Improved healthcare communication will only ever be achieved when the context is right and is understood
While compelling, the Health Service Journal’s recent research finding of a link between NHS Staff Survey results and Care Quality Commission ratings is not necessarily surprising, as patient and staff feedback collection is a known, effective and valid means of gathering data about quality improvement in healthcare. The article only reinforces its value, and perhaps more fundamentally, highlights the need for all healthcare providers to triangulate quality assessment across the key dimensions – inspection, outcome, staff experience and patient experience. A proactive approach to staff and patient experience improvement can and will support increased care quality.
Positive patient experience starts with understanding its core attributes; involvement, co-ordination and communication. Flagged as an area for improvement in both this year’s Inpatients and Staff Survey, communication is a general cause for concern for staff and patients alike. The reason for this may lie in how frequently it is perceived as having happened effectively. How well an individual, organisation or system engages with a patient is the key: being “good” must be achieved from the patient’s perspective. In a healthcare setting a complex fusion of factors affect the transmission of messages between people – more likely than not, multiple people. The likelihood is that the message shared will pass through a process that includes multiple players from different settings. All of which are important and need to be considered. It is why effective communication, whilst a constant priority, should not be considered in isolation. Indeed involvement and co-ordination of care are not only equally vital to quality but equally dependent on effective communication and engagement.
While individual responsibility is necessary, it is not the only consideration. Over focusing on this may only serve to undermine front line staff’s confidence creating further barriers. Instead if staff are supported, trained and encouraged to understand the value of strong communication in patient satisfaction & experience, better communication can be used to improve quality of care.
The overall effectiveness of any quality improvement in healthcare communication depends on four elements:
1. The person or agency creating the content
While this statement in part refers to the communication skills of the individual, it applies just as much to the impact of an organisation as a whole. Quality communications are modelled within an organisation, and begin with providers acknowledging and promoting the value of strong communications networks, not just between clinicians and patients but in all areas of the service. Equally, behaviour is learned, and individuals operating in an environment that promotes strong communications and transparency, will not only understand the value of a superior approach, but are much more likely to adopt the positive skills and behaviours around them as personal norms. The same is unfortunately true for negative behaviours.
So does quality improvement in healthcare only come from individuals and providers? Whilst individual desire and organisational culture can be the strongest drivers of change we must also consider how the system could support quality improvement. Medical school curriculums still contain very little syllabus time focused on personal interaction, and communication skills. However, the evidence that these are vital in the delivery of positive patient experiences and high quality care, holds. Locally, we are starting to see health care providers driving such change with their education partners such as Oxford and the North East of England, but these incidences are patchy and effort must be made to ensure national engagement. The picture is similar in terms of continuing professional development with little effective measurement of individual clinicians “soft skills” even with the advent of the revalidation programme. Again leading professionals such as Professor Ben Bridgewater of UHSM are driving change here, but as yet we have no solution at a system level to improve personal practice.
2. Channel effectiveness
It is often said that “it is not what you say, but how you say it” that matters, and that is definitely true of the healthcare environment. Whether a conversation, a letter or distancing body language, using the right method of communication and appropriate tone to suit the purpose or audience, is key. A big part of that is dropping the jargon. In everyday life people tend to speak in restricted code – without formality. However medical professionals have been known to lean on elaborated code or professional terminology that ultimately means nothing to their patients. The misconception is that it shows authority and credibility, but in reality for most patients it is often objectifying, incredibly distancing and ultimately counter-productive.
3. How ready / able the person receiving the information is to take, process and understand the message
A clinician can communicate perfectly and all other organisational boxes can be ticked but ultimately a consultation will not be successful if the patient does not listen. Whether that is because they are too frightened or confused, the chosen format does not work for them, or they simply do not want to; if they are not ready or able to understand the message then it won’t get through.
Therefore timing and approach to messaging are vital. Healthcare professionals need to comprehend the necessity of planning messages and understand the potential implications that not doing so may have both on the patient and the success of the overall exchange. For example, if a doctor knows they are going to be delivering bad news, it might be in both parties interests to encourage a patient to bring a family member along. This person can offer both emotional support to the patient, and communications support to the staff member, by understanding and taking in the information that the patient themselves, having received life changing information, are perhaps no longer able to.
Education is also as important a consideration for the general public as it is for health and social care staff. From compulsory education PSHE lessons through to supporting health literacy, to regular care updates, patients need to be better educated in ways that will enable them to use and process information.
4. Understanding whether the communication has happened effectively from the patient perspective
Outside of this, there is one tool and driver that supports an improved approach in all three areas, and it is here that we return to where we started; feedback. A measured, continuous and effective approach to patient and staff experience data is key to both the quality of an organisation’s communications and quality of care in general. You only have to look to the UK’s top performing trusts – Salford, South Manchester and Northumbria, all of which take a proactive approach to patient experience & satisfaction, understanding its core components, and gathering and collating feedback as a driver for quality improvement in care.
The key to success lies not only in collating feedback data, but in committing to continuously doing so using robust, effective measures to drive behavioural change. And this needs to happen on an organisational, unit, team and individual level.