Communication lies at the core of healthcare. Be it patient-clinician or clinician-clinician. When communication errors or omissions occur, failures in care and poor outcome ensue. The impact of these failures on patients can be devastating and a topic of a future post. Here, we focus on the the financial implications of communication failures on health systems. Can we quantify these costs on a system level?
Non-adherence to medication
We know that clinician-patient communication is central to patient's adhering to their medication. This communication encompasses everything from prescribing the right medication, explaining how and when it should be taken, to being reactive to side-effects. All of these aspects can impact a patients medication compliance. Any breakdown in this communication can affect adherence. The 'all cost' i.e not just the cost of wasted medicines, annually to health systems is given below-
Region | Annual Cost (in billions) |
Europe | 125 EUR |
USA | 100-290 USD |
These costs relate to the domino effect on health systems of patients not adhering to prescribed treatments. Patients that do not adhere to treatment are re-admitted to hospital more often, they access more healthcare and undergo more diagnostics and ultimately have worse outcomes. These are real and mostly avoidable costs associated with poor communication surrounding medication compliance.
Missed appointments
Appointments that are missed are particularly detrimental to health systems. This is due to the fact that not only may the original appointment need to be re-booked, but the delay could lead to worse eventual clinical outcomes. The missed appointment deprives another patient of commencing their healthcare journey as well.
It is estimated that missed appointments cost US health systems $150bn annually. In January 2023 in England, 5.9% of GP appointments in London were lost due to patients failing to attend according to NHSDigital statistics. Coupled with rising waiting times for treatment, addressing missed appointments must be central to any health service delivery improvement strategy.
Causes of missed appointments are of-course multifactorial, with some being genuinely unavoidable. However, with adequate notice and clear two-way communication paths in place avoidable non-attendance can be mitigated.
Increased errors and adverse events
Whether it be at shift-change, or hand-over between services or after discharge, poor communication can directly lead to patient harm. Data from a white paper published by Joint Commission International, revealed 80% of all adverse events were attributable to poor communication. Mean total costs of malpractice claims that involve communication failures are significantly higher than those that did not ($237,600 vs. $154,100) according to a study in the Journal of Patient Safety in 2022.
Negligence claims
While not all negligence claims are the result of poor communication, poor or ineffective communication is consistently identified as an important contributory factor in negligence claims.
82% of patients surveyed by a medical indemnity provider stated they would be unlikely to complain if their doctor communicated openly and with empathy.
£2.5bn were paid out by the National Health Service in clinical negligence claims in 2021-22. The provision for future liabilities expected to fall due for settlement 'in the future' stands at £128.6bn according to NHS Resolution. To put things into perspective, that sum is 3x the annual national defence budget for the United Kingdom. Interestingly, of this sum, £1bn has been specifically set aside for COVID-19 related claims.
Potential solutions
Whilst there is no 'silver bullet' consideration of the following can make a start to mitigate or reduce the degree and impact of communication failures:
1. Standardising communication protocols can help to ensure that all healthcare providers are using the same language and terminology. This can reduce the likelihood of miscommunication between healthcare providers and with patients. Furthermore, standardising and personalising the information patients receive, at the right time for them, is critical in the ever more complex contemporary delivery of healthcare.
2. Using technology to improve communication such as electronic medical records that patients have access to, secure messaging systems, and electronic reminders can help to improve communication between healthcare providers and patients. Ensuring patients have friction-free means of communicating non-attendance using technology can offer longer-term system savings.
3. Encouraging patients to engage with their healthcare can help to improve communication between healthcare providers and patients. Moving to more of a communication "Push and pull" where patients can request information (Pull) as well as being sent it (Push) will drive greater engagement.
4. Systems aware communication technologies that complement and seamlessly integrate with clinicians workflows rather than integrate technologically with existing systems are a priority. Poor user-experience and physician technology burnout must be at the forefront of any novel technology development.
A word of caution
Beware the unintended consequences of any implemented solution. An insightful article by Dr. Michael Stillman MD, an internal medicine specialist entitled-
Death by Patient Portal, JAMA, 2023
Laid bear the tremendous pressures and stresses associated with responding to patient messages via a patient portal. He was spending hours a day responding to an ever growing number of messages that contributed to his feeling of burn out.
The cost of any communication 'improvement' on clinicians well-being may not be as easy to calculate as the costs of malpractice claims, but awareness of any unintended consequences of well-meaning interventions, should be at the forefront of any responsible organisation.
Summary
The financial costs to healthcare systems of poor communication are demonstrably both significant and substantial. Marginal improvements in communication, by using carefully considered technology and encouraging greater patient engagement can have huge financial benefits and importantly, improve care for patients. In the value-based era of healthcare delivery, optimizing communication is a priority for all stakeholders.