Australia’s next set of national health safety standards is being drafted, with public feedback open until September 25. Advocates say the proposal lacks clear rules for how hospitals must communicate with patients who are deaf or hard of hearing.
Michele Nealon, a hearing coordinator at Macquarie University and co-chair of its Lived Experience Network, states that communication accessibility goes beyond providing interpreters. Patients must be able to receive, understand, and act on information when it matters most.
“Diagnoses are explained, consent is obtained, and treatment plans are understood through communication,” she writes. “When it breaks down, care suffers.”
A 2024 review found persistent barriers in healthcare settings, while research from the UK showed many professionals lack training to adapt to deaf or hard-of-hearing patients. As a result, patients often have to repeatedly request accommodations instead of having them built into the system.
Needs differ—some depend on hearing technology and spoken language, others on captions, speechreading, or sign language interpreters. No single approach fits everyone.
A 42-hour gap in critical information
Nealon faced this issue after a biopsy. A lymphoma diagnosis was recorded in her health record, but she remained unaware of it.
She had requested written information or a virtual consultation with captions. The specialist called multiple times without providing either. For 42 hours, she couldn’t access information that could influence her treatment decisions.
“I knew something clinically significant had happened, but I didn’t know what it meant,” she writes. Her blood pressure rose, and her family noticed her distress. The health system had shared the information internally—but not with her.
The problem wasn’t availability. The delivery method simply didn’t match her needs, despite her clear instructions.
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The draft standards fall short
The current draft of the National Safety and Quality Health Service Standards includes strong language about effective communication and person-centered care. It requires health services to identify and respond to communication needs, including accessibility preferences, and to provide adapted methods for shared decision-making.
Nealon highlights a gap: identifying a need isn’t enough. In her case, her requirements were documented, but the system didn’t follow through when it counted.
“Where are communication needs recorded? Are they visible across the patient’s care episode? Who ensures the adjustment is made? How do we confirm it worked?” The draft leaves these questions unanswered.
The standards aim to shift from compliance to consistent, high-quality care. Without explicit requirements for recording, tracking, and verifying communication accessibility, patients may still be overlooked.
Nealon argues that communication should be treated like any other safety measure—embedded in systems rather than relying on staff memory. “A message can be sent without being accessible,” she writes. “Information can sit in a record without the patient receiving it in time.”
The third edition could address these issues by requiring health services to:
- Record patients’ communication needs and preferences in their health records.
- Ensure those needs follow the patient throughout their care, not just at the first contact.
- Provide necessary adjustments—such as captions, interpreters, or written summaries—without repeated requests.
- Confirm critical information was received and understood, especially in urgent situations.
- Track whether communication was effective, not just attempted.
The draft acknowledges that safety shouldn’t depend on individual effort. The same principle should apply to communication. For truly equitable outcomes, accessibility must be a priority from the start.
“When communication fails, care suffers,” Nealon writes. The new standards will determine whether it’s treated as a patient safety issue or left to chance.
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