ACQ Vol 12 No 3 2010

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Accessible healthcare
ACQ Volume 12, Number 3 2010 123
Robyn
O’Halloran (top)
and Tanya Rose
pathologists make an important contribution to
understanding the patient’s medical condition.
However, patients also need to be able to communicate
with their healthcare providers when they are in hospital. In
fact the Speech Pathology Australia Code of Ethics states
that “The speech pathology profession recognises the rights
of individuals to possess an effective form of communication”
(Speech Pathology Australia, 2010, p. 1). Assessing a
patient for communication and/or swallowing disorder/s
within the medical model assists the speech pathologist
and the broader healthcare team to understand the patient’s
underlying medical condition, but it does not ensure that
the patient has an effective form of communication. Our
Code of Ethics points to another important role for speech
pathologists in the acute hospital setting: to ensure that
every patient in hospital has an effective (as possible) form of
communication.
The speech pathologist’s manager does, however, raise
some important points. Patients are often in the acute
hospital setting for a short period of time and it may not
be feasible for speech pathologists to assess every patient
admitted into hospital to ensure that he or she has an
effective form of communication. Alternatively, it may be
that by improving the communication environment alone
many patients might be able to communicate effectively with
healthcare providers. This could be achieved in a variety of
different ways. For example, one way to help create a more
communicatively accessible environment in hospital might be
to ensure that any patients with pre-existing communication
disabilities are identified on admission (O’Halloran, Worrall,
& Hickson, 2009); other ways include providing the patient’s
communication partners (that is, healthcare providers) with
the necessary knowledge and communication skills to
communicate with patients with communication disabilities
(Kagan, Black, Duchan, Simmons-Mackie, & Square, 2001),
ensuring that written information is available in accessible
formats (Rose, Worrall, & McKenna, 2003), and developing
systems for the maintenance of assistive listening devices on
the ward (Roper, 1995). A more communicatively accessible
hospital environment would not only benefit patients with
communication disabilities in hospital now but may also
benefit patients with communication disabilities who are
admitted into the hospital in the future. Thus, improving
the communication environment can be a very efficient
way to ensure that many patients are able to communicate
effectively when they are in the acute hospital setting
(O’Halloran, Hickson, & Worrall, 2008).
Speech pathologists working in the acute
hospital setting work within a medical model.
The medical model proposes that a patient’s
difficulties can be explained by the nature and
severity of the patient’s impairments. This
perspective can make it difficult for speech
pathologists working in the acute hospital
setting to find support for the development of
a more communicatively accessible health-
care environment. This edition of “What’s the
evidence?” draws on Speech Pathology
Australia’s Code of Ethics and Scope of
Practice documents to consider a broader role
for speech pathologists working in the acute
hospital setting. It then demonstrates how the
current evidence base may be used to support
the development of more communicatively
accessible healthcare environments.
Scenario
Clinical situation
You are a speech pathologist working in an acute hospital
stroke unit. You want to make the stroke unit a more
communicatively accessible environment for inpatients with
communication disabilities. You speak to your manager
about this. She says that it’s a nice idea but she’s not sure
that it is a high priority for the acute hospital setting. She
adds that considering patients are only there for such a short
period of time it might not make a difference to patient care
anyway. You are not sure why your manager has responded
in this way and you want to find out if there is any evidence
to support the development of a more communicatively
accessible stroke unit.
Response
The manager’s response reflects the fact that all healthcare
providers, including managers, who work in the acute
hospital setting work within a medical model. The medical
model places primary value and importance on identifying
the underlying physical cause/s of the patient’s medical
condition. Treatment is directed towards remediating the
underlying cause/s (Fulford, 1996). By assessing the patient
and determining the nature and severity of the patient’s
communication and/or swallowing disorders, speech
What’s the evidence?
Communicatively accessible healthcare environments
Robyn O’Halloran and Tanya Rose