Communication: Laying the foundations

Dr Anjali MullickClinical Lead

St Joseph’s Hospice, Hackney

Aims of the dayRefer to programme

Aims of the next hourFocus attention on the power of

communicationBackdrop to the rest of the programme aheadShare some of my experiences in order to

stimulate thinking about your own practice and how you might influence others

How do we communicate with others?

How do we communicate with others?

How we dressWhat we writeWhat we sayOur body languageHow we behave

Impact of communication

Think about the last time someone paid you a compliment and how it felt

Think about when someone said something to you that upset you

Which example is easier to come up with?

Communication in healthcare- why is it important?

Leads to holistic high quality patient careGives more patients more power and choicePatients more satisfiedStaff more satisfied-negotiated decision

makingLower level of complaintsPatients more likely to comply with advice

and suggested treatments

When communication goes wrong…

Listening and Learning:

The Ombudsman’s review of complaint handling by the NHS in England 2011-12October 2012

Our case files reveal a significant increase in people who came to us because they felt that the NHS had not acknowledged mistakes in their care – 50% more people came to us for this reason than in the previous year. Better communication would help the NHS understand the needs of patients and allow patients to understand the decisions made about their care and treatment. Inadequate communication was an issue in over 35% of complaints we resolved without the need for a formal investigation.

Good communication demands good explanation of why decisions were made, particularly where there is disagreement between the patient and the NHS.

GMC dataComplaints about doctors have hit a record

high with patients more prepared to raise concerns about their treatment, a General Medical Council (GMC) report says today (18 September).

Among these complaints there was a significant rise in concerns about how doctors interacted with their patients – allegations about communication increased by 69% and lack of respect rose by 45%.

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry

Executive summaryFebruary 2013

A common culture made real throughout the system

The negative aspects of culture in the system were identified as including:A lack of openness to criticism;A lack of consideration for patients;Defensiveness;Looking inwards not outwards;Secrecy;Misplaced assumptions about the judgements and

actions of others;An acceptance of poor standards;A failure to put the patient first in everything that is

done.

RecommendationsOpenness, transparency and candour in all the system’s

business; (electronic notesInformation accessible and useable by all allowing

effective comparison of performance by individuals, services and organisation.

Patients must be the first priority in all of what the NHS does by ensuring that, within available resources, they receive effective care from caring, compassionate and committed staff, working within a common culture, and protected from avoidable harm and any deprivation of their basic rights.

The overarching value and principle of the NHS Constitution should be that patients are put first, and everything done by the NHS and everyone associated with it should be informed by this ethos.

RecommendationsComplaints, their source, their handling and their outcome

provide an insight into the effectiveness of an organisation’s ability to uphold both the fundamental standards and the culture of caring. Whilst a complaints system should be consistent, it must never be applied in a formulaic or insensitive manner.

For a common culture to be shared throughout the system, these three characteristics are required:Openness: enabling concerns to be raised and disclosed

freely without fear, and for questions to be answered;Transparency: allowing true information about performance

and outcomes to be shared with staff, patients and the public;Candour: ensuring that patients harmed by a healthcare

service are informed of the fact and that an appropriate remedy is offered, whether or not a complaint has been made or a question asked about it.

Case studyYoung man with advanced cancerNew diagnosis- had surgery which showed

advanced disease inside abdomenOverheard surgeon talking to his team in the

corridor ‘the wound will burst open’Became extremely anxious and fixated on

wound healing- prolonged post op recovery, needing hospice for physical and psychological rehab

Patients can be very forgiving…if you make a mistake, patients are less likely

to complain if you have been polite and communicated well

Forgiving fallibility Sandy AnthonyCasebook Vol.13 no.3 August 2005 www.medicalprotection.org

There are many small things we can do to make patient feel valued, respected and listened to, despite the strains we are under at work

But they might not forgetReflect on your own experience with

communication in the healthcare system, good and bad

(my experience as a junior palliative care registrar)

Current challengesFragmented healthcare servicesMultiple agencies or professionals involvedLimited time and limited physical resourcesUncertainty and changing healthcare

environmentGreater expectations from usersLittle central funding for trainingPublic mistrust of healthcare professionals

How can we improve?Put ourselves in the patient or families shoesPractice our communication skills with

training where possiblePrepare and plan if we canReflect on how it went, what we have done

well, what we might do differentlySeek feedback from othersBe open to learning new thingsDon’t beat yourself up if it doesn’t go the way

that you had hoped

Enjoy the rest of the day!