Why clarity is assessed on real documents
Clinics tend to assess communication by reviewing the templates. The templates are usually fine, because they were written carefully once. What patients receive is often not the template: it is the template with three additions made in a hurry, sent through a channel it was not designed for, at a moment when the patient is anxious.
This rubric therefore asks for three real documents, sent to real patients, in the form they were sent. A pre-treatment instruction, an aftercare instruction and a consultation follow-up cover the three moments where failure has the highest consequence and the different failure modes: the first is often too late, the second too long, and the third too vague to act on.
The criteria are drawn from the same principles that public bodies use for guidance that must be followed by people under stress. Purpose first, one idea per sentence, ordering by time rather than by category, numbers rather than adjectives for timing, and an explicit statement of what counts as a problem. None of this is stylistic preference. Each addresses a specific way that instructions fail.
The tenth criterion, testing on a real reader, is the one clinics skip and the one that finds the most. Reading a document aloud to somebody who has never had the procedure, then asking them what they would do tomorrow morning, takes ten minutes and reliably reveals two or three instructions that do not survive contact with a reader. The GOV.UK content design guidance sets out the same discipline in more detail.
How to score the three documents
Score each criterion once across the three documents, taking the weakest. A clinic whose aftercare is excellent and whose pre-treatment instruction is confusing does not have clear communication; it has one good document.
For plain vocabulary, mark every word a reader outside healthcare might not know. Do not exempt words that feel ordinary inside the clinic. Erythema, oedema, prophylaxis and even the word topical are routinely marked by lay readers.
For actionability, convert each instruction into an action beginning with a verb. If the conversion is not possible, the instruction was not actionable. "Avoid strenuous exercise" converts to "do not run, lift or attend the gym"; "be careful with the area" does not convert at all.
For ordering, list the instructions in the order the reader will need them and compare with the order they appear. Aftercare documents commonly put the twenty-four hour instructions after the two-week ones because the clinical categories dictated the sequence.
For testing, score 0 unless somebody outside the clinic has actually read it and been asked what they would do. Intending to test scores 0.
Common scoring errors
Scoring the template rather than the sent document. Ask for a real example, including whatever was pasted into the email above it.
Confusing brevity with clarity. A short document that omits escalation thresholds scores worse than a longer one that includes them. The rubric does not reward compression.
Scoring vocabulary from a clinician's ear. Have a non-clinician mark the terminology. Clinicians systematically underestimate which words are technical.
Accepting a general phone number as a contact route. The criterion asks for hours and an out-of-hours alternative, because the anxious call happens at nine in the evening.
Treating a reassuring tone as an escalation threshold. "Contact us if you are concerned" places the diagnosis with the patient. A threshold says what to look for.
Where clarity work pays back
The return on this work is not primarily reputational. It is operational, and it shows up in the volume of avoidable telephone calls, in the proportion of patients arriving having done the pre-treatment preparation, and in how early a genuine complication is reported.
Clinics that rewrite aftercare against these criteria commonly find that calls fall in one category and rise in another: fewer calls asking what the instruction meant, more calls at the right moment about the right thing. That is the intended outcome, and a clinic measuring only total call volume will misread it.
Once the three documents score well, extend the rubric to the next tier: consent summaries, price confirmations, appointment reminders and the message that follows a declined booking. The aftercare completeness checklist assesses whether the content is complete, which is a separate question from whether it is clear, and both matter.
If any of your material is used by patients with visual, cognitive or language needs, run the accessibility and readability audit as well. Clarity and accessibility overlap but a document can be plainly written and still unusable with a screen reader.