Receives care

Shared decision making is more than just building rapport and having a discussion. It is an iterative process of bringing the best available evidence into the consultation, and incorporating it into a discussion that considers the patient’s values and preferences. It can be thought of as the integration of communication and evidence skills to come to a shared decision about what is optimal care. Shared decision making involves explaining:

• Each treatment option
• The quantitative evidence of the risks and benefits of each option 
• Then exploring with the patient their preferences and what matters to them.

Decision support tools can be electronic or paper-based resources that support shared decision making by helping consumers and clinicians draw on high-quality information about particular conditions; compare benefits and harms of each option; and clarify consumers’ values about what matters most to them.

A type of decision support tool are patient decision aids, and it has been shown that people who have used patient decision aids feel more knowledgeable, better informed and clearer about their values. When clinicians use decision support tools to complement their communication skills, patients are actively involved in decision making and have more accurate perceptions about risk.

Clinicians need to work together and collaboratively with patients, using shared decision making and goal-setting processes, to develop care plans that direct the delivery of safe and effective care. Screening, assessment and identification of risks provide a foundation for planning comprehensive care that meets patient needs.

It is necessary for clinicians to refine their skills and capacity to provide person-centred care when developing individualised care plans. Dimensions to consider when explaining and planning care include:

• Respect for patients’ preferences and values
• Emotional support
• Physical comfort
• Information, communication and education
• Continuity and transition
• Coordination of care
• The involvement of family and friends
• Access to care

Communication breakdown is a well-recognised contributor to adverse patient outcomes. Effective communication is imperative for good team work, and team work is essential to patient safety. Using structured communication techniques can improve the transfer of clinical information and responsibility between clinicians, and strengthen teamwork behaviours and attitudes.

Effective teamwork enhances patient outcomes and satisfaction, reduces adverse events and has positive organisational benefits such as reduced lengths of stay and hospitalisation costs. The advantages to individual team members include role definition and clarity, stronger work relationships, better accessibility to patients and increased job satisfaction and wellbeing.

Ensuring the right care is given to the right patient is an essential part of safe care. Patient identification is an activity that is performed routinely in all care settings and can often been seen as a relatively unimportant task. However, it is vital that safety processes are adopted for common tasks to prevent simple mistakes that can lead to patient harm.

Health service organisations are required to implement processes that define approved identifiers for patients. Clinicians must be familiar with their organisational process and use three approved identifiers on registration and admission; when care, medication, therapy and other services are provided; and when clinical handover, transfer or discharge documentation is generated.

Mismatches between patients and their care can have significant consequences including death or major permanent loss of function. While not always resulting in harm, failure to correctly identify patients and match that information to an intended treatment or intervention may result in procedures being performed on the wrong person, wrong side or wrong site; medication errors; blood transfusion errors; and errors in diagnostic testing.

Clinicians must be familiar with their organisational processes for matching patients to their care. The diligent use of checklists and tools to correctly identify patients and match them with their intended treatment helps prevent errors from occurring.

As a leader in your organisation, you have a responsibility to ensure that the systems and processes in your organisation support clinicians to effectively communicate with patients, families, carers and other members of the care team when planning care and delivering care.

Effective communication is a key requirement of the NSQHS Standards (second edition). The following table describes actions in the NSQHS Standard (second edition) that are relevant when communicating to plan care, or communicating when care, treatment or medication is provided.

For more information see NSQHS Standards (2nd ed.)

You have a key role and responsibility to effectively communicate with your patient and other members of the care team when you are planning and delivering care.

This requires an understanding of health literacy and communication skills in ensuring two-way (or multi-way) communication, building rapport and trust, and managing and communicating risk. Clinical decisions should be made with the patient to incorporate their values, goals and concerns, and considering the best available evidence about benefits, risks and uncertainties of treatment.

Effective communication and collaboration with patients, families, carers and other clinicians involved in care ensures that the care you provide is safe, appropriate, coordinated and meets the goals and preferences of your patient.

• Engage with your clinicians and discuss your goals of care, expectations, and preferences including if you have an advance care plan
• Involve family members, carers or advocate in communication and decisions about your care
• Ask for help if you need a support person, an interpreter or other help to communicate
• Be open, honest and communicate any changes about your medical history, medicines and your health including if your family or carer notice a change in your condition
• Ask questions and raise any concerns you have about your care
• Provide feedback throughout your care experience
• Discuss your ongoing care needs and plan for when you leave hospital. Ask about follow-up appointments and any instruction to optimise your recovery, involve your family or carer, and if not provided, ask for a copy of your discharge summary.