A universal service requires universal listening – Dr Andrew McCulloch on communicating with diverse groups
NHS England’s recent finding that the healthcare service is failing transgender people, and not treating them equally to other patients, raises interesting questions around prejudice, and the need for further efforts to achieve equality in health and social care.
Often when people think of prejudice they often associate it with a specific characteristic that can be discriminated against. e.g. racism, sexism, ageism etc.. But in truth, prejudice comes in many forms. Whether we acknowledge, or admit them or not, we all have them, and are in some way affected by them.
A prejudice is not so much about having a grudge against a certain group of people, as it is about our personal effectiveness as an individual. Ultimately, how well we listen, whether we welcome that other person’s input, and crucially, if we communicate with them in the appropriate way that they like to, determines our effectiveness as clinicians, managers or researchers. Examples may be; sign language, speaking in another language, adopting a softer tone or speaking at a slower pace. Or in the case of the transgender community, referring to someone by using the right pro noun and addressing them naturally and comfortably.
Failure to meet another person on their communication level is not only insensitive, but massively damaging to the interaction itself. An effective approach to communication with diverse groups is key in a healthcare setting, not because it is the politically correct way to behave, but because not doing so can have a massive negative impact on a patient’s experience, and lead to serious health inequalities.
No matter who you are, if you go to a service and have a negative experience, (for example; a senior citizen being told “this is for young people,” or a trans-person being addressed with the wrong pro noun), it will form a lasting memory, with a lasting negative impact, that can result in the individual not returning to the said service. A choice that could prove to have detrimental health implications.
To communicate effectively with a service user, you have to understand their needs and preferences, and this is impossible without effective feedback.
Good communication starts with feeling comfortable – getting someone to open up and share personal details about themselves is impossible if they do not. Sometimes it’s not so much the communicator’s unconscious prejudice that has to be considered, but the service user’s. Sexually abused women for example, may not feel comfortable discussing personal details with men, instead they may feel more at ease doing so with their peers – someone from their specific group. Healthcare providers can support and facilitate service users to collect some of their peers’ views on behalf of providers.
The same principles apply to constructing surveys, they must be built around the needs and interests of the target group. To be effective, consistent consultation is required and researchers must work with that group to establish what their priorities are, and how they wish to communicate.
Focus groups help to ensure that the core principles of a tool relate back to the needs and priorities of the patient group. And that whether communicating verbally or on another platform, we are receptive to their needs, and listening appropriately at all times.
An effective survey is also targeted and objective. One way of achieving this is to work with local patient groups, inviting them to comment on survey data results, and breakdown the meaning behind them in real terms.
Whether qualitative or quantitative, an instrument or methodology has to be built around the needs and preferences of the group. Otherwise the final tool and questions could be seen as irrelevant or worse, alienating and fuelling a negative experience.
Understanding that people’s experiences differ, and need to be captured in different ways, depending on their patient group and condition, is key to Picker’s mission. Our full commitment to enabling and supporting colleagues to listen to and capture diverse voices is reflected in our array of varied and impactful projects. For example, the recent PREM that we developed for people living with Sickle Cell Disorder, is now available nationally, and the responses being used to inform key care improvements. Our continued collaboration with the Motor Neurone Disease Association (MND Association), looking at people’s experiences of end of life care also continues to have impact. The publication; End of Life: a guide for people with motor neurone disease, created by the (MND Association), and formed around evidence from our research study, has just been awarded Patient Resource of the Year at the British Medical Association (BMA) Awards.
Our dedication to diversity does not stop at our external outputs, but is also being driven internally via the implementation of diversity and communications training for all staff. As well as an understanding of the need for workforce diversity, that is welcoming to others.
Though the health of transgender people is not an area we have covered in the past, as an organisation driven by the ethos that all experiences matter, it raises issues for us that we must consider going forward. We constantly have to re-evaluate our offering and whether it is relevant or needs to be adapted to include a particular group. Language is key for trans people, so we are going to have to give some thought to whether people are comfortable with the language we use.
Being diverse is not about who you are. Your genetic make-up or background does not affect whether you understand diverse communication needs. This requires the ability to do two things; reflect and respect. If you respect everybody you will naturally recognise their need to have their voice heard, and to be communicated with in a way that is sensitive to their needs.
Everyone has the right to have their voice heard on every level, including in healthcare, and failure to listen or communicate effectively risks excluding specific patient groups, leaving them feeling that the service and care available is not for them. If health and social care are universal services, universal listening is the only way to keep them that way.