Communication is a key patient safety systems issue in maternity care, as well as being a significant determinant in families’ experiences. In this blog, MNSI highlights the safety factors surrounding effective communication. Identifying the factors that work well, highlighting where there are barriers to effective communication and recognising the work that is taking place to overcome them.
MNSI recognises that this is a challenging area for healthcare providers and acknowledges the significant amount of work being carried out nationally across the maternity system to improve the facilities for communication between maternity teams, women and families (Cull J, Anwar N, Brooks E et al. MIDIRS Midwifery Digest, 2022).
The Ockenden report (2020) states ‘all members of the maternity team must provide women with accurate and contemporaneous evidence-based information as per national guidance. This will ensure women can participate equally in all decision-making processes and make informed choices about their care. Women’s choices following a shared decision-making process must be respected’.
In the year March 2022 to March 2023, the HSIB maternity programme (MNSI from 2023) found that in almost a third (31%) of investigations, additional support was required to facilitate our work with families. In 57% of those cases, this related to communications’ support, predominantly in relation to engaging interpretation and translation services, in order to ensure that those families were able to share fully with us their experience of the care that they and their babies had received.
Safety systems factors that worked well: examples from maternity investigations
- A timely assessment of women’s needs and communication of the identified support needs to the maternity multidisciplinary team. This led to women being able to access all relevant services during their pregnancy and being fully involved in decision-making.
- Verbal interpretation services provided consistently in the antenatal period because it was well known and documented that communication support was required.
- Interpretation services that were available 24 hours a day, were easily accessible and straightforward for maternity teams to use.
- Technological equipment being available to provide bedside interpretation for women.
Safety systems factors where there were barriers to effective communication: examples from maternity investigations
A number of maternity investigations have identified the gaps that can arise in communication. Most commonly, this relates to language barriers in written, oral and online communications:
- No assessment of potential communication support needs carried out, leading to no support being provided through the pregnancy journey.
- Women feeling that they will not need an interpreter as they speak some English. This can lead to a potential gap in understanding of information given and not being able to make fully informed choices.
- Interpretation services requested but not able to be provided (examples include difficulty in accessing interpretation services in unplanned and emergency attendances, being unable to access interpretation in a woman’s first language, delays in connecting to telephone interpreter or quality of interpretation).
- Family members being asked to interpret or women choosing to having family members interpret for them.
- Staff members interpreting, sometimes in a shared language but not a woman’s first language.
- Lack of written information available in a woman’s first language.
Other barriers to effective communication have been identified in some investigations, for example:
- Technological barriers (access to and effectiveness of apps, digital exclusion).
- Barriers to engaging with healthcare services (for instance, a lack of clear information on telephone numbers to call for information, test results or advice).
- Technical language barriers (the use of medical language and ‘jargon’ in oral and written communications).
- Training barriers; there is no national provision of advanced communication skills training for maternity teams in identifying communication support needs
- Barriers regarding the absence of effective tools. There are no nationally agreed tools consistently established for use in assisting maternity teams in assessing women’s communication needs.
What is the impact on patient safety?
Communication in healthcare has been the subject of much health literature over the past 20 years. A wealth of studies has shown the positive effects of interventions to improve communication between clinicians and patients. Studies from around the world demonstrate that effective patient/clinician communication can improve patients’ experiences and health outcomes (Improving communication between health care professionals and patients in the NHS in England, 2021).
This is reflected in healthcare literature relating to maternity safety and experience, in particular with reference to interpretation and translation services (MBRRACE, 2017).
HSIB’s work reflects these findings and the potential impacts on maternity safety and experience.
A woman in her first pregnancy booked for her maternity care in the first trimester. English was not her first language. An assessment was not carried out to identify if any potential communication support for the woman and maternity teams was needed; the woman spoke some English and the need for support was not recognised. The woman did not request an interpreter or written information in her first language. She did not know these services were available and, as she spoke some conversational English, she thought she would be fine.
The woman attended the maternity assessment unit, at term (over 37 weeks) as she was experiencing some vaginal bleeding. She and her baby were assessed and there were no concerns. Before going home, the woman was given advice verbally and in an information leaflet, in English, about when to come into hospital if she had any concerns or when she was in labour. This advice was given again, in English, at her next midwifery appointment. The woman had not laboured before and had not understood the medical language used relating to ‘contractions’ and ‘established labour’ and when to come to hospital.
She came into hospital as few weeks later, close to her estimated due date; she was in extreme pain and had been in labour for a long time. She was experiencing an obstructed labour. Her baby was born by way of a caesarean birth and sustained a brain injury due to hypoxia (lack of oxygen).
MNSI recognises the commitment within the healthcare system to improving the communication support available to women and maternity teams, and the work that is currently being undertaken.
Moving forward, MNSI intends to carry out further work on the theme of communication. This will be done by engaging with women, families and stakeholders to further improve the safety and experience for women throughout their pregnancy journey.
MNSI acknowledges not all people who are pregnant or experience birth identify as women. We use the words woman and women so that we can be concise, but we always include all pregnant or birthing women and pregnant or birthing people.