Enhancing communication and clinical practice to help realise healthcare rights

Page content: Role of healthcare providers in realising healthcare rights | Communicating with patients and consumers: a checklist | Working with patients from linguistically and culturally diverse (CALD) backgrounds | Further information

Role of healthcare providers in realising healthcare rights

Following are some ideas about how healthcare providers can help realise the seven key healthcare rights listed in the national charter and Victorian brochure: access, safety, respect, communication, participation, privacy and comment.

Many of these ideas may already be part of your ways of working. Others may provide opportunities for enhancing your practice. You may decide to explore ways of implementing these and other ideas through processes such as reflective practice sessions, group or individual supervision or staff planning.

These ideas are followed by a checklist for effective communication with consumers – a key factor in realising many other rights – and additional ideas for working with patients and consumers from culturally and linguistically diverse (CALD) backgrounds.

Access

This right is enhanced when healthcare providers:

• provide the best and most appropriate care, including referral to other services if needed
• discuss any issues about access to treatment with patients and consumers, including choices available and constraints on access.

Safety

This right is enhanced when healthcare providers:

• provide care and treatment with professional skill, care and competence
• provide care and treatment based on evidence of safety and effectiveness
• ensure ongoing continuity of care
• participate in organisational safety systems
• ensure that patients and consumers understand the treatment they are to receive, including through use of interpreters where required
• ensure that patients and consumers have an opportunity and the resources required (such as an interpreter) to communicate any information relevant to their treatment, for example regarding their medical history or current medications.

Respect

This right is enhanced when healthcare providers:

• demonstrate professional conduct based on appropriate ethical standards, and treat patients and consumers with dignity and consideration
• provide care in surroundings that allow personal privacy, for example using separate treatment rooms, screens or curtains
• provide health care and advice that is responsive to a patient’s or consumer’s culture, beliefs, practices, needs and circumstances
• treat patients, consumers, family, carers and colleagues without discrimination based on race, age, gender, gender identity, sexual orientation, carer status, disability, marital status or religious belief
• interact with clinical and non-clinical colleagues within and outside the service in a respectful manner.

Communication

This right is enhanced when healthcare providers:

• regard communication as a two-way process, and provide opportunities to ask questions and for patients and consumers to provide relevant information
• provide information in a way that patients, consumers, families and carers can understand about their diagnosis, treatment options, expected outcomes, possible side effects, waiting times and costs
• provide patients and consumers with open, complete and timely communication throughout their period of care, including if plans change or if something goes wrong
• ensure that the patient or consumer understands the information being provided to them, and are alert to confusion or misunderstanding
• ensure patients and consumers understand that they can involve a family member, carer or chosen support person, for example from a consumer support organisation, to assist with discussions and provide other support
• check preferred language and use interpreter services appropriately when required, and attend training on effective cross-cultural communication and use of interpreters
• ensure the clear and appropriate transfer of information when a patient or consumer is referred to another healthcare provider
• provide copies of the brochure in the appropriate language/format, and discuss it with the patient, consumer, their family or carer.

Participation

This right is enhanced when healthcare providers:

• encourage patients and consumers to take an active role in their health care, and to be included in all decisions and choices about their care, including for example how and when to leave hospital
• ensure that they have clearly communicated all the information that a patient or consumer needs to make a fully informed decision about their care and treatment (see under communication), including providing opportunities to ask questions and using interpreters when required
• ensure that a patient or consumer understands their rights to a second medical opinion, and to refuse treatment or withdraw consent at any time
• invite patients and consumers to consent for care that is experimental or part of teaching or research
• respect the role that family members, carers, friends and chosen support people (for example from a consumer advocacy organisation) may have in a patient or consumer’s care and treatment, including allowing time for  the patient or consumer to talk to them before making decisions.

Privacy

This right is enhanced when healthcare providers:

• ensure they share patients’ and consumers’ information appropriately with other healthcare providers, as per Victorian and federal laws, and communicate this with consumers
• recognise patients’ and consumers’ right to access their health record, and be prepared to discuss the contents with them
• clearly communicate the reason for any constraints on a patient’s or consumer’s access to their complete health record, and procedures (such as Freedom of Information requests) that patients and consumers may take to gain complete access
• recognise patients’ and consumers’ right to a say in what happens to their health record
• are sensitive to the personal privacy needs of patients and consumers (see under respect).

Comment

This right is enhanced when healthcare providers:

• acknowledge and take seriously all comments and feedback from patiens and consumers, and try to resolve these quickly where possible
• ensure that feedback channels are available, and communicated to the patient or consumer, throughout the period of care
• ensure quick and fair resolution of complaints by taking part in organisational processes
• ensure that patients and consumers know where they can take their complaint if they are unsatisfied with the provider’s or healthcare service’s response (including for example to hospital patient representatives, or to the Health Services Commissioner)
• establish reflective practices to ensure continuous improvement, including in response to comments from patients and consumers.

Communicating with patients and consumers: a checklist

Effective, two-way communication with patients and consumers is a key factor in the realisation of many other healthcare rights. Yet effective communication requires a range of skills and resources that are not always recognised or available. This may especially be the case when communicating with a patient, consumer or family member whose preferred language is not English, who is older, who has a disability (such as cognitive, hearing, sight), a physical or mental illness, or some combination of these attributes.
You may find this checklist helpful for ensuring more effective communication with all patients and consumers:

• Have you checked the person’s preferred language?
• Has an interpreter (including Auslan) been provided if required?
• Have you checked that a lack of spoken English is not complicated by disability or illness affecting communication?
• Have you ensured that you understand what the person believes their health problem to be?
• Have you checked what the person’s needs and priorities are for a hospital stay?
• Have you checked what level of family involvement the person would like?
• Have you checked, or are you otherwise aware, of any support networks that may be available, for example religious or community organisations?
• How you checked that the person has clearly understood their diagnosis, the aim of the treatment, and how to, for example, take medication? It is useful to ask the person to repeat this information back to you, or demonstrate.
• Have you checked what other medication and alternative treatments the person is using?
• Have you checked if the person understood any follow-up required, and why this is important, including what they need to do, and whether they need to come back?
• Have you asked if the person has any questions?
• Do you feel that you have a shared understanding of the problem and the plan of action?
• Do you know whether the person agrees with the plan of action?

Working with patients from linguistically and culturally diverse (CALD) backgrounds

It is important to be aware of your own values, beliefs, expectations and cultural practices, and consider how these impact on the care you give to people from cultures different from your own. This will include being responsive to the particular needs of patients and consumers whose preferred language is other than English.

Individuals vary in many ways. Historically Australians have expected people to assimilate into the dominant Anglo-Australian culture. We now celebrate cultural difference, and are becoming more attuned to the needs of individuals from different cultural backgrounds. Experiences of health and illness vary widely, as a result of different beliefs, behaviours, past experience in Australia and experiences prior to migration. Good health care depends on how we respond to these differences.

In many cultures, the patient and their family make up a single client group with which you need to interact. There are some general principles:

• Do not assume English proficiency
• Do not make assumptions about patient levels of understanding
• Respect beliefs and attitudes
• Take the time to explore any issues
• Speak clearly and slowly
• Listen and observe
• Note differences in meanings of words
• Exercise sensitivity when using interpreters

There is enormous diversity in populations of all cultures, we should all recognise that difference and diversity exists. It is important to reveal the awareness of cultural issues that conveys interest, concern and respect. Identifying these will enhance rapport with your patients and consumers, as long as you don't assume that you know what they think and believe. Ask your patient: they are their own cultural experts.

In addition, much is common across cultures. For example, most patients and consumers are nervous of clinical environments and are reluctant to question their doctors – regardless of their educational status, occupation or ability to speak English. You need to be aware of your own cultural assumptions and of the culture of your healthcare service, as well as its impact on people for whom this is unfamiliar.

Further information

For more information about working with CALD patients and consumers, visit the Culturally and Linguistically Diverse Patient Issues website. For more information about using interpreters, see the Victorian Government Language services policy, which outlines the requirements for funded organisations to enable people who cannot speak English or who speak limited English, to access professional interpreting and translating services when making significant life decisions and where essential information is being communicated.

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