Improving communication

What is it?

Communication is much more than just providing information. It is a shared process in which participants exchange information, ideas and feelings to create mutual understanding and shared meaning.¹

Communication is reflective of person centred care practices, whereby an older person is placed at the centre of a collaborative partnership with hospital staff.

The communication process is an intervention; you need to be mindful of its impact during every encounter.¹ All hospital staff have a shared role in improving communication with older patients and their family and carers while in hospital.

Why is it important?

There is much room for improvement in the area of communication. The majority of complaints received by health services are related to dissatisfaction with the person’s experience of communication.²
People wish to be engaged in healthcare discussions in a way they can understand.³ They want to know what you are doing and why.
Effective communication is one way of enhancing an older person’s experience of and participation in their healthcare, leading to better health outcomes.⁴
Improving communication:
- Empowers older people – knowing and understanding what is happening, what to do and where to get help when needed.⁵
- Enables older people to express their views and beliefs, identifying “what matters to them” rather than “what is the matter with them”.⁶
- Increases a person’s capacity to manage their health condition(s).
- Requires clear expression from the person delivering the message and the full comprehension of the person receiving the message within a two-way dialogue.

How can you improve your communication with older people?

As an individual:

Be mindful that an admission to hospital can be a major life event for some older people.
Introduce yourself, explaining your role and why you are seeing the person.
Ask the older person how they would like to be addressed, making eye contact and engaging in general conversation.
Gain consent to involve the family or carers. They can provide important information about the older person’s life.
Screen, assess and adjust the way you respond to people who have vision, hearing, speech or cognitive impairment.
Adjust your own voice, tone and body posture to demonstrate respect and interest.
Listen and support an older person to express their needs and wants.
Be mindful of not using patronising language like ‘love’ or ‘dear’ and consider how your own attitudes and value base to ageing may influence the encounter.
Don’t refer to the person as a task, bed number or diagnosis either directly or to colleagues on the ward (acknowledging privacy and confidentiality concerns).
Avoid using acronyms for diagnoses, hospital wards, service providers etc. that are likely to be unfamiliar to older people.
Be sensitive to the potential impact of low literacy levels, in particular health literacy.
Use language-specific interpreters for all important conversations.
Use language aids to assist with day-to-day care.
Encourage the older person to use the ‘ask me 3’ questions – “what is my main problem?”; “what do I need to do?” and “why is it important for me to do this?”. ⁷

As a team:

Decide who will engage the older person and their family or carer in difficult conversations.
Decide which team members will be involved in the conversations.
Nominate one member of the team to lead the conversation.
Discuss the routines of the hospital and explain when the older person and their family or carers will have the opportunity to discuss their concerns with the doctor/treating team.
Provide the older person with the number of the person they can contact post discharge if they have any questions.

Consider simple adjustments:

Check that lighting is adequate.
Reduce reflective glare/visual distractions.
Reduce background noise.
Encourage the patient to use their hearing aids or amplifiers and ensure they are within reach.
Provide quality written materials in plain language/easy English/alternative languages.
Ensure the room set-up is as comfortable as possible when having family and carer meetings.
Consider and respect privacy and gender differences in shared wards.

1. Hill S, Lowe DB & Ryan RE 2011, Interventions for Communication and Participation: Their Purpose and Practice. In: Hill S (ed.), The Knowledgeable Patient: Communication and Participation in Health , Wiley-Blackwell, UK.

2. Office of the Health Services Commissioner 2008, 2008 Annual Report , Office of the Health Services Commissioner , Victoria.

3. Prictor M & Hill S 2011, Does communication with consumers and carers need to improve? In: Hill S (ed.), The Knowledgeable Patient: Communication and Participation in Health , Wiley-Blackwell, UK.

4. Department of Health 2012, Best care for older people everywhere – The toolkit , State Government of Victoria, Melbourne.

5. Hill S & Draper M 2011, A new conceptual framework for advancing evidence-informed communication and participation. In: Hill S (ed.) The Knowledgeable patient: Communication and participation in health , Wiley-Blackwell, UK.

6. Berwick D 2013, A promise to learn – a commitment to act: improving the safety of patients in England . Report to the National Advisory Group on the Safety of Patients in England.

7. National Patient Safety Foundation, 2014, Ask Me 3 , Retrieved 8 Dec 2014.