ACQ Vol 12 No 3 2010

Accessible healthcare

Improving communication access across Austin Health Kathryn McKinley, Shauna Poole, and Melanie White

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

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.

Keywords COMMUNICATION ACCESS COMMUNICATION

DIFFICULTY EDUCATION

This article has been peer- reviewed

Kathryn McKinley (top), Shauna Poole (centre), and Melanie White

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing