Center for the Advancement of Healthcare Quality and Patient Safety (CAHQS)
Health expenditures in industrialized countries have doubled in the last 30 years. However, the quality of healthcare has remained at substandard levels. Healthcare systems across the world are producing substantial unnecessary costs through the underuse, overuse, and misuse of resources, services and interventions. Even in developed countries, only every second patient receives recommended treatments, only one in four physicians follow medical guidelines, and three of four surgeries take place in underequipped operating rooms. This evidence calls for urgent interventions that effectively improve the quality of care worldwide.
Healthcare also constitutes a severe safety threat to patients. First global estimates by the WHO evidence that at least 43 million patients are harmed by medical care each year at a cost of at least 23 million disability-adjusted life years and $132 billion in excess health care spending. More than two thirds of these incidents result from preventable human error, ranking medical errors among the eight most common causes of death and among the top 10 medical causes of disability in the world. In colloquial terms, this count exceeds fatalities that would be incurred by three jumbo jets crashing every two days and the combined number of injuries and deaths that result from motor and air crashes, suicides, falls, poisonings, and drownings, making medical errors are a worldwide public health problem ahead of high-profile diseases like AIDS and cancer.
Ineffective communication has been repeatedly identified as a major root cause of harmful events in medical care, accounting for between 25% (Wakefield, 2007; Australian Institute of Health and Welfare & the Australian Commission on Safety and Quality in Health Care, 2007) and 70% (Joint Commission, 2013) of “sentinel event” reports. The literature consistently implies that health outcomes are substantially enhanced when clinicians communicate well with colleagues and patients. On the other hand, when communication is performed poorly, health outcomes and patients are put at significant risk (Kesten et al., 2010; Klipfel et al., 2011; Pfrimmer, 2009; Twedell & Pfrimmer, 2009).
To date, research on quality and patient safety has generally concentrated on optimizing the quantity and clarity of communication contents in medical interactions. However, human communication encompasses much more than that. Miscommunication is not only the consequence of insufficient or unclear message contents. Instead, it often results from the complex process of co-constructed human communication. Thus, beyond optimizing the quantity and clarity of message contents to avoid or minimize error, it is important to understand the communication processes that hinder and foster favorable outcomes.
Communication science, which for over 100 years has systematically applied scientific methods and observations to describing phenomena across a variety of communicative contexts, focuses on understanding these communication processes as a prerequisite for successful translations of communication-centered issues into safe and high quality clinical practice. Thus, insights from communication science can theoretically inform medicine’s pressing interest in effective communication processes and functions. However, few efforts to date have attempted to shed light onto such critical interdisciplinary connections that have the potential to enhance the quality and safety of care.
The objective of this center ist to initiate strategic research teams and recruit funded research collaborations that calibrate existing knowledge from the fields of communication science and medicine through theoretical integration, data-sharing, and data generation to generate cutting-edge joint publications that shed innovative interdisciplinary light onto current conceptions and practices related to healthcare quality and patient safety. The focus of effort will be to identify how the disciplines can inform areas of medical practice in which harmful human error is common, such as diagnosis, medication, team interactions, whistleblowing, speaking up, handoffs, and disclosure.