A recent study by Russell et al.1 set out to understand the role of communication in claims for alleged professional negligence. The study aimed to identify both the frequency and types of communications problems seen in small animal veterinary practice.
One hundred alleged professional negligence cases involving canine patients from the Veterinary Defence Society (VDS) were randomly selected, and all written documents (including clinical records, correspondence from both veterinary staff and owners, and VDS case documents) were obtained for analysis. A mixed methods approach was used; firstly, qualitative content analysis was undertaken to determine the frequency of communication problems, and to categorise how communications failed, who was involved, the effect of the communication problem and the patient outcome. Thematic analysis was then used to describe the nature of communication problems encountered in these cases. Finally, the written findings of the document analysis were presented to a modified focus group comprised of veterinary surgeons employed by the VDS, and a semi-structured script was used to determine the extent the findings resonated with the experiences of the participants.
Of the cases analysed, communication problems were deemed to have played a role in 80% of cases. A total of 170 individual communication problems were identified; 49.4% of these involved communication with the owner, 42.3% involved communication within veterinary teams in the same practice, and 8.2% involved communication problems between practices/organisations. When exploring how communication failed, 48.0% of problems resulted in failure of information transfer whilst the remaining 52.0% resulted in a failure to achieve shared understanding.
Thematic analysis of cases identified five themes associated with communication failure:
- Content: this included issues such as not recording sufficient information, errors in the content and content insufficient for the receiver.
- Context: this included how the physical environment, such as a busy practice, and previous client experiences affected the success of the communication.
- Channel: this included the impact of method of communication on the success of the communication.
- Systems: this included how factors such as staffing, work processes and organisational culture affected the success of the communication.
- Perspectives: this included veterinary staff and owners not necessarily understanding each other’s perspective.
The findings from the focus group supported both the qualitative content analysis and thematic analysis.
The findings of this study indicate that communication problems are a common contributory factor in claims for alleged professional negligence. The veterinary profession recognises that communication skills are a key requirement for veterinary staff, however, much of the discussion to date has focussed on interactions with the client, such as during consultations. Whilst the findings of this study support the need for continued support and training in this area, they also identify that communications between veterinary teams are equally as important, and present opportunity for increased focus on team communication.
Whilst this paper had identified areas for future discussion and research, the limitations of the approach should be considered. Firstly, this study analysed 100 cases of alleged professional negligence from the VDS; the cases may not be representative of all professional negligence cases and furthermore, a study involving a large sample size may be needed to validate the findings of this study. In addition, the claims records were not collected for research purposes and were reviewed retrospectively which may have introduced bias. Due to time constraints, it was not possible for a more formalised consensus building approach (such as a Delphi method) to be used. Finally, all cases were based on canine patients, and there may be differences in communication problems identified between species.
1Russel E, Mossop L, Forbes E and Oxtoby C (2022) Uncovering the ‘messy details’ of veterinary communication: An analysis of communication problems in cases of alleged professional negligence. Veterinary Record, 190 (3), e1068. Doi: 10.1002/vetr.1068