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

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.”

Notes to editors

When no news is bad news: communication failures and the hidden assumptions that threaten safety (DOI: 10.1177/0141076817738503) by Carl Macrae will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 29 November 2017.

The link for the paper when published will be:

For further information or a copy of the paper please contact:

Rosalind Dewar
Media Office, Royal Society of Medicine
DL: +44 (0) 1580 764713
M: +44 (0) 7785 182732

The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi.

JRSM is a journal of the Royal Society of Medicine and it is published by Sage Publishing.

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