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Accessible healthcare
112
ACQ
Volume 12, Number 3 2010
ACQ
uiring knowledge in speech, language and hearing
Kathryn
McKinley (top),
Shauna Poole
(centre), and
Melanie White
This article
has been
peer-
reviewed
Keywords
COMMUNICATION
ACCESS
COMMUNICATION
DIFFICULTY
EDUCATION
and skills), increasing access to interpreters for culturally
and linguistically diverse patients (services, systems and
policies), and provision of a generic assistive and augmentive
communication (AAC) device in the intensive care unit (ICU;
physical environment).
Project 1: Communication access
training
Background
Healthcare workers may need to learn skills to communicate
effectively with people with a range of communication
difficulties (Kagan, 1995; Roter & Hall, 2006).
Communication skills training has been shown to be effective
in improving healthcare workers’ communication skills (Legg,
Young, & Bryer, 2005). Staff working in health settings do not
always have access to education programs that teach these
important skills, as training is often only offered to clinical
staff or is not conducted at all.
The
Communication Access Toolkit
(Parr, Wimborne,
Hewitt, & Pound, 2008) is a training package developed
by Connect. Connect is a UK-based organisation that
provides information and supports people with aphasia,
provides training and consultancy to service providers, and
champions the rights of people with aphasia. This package
provides the trainer with the skills, knowledge, and resources
to run “Making your service accessible: Communication
matters” workshops for people working in health and
community settings. The training runs through eight modules
and includes information about communication difficulties,
communication access, and ways to improve communicative
access. Parts of the training are based on Supported
Conversation for Adults with Aphasia (SCA™) by Kagan
(1995). Although they use examples of people with aphasia,
they avoid using aphasia-specific terminology and have
used the broader term “communication access”, making the
training relevant to a wider audience. The first author visited
Connect in 2008 and completed training shortly after the
toolkit was published.
Project aims
The aims of the project were:
•
to implement Communication Access Toolkit training
program across Austin Health, and
•
to evaluate the effectiveness of the training program, in
terms of changes to participants’ knowledge, practice,
and behaviour.
This article describes three projects aimed to
increase communicative accessibility in a
hospital environment for visitors, family
members, and patients, including those not
referred for speech pathology management.
The first project describes the implementation
and evaluation of a training program aimed at
educating Austin Health staff about
communication access using the
Communication Access Toolkit. The second
project used the Inpatient Functional
Communication Interview to identify and break
down barriers to effective communication
between patients and staff in a subacute
setting. The third project, conducted in the
20-bed intensive care unit (ICU) at Austin
Health, involved the production of a generic
durable AAC device used to facilitate
communication for all ICU patients,
particularly intubated and nonverbal
tracheostomised individuals.
S
peech pathologists have a role in creating and
promoting communicatively accessible environments
for all, as well as advocating for those with specific
communication disability. A communicatively accessible
hospital environment is one in which environmental factors
creating barriers to communication have been addressed.
The World Health Organization’s
International Classification
of Functioning, Disability and Health
(ICF) (2001) states that
environmental factors comprise the physical environment,
social environment, and systems, services and policies.
Environmental factors that facilitate or create barriers for
people with communication disabilities in acute hospitals
have been described by O’Halloran, Hickson and Worrall
(2008). These include healthcare providers’ knowledge and
skills, attitudes of healthcare providers, the physical hospital
environment, and services, systems and policies.
Three clinicians working at Austin Health, an 800+ bed
tertiary facility in Melbourne’s north-east comprising of acute,
subacute, and community services, independently embarked
on projects that have addressed environmental factors in the
hospital setting. The factors addressed included education
and training about communication access (knowledge
Improving communication
access across Austin
Health
Kathryn McKinley, Shauna Poole, and Melanie White