“Some doctors type notes with their backs turned while I say things. I have aphasia. I need to be able to see people’s mouths and their eyes to help me understand.”

As a certified speech-language pathologist (SLP), I have spent most of my career working across the continuum of health care with people who have communication disabilities, such as aphasia. My patients have also included people with other acquired or developmental speech, language, voice, hearing, and cognitive-communication difficulties. I also have worked as a sign language interpreter in health care settings.

Often, patients share stories like the one above about the communication barriers they experience in health care encounters. They are frustrated with providers who are not guided by care plans and strategies for people with communication disabilities or presume them to be incompetent and exclude them from making their own health care decisions.

Some health care providers have shared with me that they are not sure how to best meet the needs of patients with communication difficulties. They want to be accommodating, but either they don’t know the best way to go about it, or they feel short on time and pressured to move on to their next patient.

Undeniably, time is a precious commodity in health care. Still, it often takes extra time to ensure that communication with health care providers is accessible for patients and aligns with their unique support needs. This is particularly the case when there are no established policies or procedures to ensure effective communication strategies and other accommodations for individuals with disabilities—some of which are legally mandated.

Nevertheless, it’s critical that health care practitioners take the time to make sure the needs of people with communication disabilities are met from the start of any encounter. This leads me back to the question I referenced at the outset of this column. By asking a person, “What communication supports do you need?” before you launch into a visit or other interaction, you can transform the patient experience and do your work more effectively.

Poorer outcomes, safety concerns

Research shows that people with communication disabilities have worse health and health care outcomes than people without communication disabilities—and that lack of effective communication access is a key contributor to these outcomes. Known health disparities in people with communication disabilities include more chronic conditions, avoidance or delays in seeking care, and higher rates of health care utilization.

Lack of effective communication also results in safety concerns like preventable medical errors and misdiagnoses or late diagnoses. Without effective communication, there is risk that a patient may not follow their treatment plan as intended.

All of this can result in significant costs. A 2018 study in Perspectives of the ASHA Special Interest Groups put the price tag of ineffective communication associated with adverse events in U.S. hospitals at $29 billion annually.

Communication access support for medical professionals

As one remedy for what I’ve reported, the American Speech-Language-Hearing Association (ASHA) recently launched a new initiative: Communication Access. It is centered on the idea that “Better Health Starts with Effective Communication.” The primary goal of the initiative is to improve health equity and outcomes by advocating for effective communication access prior to starting care.

What is effective communication access? It is when there are resources in place to support patients’ communication needs so that everyone in a health care interaction has equal opportunity to share, receive, and understand information in ways that work best for them.

At the heart of ASHA’s initiative is the ACCESS framework. It outlines six core principles to help ensure that the health information we give or receive is inclusive of people with communication disabilities:

Ask about communication preferences, strategies, and accommodations before care begins.

Communicate directly with the person unless specified otherwise.

Confirm understanding of information given and received.

Eliminate environmental distractions—and give your full attention.

Slow down to allow time for processing information and responding.

Support interactions using different communication methods—like gestures, writing, drawing, pictures, communication boards, videos, or assistive technology.

If we all commit to these principles as a standard of care, people with communication disabilities can have the same opportunities to participate in quality, patient-centered health services as people without communication disabilities. Many of these principles cost little to nothing to implement and are steps that could be taken individually and immediately. In the end, we all benefit.

Where to turn

Support for improving communication access for you and your patients is available in several ways. Audiologists and speech-language pathologists (SLPs) in hospitals, medical practices, and other health care settings can provide training and tools for proactively navigating various communication touchpoints (e.g., appointments, signage and forms, direct patient care and education, billing). They can also offer insights about how to:

• Communicate complex messages to individuals with communication disabilities in different formats.
• Create accessible health information and services for varied communication support needs.
• Integrate accommodations, strategies, and assistive technologies to support efficient exchange of clear, accurate information.
• Modify policies or environmental factors that are barriers to communication.

In addition, they can work with people who have communication disabilities or with their care partners, providing them with tools to self-advocate for communication access and share health concerns by:

• Addressing health-related vocabulary and ways to explain medical issues.
• Practicing communication strategies and how to request accommodations for health care.
• Preparing health records, visit checklists, and communication access plans.
• Programming assistive technologies and creating augmentative/alternative communication aids.

Don’t hesitate to reach out to an audiologist or SLP in your area or health system for support or to make patient referrals.

The more we champion effective communication access when providing health care to people with communication disabilities, the better the outcomes for everyone involved.

Adena Dacy is a speech language pathologist.