Quality communication

Citation

Gourlay, R. (2003), "Quality communication", International Journal of Health Care Quality Assurance, Vol. 16 No. 3. https://doi.org/10.1108/ijhcqa.2003.06216caa.001

Quality communication

Quality communication

One of the paradoxes of the "information" age is that there is an increasing amount of information/communication happening – just consider the number of e-mails any manager receives – yet there are still loud allegations of "not being informed" or complaints about not knowing because "nobody told me". In a multi-disciplinary/multi-professional organisation such as a hospital, good and effective communications are essential if work is not going to be bogged down in trying to sort out who does what when.

Even more critical is the need for effective communications in times of change. This is especially true when changes are made which affect relationships, organisation behaviour and work to be done.

Yet despite the plethora of papers, guidance, organisational charts, there is evidence that important messages are not getting through to the front line of doctors, nurses and midwives.

In the Health Service Journal of 23 January 2003, Dr Anna Curley and her colleagues found plenty of evidence concerning lack of knowledge – and therefore understanding – of the National Health Service. For example, in a survey of staff in a teaching hospital, 203 doctors and nurses were unaware of the key factors of the government's "new NHS policy"; 79 per cent were even unaware of there being a set of policies creating the "new NHS". Going further, only 44 per cent of staff surveyed believed that the principles of the "new NHS" had any value for them as clinicians. In my own work with specialist registrars, I find that few of them have any understanding of such aspects as:

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  clinical governance;

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  the composition of the trust board;

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  the role of the medical director;

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  the difference between executive and non-executive board members;

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  the role of patient advisory and liaison staff;

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  the names of key individuals such as the chief executive; and

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  the difference between politicians, Civil’Servants and managers.

It may be argued that none of this really matters just as long as the clinicians carry on practising. It is also pointed out that the doctors have more important things to understand – for example, developments in their own practice area.

However, this is increasingly a weak argument when so many political and managerial initiatives impact on clinical practice. For example, the plethora of targets produced by the Centre inevitably impacts on the work of clinicians. However one may criticise the Centre for these, it is important to understand their source and legitimacy – as well as being aware of the consequences of failure to meet the targets.

As a specialist registrar it is important to understand these aspects; as a newly appointed consultant it is vital to know and understand the pressures under which a trust board operates and their role in perhaps "alleviating" these pressures through team working and the search for constant improvement. This raises the question as to how a greater understanding of the context of their work can be brought about.

In many trusts and hospitals these are active communication strategies aimed at the staff of the trust with the purpose of informing them about current NHS and trust issues. These strategies often rely on internally produced news-sheets for disseminating information. They tend to be informal and chatty. Other strategies in use’include that of "briefing groups" where information is disseminated at the top and cascades down often through the managerial hierarchy. Yet another approach is through bulletins being published on the Internet. All these initiatives are useful and important, but they often miss the "junior" clinicians, as evidenced by Anna Curley's research that has already been quoted.

What is needed is a targeted approach to communications to supplement the existing general strategy. The elements of a "targeted communications" strategy are as follows:

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  Outcomes. There are clearly defined outcomes in terms of changes of behaviour and understanding from the communication intervention.

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  Review of outcomes. There are regular reviews of the outcomes achieved and changes made to the strategy in the light of the outcomes in the targeted group.

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  Targeted. The strategy must be targeted at a defined group of staff whose understanding and behaviour one wishes to affect.

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  Enhancement of teamwork. The strategy should be so designed that it encourages staff to discuss issues in a productive atmosphere, searching for the better way.

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  The strategy should be two-way. The strategy should be so designed that it makes it easy for staff to "relate" to management and provide feedback to key’managers on vital topics.

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  The issues should be relevant. The strategy should give pre-eminence to these issues that are of concern to the targeted "group", and are likely to be owned by them.

In essence a targeted approach to communication is discriminatory. It focuses on identified groups of staff whose behaviour one wants to change. In this way the content of the communication will be seen as relevant and not ignored as mere "management" stuff!

To avoid the possibility that some staff will feel they should have been informed and were not, there needs to be a "reservoir" of information and communications that have been despatched to the targeted group but are also available for others so that they may "dip" into them.

It is important to have a targeted communication strategy because of all the changes that are taking place in health care. A targeted communication strategy can prepare staff for the unique changes that may impact their daily work. An understanding of the rationale for changes, and having a part to play in the design of those changes, will enhance commitment and team "togetherness".

A targeted communication strategy is a very active approach to gaining commitment to and an understanding of what is going on around the staff.

It requires:

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  a diagnosis of the changes that need to brought about on the targeted group;

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  an assessment of the appropriate tactics (possibly including a modicum of facilitation);

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  a design which incorporates the tactics;

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  a design for a two-way flow;

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  a timescale that ties in with the strategies; and finally

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  access to all the tools of communication such as video programmes, Internet facilities, publicity and mail shots.

Robin Gourlay