Introduction by Croakey: The third iteration of the National Safety and Quality Health Service Standards is being developed, with an initial draft open for consultation until 25 September.
The Australian Commission on Safety and Quality in Health Care will be urged to ensure the standards, against which public and private hospitals and day hospitals in Australia are assessed, put a greater focus on communication accessibility for people who are deaf or hard of hearing.
Michele Nealon, Hearing Coordinator at Macquarie University Hearing and Co-Chair of its Lived Experience Network of deaf and hard-of-hearing people, draws upon some of her personal experiences with healthcare to explain why this should be a priority.
Michele Nealon writes:
Patient safety is a cornerstone of modern healthcare. Health systems invest heavily in reducing medication errors, preventing healthcare-associated infections and strengthening clinical governance.
Yet one essential component of safe care remains consistently under-recognised: communication accessibility for people who are deaf or hard of hearing.
Communication is not an adjunct to healthcare – it is the mechanism through which healthcare happens. Diagnoses are explained, consent is obtained and treatment plans are understood through communication. When communication fails, care can fail.
The evidence is increasingly clear that communication barriers are not minor inconveniences. They affect healthcare quality, patient participation and patient safety.
A 2024 international systematic review examining communication between healthcare professionals and patients found persistent barriers across healthcare settings.
A recent publication by United Kingdom researchers highlights limited preparation among healthcare professionals to communicate effectively with deaf and hard-of-hearing people. Inconsistent approaches can leave patients repeatedly advocating for their own communication needs, rather than having accessibility embedded across the health system.
Importantly, communication accessibility is not synonymous with interpreter provision. People who are deaf or hard of hearing have different communication needs: some use spoken language and hearing technology, while others rely on captions, speechreading, interpreters or a combination of supports.
Personal experience
Recently, I experienced this firsthand.
Following a biopsy, a lymphoma diagnosis had been made and documented within the health system. I did not know this.
During the consultation, I had explicitly and repeatedly explained that, because I am deaf, I would need either written information or a virtual consultation with captions to ensure I could accurately access and understand important clinical information.
After the diagnosis, I missed several voice calls from the specialist. There was no written information and no virtual consultation with captions. The specialist, accustomed to communicating verbally, had “forgotten” my stated communication requirements from the day before.
For 42 hours, I had no access to information that was critical to my health and potentially to decisions about my treatment.
This was not a failure to communicate information clearly. It was a failure to communicate with me at all, despite my having clearly identified what I needed for communication to work.
During those 42 hours, I was aware that something clinically significant had occurred, but I did not know what it was or what it meant for me. I was aware that my blood pressure had risen considerably. I experienced the frustration and loss of control that comes with being excluded from processes that are critical to my participation in healthcare. I had no reliable way to access information I needed to understand my health and what might happen next.
My family and friends also noticed a deterioration in my wellbeing during this period. I was being excluded from information about my own health because a communication method I had clearly identified as necessary had not been provided.
There had been communication within the health system. What was missing was timely, accessible communication with me.
That distinction matters. If a patient cannot access the communication method being used, communication has not been effective for that patient. This is particularly important when information is time-sensitive or clinically significant.
Timing
The timing of my experience is significant. The Australian Commission on Safety and Quality in Health Care is currently consulting on the draft third edition of the National Safety and Quality Health Service Standards.
The stated purposes of the third edition include responding to “the importance of equity of outcomes”, prioritising “how patients experience care” and moving beyond accreditation compliance towards building an organisational culture that supports consistent delivery of high-quality care.
The overview of the Person-Centred Practice Standard also says patients should receive care that is “person centred, safe, effective, accessible and integrated”.
These ambitions are welcome. But I struggled to find evidence that communication accessibility is embedded throughout the draft in a way that would make these aspirations a reality.
There are, however, some strong statements. Under Effective Communication and Teamwork, the draft says effective communication supports person-centred care and requires health services to identify and respond to communication needs and preferences across the episode of care, including accessibility needs, and provide communication resources and adapted methods to support shared decision-making.
But my experience demonstrates why identifying a communication need cannot be the end of the requirement.
My communication needs had been identified. I had clearly stated what methods worked for me. The failure occurred when that information was not carried forward and acted upon when critical communication was required.
The draft needs to go further. Where are communication needs and preferences recorded? Are they visible across the patient’s episode of care? Who is responsible for ensuring the appropriate adjustment is provided? How do we know whether it was effective? Is the patient asked? Is this measured and reported?
The draft states that health services should provide care so that safety and quality are not dependent on individuals, but are built into every system, process and environment. Communication accessibility should work the same way.
Broader issue
There is also a broader issue with how communication is framed. Much of the draft describes communication as the transmission of information from the health service to the patient or carer. But communication is not simply the delivery of information. It is a two-way process.
For communication to support safe, person-centred care, the health service needs to know not only that information has been provided, but that the patient or carer has been able to access it, understand it and participate in decisions about their care – and to do so in a timely manner.
This is particularly important when information is clinically critical. The draft requires prompt notification of critical information to the patient and requires critical results to be communicated, received, acknowledged and acted upon.
But what does “received” mean if the patient cannot access the communication method being used?
A message can be delivered without being accessible. Information can exist in a health record without the patient having timely access to it.
Communication accessibility should therefore be explicitly incorporated into clinical governance. Healthcare records should record patients’ communication needs and preferences and, ideally, what adjustments have been provided. Health services should be able to determine whether critical information reached the patient in a timely and accessible way and whether the communication was effective.
The third edition provides an opportunity to make this expectation explicit. It does not need to prescribe a single communication method. It should require health services to identify individual communication needs, record them, carry them across the episode of care, provide appropriate communication methods, ensure timely access to critical information and check whether communication has been effective.
If the new standards are genuinely intended to prioritise equity of outcomes and how patients experience care, communication accessibility cannot remain implicit.
It needs to be visible in the standards, embedded in systems and measured through clinical governance.
Because communication is not simply about whether information has been sent.
It is about whether the patient can access, understand and act on the information they need, when they need it, and participate meaningfully in decisions about their care.
When communication fails, care fails.
About the author
Michele Nealon is Hearing Coordinator at Macquarie University Hearing and Co-Chair of its Lived Experience Network of deaf and hard-of-hearing people. She is congenitally deaf and communicates orally.
See Croakey’s archive of articles on safety and quality of healthcare
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