Catastrophic failures in the NHS can be caused by basic communication breakdowns

The NHS sometimes struggles to manage basic communication systems that are often critical to the safety of patients. Writing in the Journal of the Royal Society of Medicine, Carl Macrae, of the University of Oxford, reports that many communication processes in the NHS are still commonly viewed as mundane administrative tasks, instead of safety-critical processes that are essential to safe care.

The systemic breakdown in NHS clinical correspondence handling, made public earlier this year, revealed that 709,000 items of clinical correspondence failed to be delivered between 2011 and 2016. Reviews suggest that as of 31 May 2017, around 1,788 patients may have suffered potential harm as a result.

A social psychologist focusing on organisational safety in healthcare and aviation, Dr Macrae describes the moment when he was told after a routine procedure 'We'll send that off to be tested. If you don't hear from us everything's fine.' He writes: "To someone who has been fortunate to research, work in and generally hang about safety-critical organisations for the past 15 years, this was immediately alarming.

"The assumption that no news is bad news - and that communication processes are fragile, prone to failure and need strong systems of internal checks and balances - have been essential features of safety-critical industries for decades. So why are these assumptions not yet systematically embedded in all areas of healthcare?"

Dr Macrae says that an immediate answer might simply be that healthcare systems are often under considerable financial pressure and are forced to make necessary and hard-nosed trade-offs between efficiency and safety. But, he writes: "Rather than making a conscious trade-off between safety and efficiency, it seems many of the risks associated with failures of communication are not widely appreciated in the first place. Assumptions that 'no news is good news' can hide the problem itself."