ACQ Vol 12 No 3 2010

Accessible healthcare

What’s the evidence? Communicatively accessible healthcare environments Robyn O’Halloran and Tanya Rose

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

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).

Robyn O’Halloran (top) and Tanya Rose

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ACQ Volume 12, Number 3 2010

www.speechpathologyaustralia.org.au