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Leadership and management
The role of Leaders and Managers, and the importance of communication skills to the service
This section explains that good communication skills benefit the whole service and identifies opportunities and levers to support and encourage experiential work-place based communications training and development
Good communication skills benefit the whole service
The Parliamentary and Health Service Ombudsman argued that in almost all of a number of the cases studied there were failings in communication between health professionals on the one hand and patients, clinicians and families on the other; clinicians and their teams; clinicians and other teams; and between hospitals and care providers in the community. If we were to attribute just one fifth of the outlay of litigation costs incurred by NHS England in 2015 to inadequate communication, it would have cost more than £200 million. In addition, healthcare professionals experience psychological wear and tear, including stress and burnout. This generates direct costs as new staff have to be drafted in as replacements. Beyond that, there are intangible costs in the loss of experience and expertise acquired by senior members of staff.
References:
- The Parliamentary and Health Service Ombudsman, in a report on end-of-life care in May 2015
- Marie Curie’s “A long and winding road”
Good communication within and between teams benefits patients as well as those working as part of the team, helping to reduce risks and to build resilience. For example:
- Timely communication, such as when a very sick or dying patient is transferred from an Accident and Emergency department to a ward, will allow the ward staff to make appropriate arrangements for the patient’s reception.
- Supervision or support for staff following events likely to cause them distress has been shown to be helpful.
- Poor and incomplete written and verbal communication can leave the next shift ignorant of factors relating to patients.
Opportunities and levers to support and encourage experiential work-place based communications training and development
Leaders and managers are aware that while the training, education and the capability of individuals is important, long term behaviour change needs to be supported by their example and the culture of the organisation. They need to provide both the opportunity and the motivation for behaviour change – and opportunities for reflection, review and development of skills.
Organisational culture
At the strategic level, sustained change is more likely to happen in an environment where staff across an organisation can reflect on how things are done now and think about how they could be done better in the future.
A recent King’s Fund report, co-authored with the Health Foundation, Making the case for quality improvement: lessons for NHS boards and leaders, tells us that effective quality improvement requires a focus on relationships and culture and that relationships and behaviours are perhaps more important than the technical use of tools and models.
The report refers to:
- Clear, aligned objectives for all teams, departments and individual staff
- Effective team-working
- Supportive and enabling people management
- High levels of staff engagement, with learning, innovation and quality improvement embedded in the practice of all staff.
It is self evident that good communication skills are needed at all levels of the organisation to enable these activities to take place.
Case study:
A patient’s daughter complained that a staff nurse was abrupt and dismissive in her manner. The ward manager talked to the staff member, who was completely unaware that she had unwittingly upset the family concerned, and very upset. The ward manager asked her to recall the incident, and to review it from the patient’s and her daughter’s point of view. They talked about the way her language was used and the brevity of the exchange. The ward manager asked the staff nurse to think about the her style of communication, and to be aware of the impact it might have on other patients and perhaps staff, and to keep a brief daily reflective log of occasions where she felt that her interactions had a positive, neutral or negative impact. After a week, the ward manager and the staff nurse reviewed the log. The staff nurse was able to attend a Trust communications course, and to bring back and apply the techniques she learnt in practice, working with her ward manager. Using her log, she was able to see how her learning could be applied in practice, and to recognise the positive effects it had in her daily work.
Annual updates, in-house training and education, e-learning, experiential learning, coaching, mentoring, supervision and reflective practice are all tools to help individual staff members to develop and put skills into action. Effective performance appraisal and review of staff performance and development contribute directly to improved patient outcomes. It gives staff and managers an opportunity to discuss ways in which people can improve their own skills and confidence in the workplace. Discussion with those who have undertaken courses to ensure that the learning is useful, understood and applied in context is helpful.
Development and appraisal
The Royal College of Nursing resources on Reflection, and for Continuing professional development.
For help with appraisal systems, see the Royal College of Nursing guides; for health care assistants and for registered staff.
NHS Leadership Academy: Programmes for every level of leadership responsibility, including the Edward Jenner programme, open to all, aimed at developing a strong foundation of leadership skills.
Management and Leadership Skills programme, e-learning for Healthcare
These e-learning modules are designed to develop your knowledge and understanding of a range of management and leadership topics, including appraisal.
CIPD Research Report, December 2016
Could do better? Assessing what works in performance management. The CIPD is the professional body for HR and people development.
The benefit of courses and e-learning needs to be evaluated in the context of the individual and the service provided. Has the individual found the learning helpful and positive, and how has it benefited their practice? Does it benefit the team? Other indicators, such as patient and service user feedback, staff satisfaction levels, investigation of complaints and incidents should be taken into account.
Staff who have undertaken communications training say:
“Since doing the course I have been more confident in gathering information from a patient when in distress to find out what is really bothering them. It is not always the first issue they may express.”
“I often avoided conversations around prognosis and death as I found it difficult to conduct a conversation. Now I feel satisfied. I am confident to lead a structured interview.”
“I have worked in a health or social care setting for 38 years and I learnt something from the course, so you are never too old or too experienced to learn new ways of communicating, listening and responding to the needs of patients, carers and work colleagues.”
(www.sageandthymetraining.org.uk/testimonials)
Some available education and training
Skills for Health, Skills Platform
Person Centred Approaches
The aim of this free course is to enable staff to behave in a person-centred way, based on the person-centred approaches framework, which aims to distill best practice and to set out core, transferable behaviours, knowledge and skills.
In particular, please note Module 4: Core Communication and Relationship Building Skills.
Personalised Care Planning
The PRosPer programme provides elearning on supporting people with cancer in personalised care and support planning, prehabilitation and rehabilitation. It also covers managing the consequences of cancer and its treatment, workforce development and service redesign.
Stand By Me – Dementia
Free online e-learning developed by Skills for Health, the Association for Dementia Studies and key partners to improve the communication and person-centred care for people with dementia. This course has a communication module.
End-of-life care for all (e-ELCA) elearning programme
The End-of-life care for all (e-ELCA) elearning programme aims to enhance the training and education of the health and social care workforce so that well-informed high-quality care can be delivered by confident and competent staff and volunteers to support people wherever they happen to be.
Macmillan Funded Courses
Resources, information and support to help health and social care professionals in their role.
In addition to the resources available online, Macmillan’s geographical Learning & Development teams also provide free face to face courses and events for both Macmillan and non-Macmillan health and social care professionals who care for people affected by cancer on a more local level. https://learnzone.org.uk/prospectus/
SAGE & THYME® foundation level workshop (S&T FL) teaches clinical and non-clinical staff at all levels, evidence-based communication skills to provide person-centred support to someone with emotional concerns using the SAGE & THYME model.
The SAGE & THYME model is suitable for talking to anyone: patients and carers, students, colleagues and children – inside and outside of health and social care.
Working with staff, it is incumbent on leaders and managers to:
- build collective responsibility and improved staff engagement, resilience, motivation and retention through a facilitative and integrated way of working
- use a person-centred approach to develop healthy workplaces, improve workforce health literacy and improve staff to staff conversations
- improve the capacity and skills of the workforce to assist people and themselves to make positive behaviour changes to improve their own health and wellbeing within the workplace and into the community
- recognise, encourage and support person-centred and community focussed practice through supervision, action learning, service improvement, appraisal or revalidation processes
- ensure that the workforce have the skills, abilities, confidence and attitudes needed to deliver services relevant to sustainable health and care now and in the future
- ensure that investment in staff training supports sustainable behaviour change and improvement in services and put in place support for personal behaviour change and ongoing developmental needs.
Relevant to all staff - leadership web resources
For further information about Leadership and Team working see:
- NHS Leadership Academy Healthcare leadership model
The Healthcare Leadership Model is useful for everyone because it describes the things you can see leaders doing at work and demonstrates how you can develop as a leader – even if you’re not in a formal leadership role. - Teamwork, Valuing your role and others, Royal College of Nursing
Research carried out by the RCN has shown that good teams are creative in the way they organise services, make sound decisions, respond effectively to sudden changes, provide high-quality services to patients/clients.