The theme for this year’s World Health Day (7 April) is building a fairer and healthier world for everyone. Making sure all patients can access and understand healthcare information is absolutely key to this.
In this interview, anaesthetist Rachael Grimaldi tells us about CardMedic, the organisation she founded to empower staff and patients to communicate across any barrier. Rachael explains how their tools can be used to support vulnerable groups and reduce inequalities.
Questions & Answers
Hi Rachael, how would you describe CardMedic in a nutshell?
CardMedic is a website and app designed to improve communication between frontline healthcare staff and patients, across any barrier. Whether that’s visual, hearing or cognitive impairment, language barriers or PPE (personal protective equipment). CardMedic is an A-Z collection of digital flashcards that replicate clinical conversations around common healthcare topics. It’s available in Easy Read with pictures, Sign Language videos, read aloud mode and it’s multi-lingual. We also host an integrated translation tool.
It’s designed to improve patient safety, experience and quality of care, and to lower health inequalities by reducing the risk of miscommunication. The attached document will tell you a bit more about us.
What inspired you to set up the organisation?
Last year, I was in the States visiting family, during the pandemic. We had our flights cancelled several times and couldn’t get home. During that time, I read a news story about a patient who was terrified because they couldn’t understand healthcare staff through the PPE barrier.
I was desperate to do something to help. How were people coping? What were they doing to communicate through PPE? Were they writing notes on a piece of paper? What’s the solution? Nothing seemed scalable for the pandemic.
But then I thought…
What if I replicated those conversations so that healthcare staff could easily access them, choose a topic, show the patient a screen and guide the discussion from there?
It was concept to launch in 72 hours and it was very much inspired by a desire to help staff communicate through PPE, and help my friends through the pandemic. Actually, what rapidly came about through feedback from frontline users, staff, patients and the public, was that this is a really useful tool that needs to stay around after the pandemic. They highlighted the many long-standing barriers to good communication in healthcare that pre-dated the pandemic and will continue long after. This inspired us to develop CardMedic much further than originally planned.
How can communication barriers impact health inequalities?
Barriers to good communication in healthcare can massively impact on health inequalities. If patients are unable to understand the healthcare information that is being provided to them it can lead to anxiety, reduced compliance with medication, mental health problems and reduced interaction with healthcare settings. This can lead to increased risk of co-morbidities and can widen the health inequality gap.
Patients who have underlying communication issues account for 20% of the UK population, and they are less likely to seek healthcare support or intervention if they’re unable to understand the staff looking after them. There’s a certain level of embarrassment around it, a fear of not being able to understand them or vice versa. It just widens that access gap to healthcare and ultimately worsens outcomes. This is obviously worse for the patient but is also a burden for the healthcare system in the long term.
Which patient groups do you feel are most vulnerable to communication barriers?
I think it’s a whole range from children up to very elderly patients, including those who have visual or hearing impairment. Particularly those who rely on sign language alone, as English may be their second or third language. They may struggle to understand written English and are definitely vulnerable. Those who speak a different language are at risk too, as are those with literacy issues (which impacts nearly 15% of the adult population of the UK).
The pandemic has also thrown in the communication challenges presented by PPE.
How is CardMedic helping staff and patients to overcome those barriers?
When people are unwell, they are stressed and anxious. It can be challenging to take information on board at the best of times and without any barriers to communication. Add an additional communication need into the mix and these patients are at far greater risk.
We aim to support patients and staff by presenting jargon-free clinical information, simply and succinctly. Staff can ‘flex at the point of care’ to overcome any communication need, at the touch of a button, converting content to Sign Language, Easy Read, read aloud or a different language. If conversations expand beyond the cards, we also host an integrated translation tool to support two-way communication.
How are patients involved in the development of your communication tools?
Since last spring, we have been working with an absolutely fantastic group of volunteer Speech and Language Therapists and Learning Disability Nurses from across the UK, to develop CardMedic into Easy Read English with pictures. They have brought untold expertise and invaluable input into the design and content style and we’re very grateful! They have also provided support in collating feedback from a number of user groups, including patients who have had a stroke and those with acquired brain injury, aphasia and dementia. We will continue to expand our user groups and have been really proud to work with the Alzheimer’s Society recently to gather user experience input. Feedback from patients, public and frontline staff is absolutely vital in order to allow us to make rapid live enhancements to CardMedic as well as integrate new features, content and functionality into our roadmap. We are curating this through emails, Twitter, LinkedIn, webinars, podcasts and conferences.
Can you give an example of when CardMedic has influenced care?
We were speaking to a Speech and Language Therapist who works in a hospital in the States. They had a 16-year-old patient who only spoke Spanish. He had been taken off a ventilator and was struggling to breathe. They had no interpreter present, but they were able to play some of the content on CardMedic in Spanish. This really reassured the patient and calmed them down. An interpreter arrived later on which of course helped, but CardMedic was able to bridge that gap. And that speaks to exactly what we are trying to do – bridge huge gaps in service provision in the NHS and improve patient safety, experience and quality of care, and reduce health inequalities.
Are there any broader changes (beyond CardMedic) that you believe need to happen to support better communication between healthcare staff and patients and reduce health inequalities?
Despite legislation necessitating support for patients with additional communication needs and demanding healthcare providers offer information in an accessible format (e.g. Accessible Information Standard, Equality Act, Human Rights Act), the reality is that there is a huge gap in service provision. The logistics of organising translators, signers, Speech and Language Therapists, and Learning Disability Nurses to support every patient, every time they need it, is extremely challenging and results in ‘quick fix’ solutions; healthcare staff often rely on other staff, Google Translate or the patient’s family, friends, or even children, to translate complex and personal medical information and it’s just unethical. In an ideal world, hundreds of millions more pounds would be spent supporting these services, but it isn’t feasible. That’s exactly why we are now trying to provide a cost-effective solution to bridge this gap and complement existing services and offerings.
What's next for CardMedic?
We are building up the content and we are about to add our Easy Read with pictures and our Sign Language videos to our emergency content. We’ve just launched our commercial subscription model for healthcare settings, whilst ensuring all our emergency content remains free for staff and patients through the CardMedic Lite platform for use anytime, anywhere (pre-hospital / primary care / residential care / hospitals / dentists / pharmacies etc). It has restricted content, but all the functionality as mentioned and is free to end-users. Then our subscription models allow access to all content, features and functionality, and are also free for staff and patients.
Is there anything else you would like to add?
We are extremely proud and very excited to be working with our first pre-hospital beacon site, KentSurrey Sussex Air Ambulance Trust!
There are many other exciting things in the pipeline, but I can’t say much more at this point so please watch this space!
Find out more and stay connected:
Reducing health inequalities and improving patient safety
Are you passionate about improving healthcare communication? Do you have a project to share that has helped break down barriers and improve patient safety and outcomes? Perhaps you’re a patient who has experienced communication barriers in healthcare and would like to share your experiences?
Patient Safety Learning would love to hear your insight. You can get in touch with us at firstname.lastname@example.org. Don’t forget to also sign up to the hub (for free), to access the full benefits of being a member of our online patient safety community.