Masked communication: Impact of a purpose-built training program on communication effectiveness between staff and patients

Ms Rebekah Rajakone1, Dr Nicola Clayton1,2,3, Ms Rachel McKenzie1, Ms Helen Ryan1

1Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia, 2School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia, 3Faculty of Health Sciences, University of Sydney, Sydney, Australia

Background: Effective communication between healthcare professionals and patients is critical to ensure optimal and accurate care. The COVID-19 pandemic presents challenges to communication, including the use of surgical masks, in efforts to prevent potential viral transmission. The use of surgical masks can impact communication effectiveness by visually obstructing nonverbal cues and physically degrading the auditory speech signal within noisy healthcare environments. This can negatively impact perceptions of empathy and ability to interact informatively and collaboratively.

Aim: Evaluate the impact of 1) surgical masks on communication effectiveness, and 2) a purpose-built Speech Pathology-led training program to enhance communication effectiveness in masks, in the inpatient hospital environment.

Methods: A mixed-methods study design was implemented over two time-points (pre and post implementation of the training program). Staff and patients were surveyed for qualitative data on the impact of surgical masks on communication effectiveness, and an audit tool was used to obtain quantitative data on the frequency of communication breakdown during clinician-clinician and clinician-patient interactions.

Results: Preliminary baseline data suggests that clinicians and patients identify background noise, hearing impairment, accent and increased speech rate can impact communication success in the inpatient hospital environment. Baseline data has informed development of a training program targeting multimodal communication skills of staff via therapeutic strategies including ‘Clear Speech’ and ‘Total Communication’. Upon completion of the purpose-built training program being delivered to select inpatient wards, follow up surveys and audits will be conducted.

Conclusion: Implementation of multimodal communication facilitates communication success in the presence of a surgical mask.


Rebekah Rajakone is an experienced Speech Pathologist at Concord Repatriation General Hospital in Sydney with comprehensive experience in Neuroscience with refined clinical skills in communication disorders and dysphagia. She has taken on responsibility for Speech Pathology services to the respiratory and designated COVID-19 ward during the COVID-19 pandemic. She has a strong interest in the impacts of COVID-19 on communication and healthcare.

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