ACQ Vol 12 No 3 2010

Accessible healthcare

Creating communicative access in Barwon Health: Dwelling in possibility Natalie Anderson

This paper describes the development of the Communicative Access Care Improvement Group – a multidisciplinary practice improvement group comprised of clinicians, managers, and consumers. The primary objectives of the group are to identify potential barriers to effective communication within Barwon Health; to motivate for change toward a communicatively accessible and inclusive healthcare system; and to participate in achieving this by providing ongoing education and consultation. This discussion focuses specifically on the key strategies used and lessons learned in our attempts to put communicative access on the agenda of our large healthcare network. M ost people would agree that effective communi­ cation is fundamental to the quality of life of every individual. This applies across all cultures and all facets of life, including those times in our lives when we require access to healthcare. The collaborative and respectful partnership that is an integral concept to person-centred care cannot be achieved without effective communication between the health provider and the user (Bensing, Verhaak, van Dulmen, & Visser, 2000). People with communication disabilities, however, are at risk of not being able to communicate effectively with healthcare providers and as a consequence have their right to participate in their own care compromised (O’Halloran, Hickson, & Worrall, 2008). It was at a routine staff meeting in October 2003 that this issue came sharply into focus for the speech pathology group at Barwon Health (BH). Discussing the Inpatient Functional Communication Interview (IFCI; O’Halloran, Worrall, Toffolo, Code, & Hickson, 2004) through the conceptual framework of the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001), Robyn O’Halloran spoke of a fundamental shift in the way we might view our roles as therapists and the responsibility we have to our patients. Many of us employed the traditional, individualised therapeutic approach aimed at addressing communication problems with an individual, at an impairment level. Exposure to the work of Connect (Communications Forum, 1997; Parr, Wimborne, Hewitt, & Pound, 2008), and the work of the

Keywords COMMUNICATIVE ACCESSIBILITY HEALTH CARE ORGANISATIONS

Aphasia Institute (Kagan, 1998), however, was beginning to reveal the crucial role environmental barriers and facilitators play in determining an individual’s ability to participate in communicative life. We had started to embrace a more integrated, functional approach, which gave us options beyond the limits of addressing impairment alone. But it was this particular discussion, in October, that opened my eyes to the plight of the many people spread across our healthcare network right at that moment struggling to make sense of the systems, information and attitudes through which we delivered our care. For me there was a sudden clarity of purpose. The next day I sent an email to a handful of colleagues across Barwon Health inviting them to a meeting to discuss the issue of communicative access (CA). The result was the Communicative Access Care Improvement Group (CACIG). What follows is not a discussion of CA per se but rather an attempt to highlight and share key learnings that have emerged through our struggle to make organisation-wide improvement to CA in our corner of the public health system. The Barwon Health Communicative Access Care Improvement Group (CACIG) The CACIG is a multidisciplinary group of clinicians, managers, and consumers. We dwell in the possibility that one day: All consumers (will) readily access the information they need to communicate effectively with others, make decisions and participate more fully in their own healthcare. The group’s mission is to: Strive to be instrumental in creating healthcare that is accessible to, and inclusive of, those who struggle to talk, read, hear or understand. We work to achieve this by:

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ACQ Volume 12, Number 3 2010

ACQ uiring knowledge in speech, language and hearing