, the US Joint Commission on Accreditation of Healthcare

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Organizations analysed 2,455 adverse event incidences in hospitals in the USA and found that failures in communication were responsible for 70% of those events and that 75% of the patients that had been involved in these communication failures had died (Leonard et al., 2004).

Further research has shown the effect of poor communication on patient safety, such as an observational study conducted by Christian, et al. ( 2006). A total of 10 surgery cases were checked to see the effect of the operation room systems on patient safety. The study found that ineffective communication between the staff was one of the main potential problems that could threaten patient safety. A report from WHO (2009) asserted that there are five benefits from investment and improvement of communication in health care organisations, as follows: Improved patient safety; improvement in the quality of health care and patient outcomes; decreased length of stay for the patients; increased patient and family satisfaction; and improved job satisfaction and staff morale.

Furthermore, communication is seen as having a very important role for health care staff through providing knowledge, establishing relationships and behaviour patterns and in supporting leadership and team co-ordination (WHO, 2009). Leonard et al. (2004) emphasised the significance of good communication in protecting patient safety and indicated that communication failures can lead to inadvertent patient harm. In particular, Leonard et al. (2004) identified problems faced within a large, not-for-profit health system in America, through a detailed case study of the experiences of communication and teamwork within human factors training. They identified that failures of communication and teamwork occurred in the following circumstances:

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 If health care staff have no clear division of their duties and responsibilities to help them to work in a team.

 If health care staff are distracted and interrupted during their work.

 If there are differences in the level of skills between staff and the amount of training they have received.

 If there are problems with the relationships between health care staff within different professions and at different levels.

 If staff are affected by work conditions, such as an excessive workload and pressures of time, as well as human factors such as stress and fatigue.

 If there are differences between staff due to cultural and gender-related factors.

Researchers suggest that patient safety can be negatively affected by the challenges presented by inter-professional communication between nurses, physicians and other care workers (Baggs,1999). In this context, Reader et al.(2007) conducted a cross-sectional study in four hospitals in the UK to investigate whether nurses and doctors in Intensive Care Units (ICU) had a shared perception of interdisciplinary communication. The study used a survey involving a sample of 48 doctors and 136 nurses and found differing perceptions amongst staff. For example, the study showed that nurses reported that there was a low level of interdisciplinary communication openness between them and doctors. The study also showed that the communication and openness was low between trainee doctors and senior doctors.

However, the study was limited in that the sampling method involved a small, unequal sample between the different types of staff, which could lead to bias. For instance, the number of senior doctors was small compared with the nurses and trained doctors surveyed. The authors acknowledged that it would be more useful if the study had used another data

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collection method, such as an observational methodology. To overcome the inter-staff communication problems and their effect on patient safety in the hospitals, a number of researchers have shown that communication between staff could be improved through the use of communication tools. For example, a prospective cohort study conducted by Pronovost et al. (2003) in 3 health care settings, showed that using a daily goals form, which included a good communication plan and the identification of staff tasks, improved the quality of health care for the patients and led to a reduction in their stay in hospital.

Similarly, an intervention research project was conducted by Clark et al. (2009) to evaluate PACT ( Patient assessment, Assertive communication, Continuum of care and Teamwork with trust) in a private hospital in Victoria, Australia seeking improvement in inter-staff communication during the handover of the patients. The research showed that the communication between nurse and doctors improved after written SBAR (Situation, Background, Assessment and Recommendation) reviews of patient care during handover procedures were produced by those involved. The findings of both studies showed the effect of communication in improving the quality of health care and patient safety practice. However, the research findings would be more reliable if these tools had been used in more than one work area and if they had been used in both public and private hospitals.

Research has shown that communication problems happen not only between the health care professionals in hospitals but also between the staff and managers. For instance, a recent cross-sectional study by Braaf et al. (2013) that used a questionnaire with 281 health care providers from 3 general Australian hospitals in the perioperative pathway, concluded that patient safety in hospitals could be affected by poor organisational communication in the transfer of information from managers to health care workers. Furthermore, they found that patient safety problems can be caused by a lack of

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communication in health care delivery due to poor documentation of patient information and miscommunication during patient handover procedures and between medical shift exchanges.

The system for communication may also have weak points during the transmission of patient information between hospitals, for example in safety alert scenarios. Status issues may also play a part, with junior staff perhaps fearful of speaking up (WHO, 2009). It can be noted that effective communication can improve patient safety practice and reduce medical errors, and improvement in communication can also have an effect upon other important aspects of patient safety culture practice such as teamwork.