Bridging the communication divide and tackling health inequality

Communication barriers in healthcare have far-reaching implications and are a key contributor to health inequality.

Now, a unique app is aiming to bridge the communication divide through the power of digital. 

People with limited English proficiency, sensory impairments and cognitive challenges often find themselves grappling with a healthcare system that fails to bridge the language and understanding divide.

These barriers not only hinder patients’ understanding of their conditions and treatments but also contribute to health inequality, disproportionately affecting vulnerable populations.

Although this struggle existed long before the pandemic, the crisis brought it to the forefront, exposing an urgent need for innovative solutions.

During the pandemic, language barriers coupled with muffled voices and faces obscured by increased PPE made comprehending vital medical information an uphill battle for patients with little or no understanding of English.

For much of this time, patients were unable to bring family members into the hospital with them which only exacerbated the issue.

Communication challenges extend beyond the language barrier. Often for patients with hearing impairment, healthcare providers assume they can effortlessly read written English.

But in many cases, English is a second or third language after Sign Language so communicating via written notes may not always be possible.

These assumptions only deepen the chasm, leaving patients frustrated and confused about their condition and treatment.

Communication barriers are known to have a detrimental impact on patient outcomes and experiences.

Research consistently reveals the correlation between poor communication and worsened health outcomes.

Patients who cannot effectively communicate with their healthcare providers face increased morbidity and mortality rates. They struggle with medication adherence, experience higher rates of mental health issues and endure longer hospital stays or unplanned readmissions.

An estimated 30 per cent of medical litigation in the US stems from communication breakdowns in healthcare.

It is within this context that CardMedic emerged as a promising alternative, leveraging the power of digital tech to foster improved communication between patients and clinical teams.

Founded by Rachael Grimaldi, a senior anaesthetic registrar in the NHS, CardMedic is designed to break down communication barriers in a hospital setting.

It presents a comprehensive library of pre-written scripts replicating common clinical conversations and accommodating 49 languages. Features include multilingual translations, easy-to-read text and sign language videos.

“CardMedic was designed initially during COVID […] to address the acute crisis in communication and healthcare caused by PPE, and against the background of long-standing barriers to good communication in healthcare.” Dr Grimaldi said.

When the first lockdown hit, Dr Grimaldi became stranded in the US after visiting to see family while on maternity leave.

She felt “desperate” to be with her colleagues on the front line and couldn’t help but be “glued” to the news.

“I read about someone who’d been to intensive care with COVID, and was terrified because he couldn’t understand health care staff through PPE,” she said.

“This patient looked like he was in his 30s, he didn’t have any obvious communication problems and he spoke English.

“I thought, if he’s struggling, what about everyone else that doesn’t speak English, or is deaf or has a learning disability and so on.”

Rethinking traditional approaches

While hospitals are legally required to provide translators and interpreters, limited capacity means clinicians must often rely on DIY solutions, including the use of handwritten notes, communicating via friends and family, or simply speaking louder to patients or at a slower pace.

Dr Grimaldi said: “If you can’t communicate with someone because of a language barrier, you would ideally contact a translator and interpreter, but there are lots of challenges around that; logistical challenges, timing, or you might not have the hardware like a phone.

“Hence, the gaps in service provision.

“What people end up doing instead is relying on friends and family to communicate, or they pull in other staff members, but they may or may not have medical [knowledge].”

Even if a clinician has access to a translator, obstacles can still arise.

The interpreter will often be called in remotely which can bring about issues with background noise.

And while there are many translators who are well-equipped to deal with the complexities of a medical setting, others “lack nuance” due to insufficient training, Dr Grimaldi said.

How communication barriers feed into wider health inequality

Communication barriers are known to fuel health inequality, exacerbating existing disparities within the healthcare system.

The social determinants of health, such as housing, education and income, intertwine with language barriers, cultural differences and limited accessibility, forming a complex web that can perpetuate a cycle of inequity.

While healthcare providers strive to deliver high-quality care, an inability to communicate with patients can hamper their efforts.

“For patients who don’t understand healthcare staff and have a communication barrier, their outcomes are a lot worse,” Dr Grimaldi said.

“They have increased morbidity and mortality, they’re less compliant with medication, they have more mental health issues, they stay longer in hospital and they’re more likely to be readmitted to hospital in an emergency.

“Ultimately, if they don’t understand the healthcare providers, they don’t understand the condition, what it is, what the prognosis is, what the potential risks are, why they need medication and for how long.”

Aside from language barriers, more nuanced cultural differences can also contribute to failed communication between patient and clinician.

CardMedic seeks to address these nuances by enlisting care professionals from a broad range of cultural backgrounds to ensure that the app is “human translated and culturally appropriate”, Dr Grimaldi said.

The app also includes informative content for individuals who may be unfamiliar with the UK healthcare system, helping them access and navigate the NHS.

CardMedic in action

CardMedic is now in use in 25 hospitals across the UK and the US, including five integrated care systems.

So far, the platform has yielded promising results in breaking down communication barriers.

Clinical staff at The Christie, Europe‘s largest single-site cancer centre, have had their share of difficulties communicating with patients.

“On a 12-hour shift, we would normally only have an interpreter on the ward with us for one hour to help us have the most important conversations about a patient’s care,” said Bethany Allen, oncology staff nurse and digital nurse implementer at The Christie NHS Foundation Trust.

“For the other 11 hours, at times it could be really difficult to communicate.”

The Christie was the first specialist cancer care provider to deploy CardMedic.

By rolling out the app to over 100 users, the centre has since observed improved patient experiences and reduced reliance on face-to-face interpreters.

“Since using CardMedic, we have been able to bridge a major gap in service provision and be assured that we are communicating with patients effectively and sensitively, which is essential in cancer care,” Allen added.

The road ahead

Advancements in artificial intelligence (AI) and translation tools offer exciting opportunities to further enhance tools like CardMedic.

The integration of AI technology could provide real-time translation services, voice recognition and facilitate personalised care recommendations.

CardMedic’s future plans include expanding its functionality and collaborating with healthcare partners to develop specialised content, tailored to specific medical specialties and conditions.

“We have a lot in our roadmap,” Dr Grimaldi added.

“We are actively looking at ways to harness AI to scale the platform, but at the heart of it will always be the human experience and the clinical experience.

“There are a lot of potential partners to collaborate with which is really exciting.

“There’s a lot in that space in terms of increasing our offering and in terms of how patients and staff interact with it. It’s going to keep us busy for the foreseeable future.”