Communication Is Crucial: Why the Latest Evidence Demands We Transform How Healthcare Trains Its Workforce
Healthcare is at a crossroads. Despite decades of progress in safety systems, structured handovers, and reporting frameworks, one stubborn truth keeps resurfacing:
Communication failures remain one of the most pervasive and preventable causes of patient harm.
A major 2025 systematic review (Keshtkar et al., 2025) of 46 studies found that poor communication contributed to approximately one quarter of all patient safety incidents and was the sole identified cause in around 13% of cases. These failures spanned miscommunication, documentation gaps, unclear handovers, delayed escalation, and misunderstandings between clinicians, non‑clinical staff, patients, and carers.
This isn’t a niche issue. It’s a global one. And the findings reinforce what clinicians and educators have been saying for years: communication is not a “soft skill” it’s a crucial and foundational clinical skill.
Communication Failures Are Systemic.
I recently highlighted the systemic nature of communication breakdowns where I pointed to a 7NEWS investigation showing thousands of preventable hospital deaths in Australia linked to human error at moments when communication should be protecting patients, not compromising them. I argued that clear escalation, structured handover frameworks, and a Receiver Mindset can turn hesitation into timely action and save lives.
The systematic review by Keshtkar and colleagues echoes this reality: these failures occur across continents, professions, and care settings, signalling organisational, rather than individual failings.
Why Traditional “Speaking Up” Training Isn’t Working
One of the strongest critiques in the Reframing Conversations blog series is that most speaking‑up programs only teach how to voice a concern, not how to have the conversation that follows. They emphasise assertiveness scripts and escalation phrases, useful, but incomplete.
The blog “Why Speaking Up Training in Healthcare Isn’t Working — And What Needs to Change” argues that effective communication requires what many programs overlook:
genuine listening
emotional regulation
understanding power dynamics
responding constructively under pressure
These aren’t “extras,” they are the cognitive and social processes underpinning every clinical action.
The systematic review’s findings support this critique. Failures often arise not simply because someone didn’t speak up, but because the message wasn’t heard, understood, or acted on.
Scripts Aren’t Enough, especially in the age of AI
My recent post “Why Communication Training Matters More Than Ever in the Age of AI”, warns that as AI becomes more capable, it will excel at producing standardised communication; SBAR prompts, handover templates, escalation scripts. But AI cannot interpret emotion, read a room, understand cultural nuance, or respond to distress.
This reinforces an urgent point:
The future of safe communication will rely on the skills AI cannot replace: human adaptability, empathy, reflexivity, and relational awareness.
These are the very skills missing in many traditional communication programs.
Reframing Language: The Micro‑Skills That Strengthen Safety
Communication isn’t just about what we say, it’s how we frame it.
Negative or ambiguous language can trigger stress, impair cognition, and escalate conflict, making safety conversations harder. Techniques for reframing messaging, toward clarity, collaboration, and psychological safety, are central to shifting culture. This is especially relevant when navigating difficult conversations or de‑escalating patient and staff distress.
Healthcare doesn’t just need more communication; it needs better communication.
So, What Should Communication Training Look Like Now?
Bringing together the systematic review and the Reframing Conversations insights, a clear vision emerges.
1. Treat communication as a core clinical competency
It should be taught, assessed, practised, and embedded across the health professions pipeline, not treated as optional or “soft.”
2. Train both the sender and the receiver
The Receiver Mindset (Barlow et al., 2023) helps ensure messages land and responded to safely, especially under stress.
3. Develop adaptive, reflexive communicators, not script readers
Teams need to navigate nuance, rapid change, and emotional complexity.
4. Build deep listening into every program
We cannot expect psychological safety if staff are trained to speak but not trained to listen and respond in ways that support collaboration and shared understanding.
5. Ensure training is interdisciplinary
Because communication failures cross professional and organisational boundaries.
In conclusion: Communication Saves Lives: Let’s Train It Like It Does
If poor communication is responsible for a quarter of patient safety incidents, then improving communication is not just a workforce initiative, it is a priority patient safety intervention.
The evidence is unambiguous. The commentary from frontline leaders is consistent. And the skills needed for safe, human‑centred care cannot be automated, scripted, or standardised away.
Communication is a crucial clinical skill
It’s time our training, systems, and culture reflected it.
Want to know more? www.reframingconversations.com
Barlow, M., Watson, B., Morse, K., Jones, E., & Maccallum, F. (2023). React, reframe and engage. Establishing a receiver mindset for more effective safety negotiations. Journal of Health Organization and Management, 38(7).https://doi.org/10.1108/JHOM-06-2023-0171
Keshtkar, L., Bennett-Weston, A., Khan, A. S., Mohan, S., Jones, M., Nockels, K., ... & Howick, J. (2025). Impacts of communication type and quality on patient safety incidents: a systematic review. Annals of Internal Medicine, 178(5), 687-700. DOI: 10.7326/ANNALS-24-02904