Staff

Communication and staff, why it is important and how skills may be improved

This section explains:

• that good communication skills benefit the health care team
• how you can improve your communication skills in practice.

Good communication skills benefit the health care team

Good communication within and between teams benefits patients, but also benefits those working as part of the team, helping to reduce risks and providing support for staff. Understanding individual communication styles and how they impact on team function is crucial for the development of positive team attributes and the reduction and management of conflict.

For further information about team working see:

• Teamwork, Valuing your role and others, Royal College of Nursing
• NHS Leadership Academy 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.

Team members must share information and an understanding of the work in order to coordinate their efforts and achieve their objectives. In a successful team, individuals know what their role entails because team working enables good communication and detailed negotiation of effective work roles. In addition, members of a successful team are able to support each other, both practically and emotionally, during times of difficulty or stress, and members know where they can go for advice, support and supervision.

The website, Civility Saves Lives tells us that almost all excellence in healthcare is dependent on teams, and teams work best when all members feel safe and have a voice. Civility between team members creates that sense of safety and is a key ingredient of great teams. Incivility robs teams of their potential.

Some health care teams have found Schwartz Rounds helpful. They were brought to the UK in 2009, by the Point of Care programme at The King’s Fund and continue to be implemented by The Point of Care Foundation. They provide a structured forum where all staff – clinical and non-clinical – come together regularly to discuss the emotional and social aspects of working in healthcare.

The underlying premise for Schwartz Rounds is that the compassion shown by staff can make all the difference to a patient’s experience of care, but that in order to provide compassionate care staff must, in turn, feel supported in their work. The purpose of the Rounds is to understand the challenges and rewards that are intrinsic to providing care, not to solve problems or to focus on the clinical aspects of patient care. Rounds can help staff feel more supported in their jobs, allowing them the time and space to reflect on their roles. Evidence shows that staff who attend Rounds feel less stressed and isolated, with increased insight and appreciation for each other’s roles. They also help to reduce hierarchies between staff and to focus attention on relational aspects of care.

Research pilot sites in America and England show staff who attend Schwartz Rounds:

• feel they communicate better with their patients and colleagues
• feel less isolated and more supported
• feel better able to cope with the emotional pressures of their work
• understand better how their colleagues think.

How can you improve your communications skill in practice

Training, education and the capability of individuals is important, but an improvement in communication skills throughout the workforce is part of long term behaviour change supported by the leadership and culture of the organisation – ‘the way we do things around here’. There needs to be opportunities for reflection, review and further development of skills for each member of staff in order to put learning into practice. (There is further information in the leadership and management section)

Communication skills are relevant to everyone and as important to interactions between staff as to those with patients and carers.

The Person-Centred Approaches core skills education and training framework describes the behaviours, knowledge and skills required to put a person centred approach into practice.

At the core of person-centred approaches are:

• Values.
• Core communication and relationship building skills.
• Conversations to engage with people.
• Conversations to enable and support people.
• Conversations with people to manage the highest complexity and significant risk.

Attitudes are the way a person applies their values and is expressed through their behaviours and what they say and do.

Case studies, examples of good and poor practice

Scenario 1: Following treatment for cancer, and having understood from his previous appointment that his cancer was no longer active, Edward returns to clinic.

• Good: The doctor introduces himself, invites Edward and his partner to sit down.
• Poor: To be told with no introduction “your tumours have all grown”, by a doctor he has never seen before.

Scenario 2: Alex approaches the reception desk at the doctors surgery.

• Good: The receptionist looks up and greets Alex with a smile, she says hello, my name is Sue. How can I help you?
• Poor: The receptionist has her head down looking at her computer screen. She does not appear to notice Alex at all.

Scenario 3: Caleb, a registered nurse, says to Abdullah, a healthcare assistant, ‘I need you to help me monitor Mrs Reynolds please.”

• Good: Caleb’s tone is calm and professional but conveys the seriousness of the situation. “Her routine observations need to be done hourly and the results recorded accurately in her notes. Dr Morgan will be monitoring Mrs Reynolds really closely because she’s so unwell. Do you have any questions?’
• Poor: Caleb’s tone is agitated and flustered. “Do the observations, doctor will want to see them”

Scenario 4: Jamila is an eighty-year-old woman, who is walking slowly along the corridor using two walking sticks. Tom, a porter, nearly bumps into her as he turns the corner on his way to a team meeting, which is starting shortly. As he apologises she says, ‘Excuse me, how do you get to the Physiotherapy Department?’

• Good: Tom stops to talk to Jamila, and seeing her uncertainty, guides her to the Physiotherapy department himself.
• Poor: Tom sighs loudly and says quickly and mumbles as he walks away, ‘Turn left by EEG, then third door on the right after the ED, then straight down the passage past MRI.’

Scenario 5: Dan is a forty-two-year-old man, who recently had a car accident which damaged his spine. He arrives at the re-ablement centre in his wheelchair with his partner, Beth. Dan asks the care assistant when his next visit should be.

• Good: The care assistant directs his attention and conversation to Dan, explaining when his next visits are likely to be and their purpose.
• Poor: The care assistant doesn’t make eye contact with Dan and explains the details of Dan’s next visit to Beth.

Scenario 6: Dave goes in to see his GP.

• Good: The GP asks Dave what has brought him to the surgery today. Dave says he is having trouble weeing. The GP asks if Dave wants to talk about anything else. Dave mentions he is struggling with everything going on, days off sick, feeling low.
• Poor: The GP asks Dave what has brought him to the surgery today. Dave says he is having trouble weeing. The GP takes a history, and they agree a course of action for the problem. Dave leaves.

Staff can work with their managers and team leaders to identify the best ways of developing their communication skills within the environment in which they are working, suited to their style of learning, with the aim of making a difference to their own practice. Opportunities for reflection on interactions, utilising a reflective diary, understanding how they are perceived by others, thinking about self-awareness and the use of emotional intelligence will all help people to develop their communication skills, particularly where they are supported by their managers.

It is good to use everyday activities as learning opportunities, identifying where a particular activity, for example a ward round or meeting with a patient, has gone well or might have been improved had the communication taken place in a different way. The appraisal system, along side continuous professional development, in-house training and education, coaching, mentoring, supervision and reflective practice all offer opportunities for individual staff members to develop skills and put them into practice.

Appraisal and re-validation

Many health care professionals must demonstrate that they maintain and improve their skills in order to remain registered practitioners, doctors undertake a process of re-validation using a framework set by the General Medical Council. As part of this, they discuss with an appraiser feedback from their patients and from people they work with, what they’ve learnt from training they’ve completed, what they’ve learnt if something has gone wrong and any complaints about them.

The Nursing and Midwifery Council regulates nurses and midwives in England, Wales, Scotland and Northern Ireland. It sets standards of education, training, conduct and performance so that nurses and midwives can deliver high quality healthcare throughout their careers. Nurses and midwives also undertake re-validation.

In a similar way, the Health and Care Professions Council regulates health, psychological and social work professionals. Allied Health Professionals undertake continuous professional development (CPD) in order to continuously improve and maintain the quality of their practice and service delivery, and to benefit the service user.

Reflection and appraisal – useful for all staff

• The Royal College of Nursing resources on Reflection are useful here, and for Continuing professional development.
• Care Quality Commission, Supporting information and guidance: Supporting effective clinical supervision, July 2013.
• For help with appraisal systems, see the Royal College of Nursing guides, for health care assistants and for registered staff.
  
  also
• 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.

What you can do

Working alongside leaders and managers, staff must be prepared to:

• become part of a future workforce with the skills, knowledge, confidence, behaviours and habits required to best serve the needs of our population
• understand what a person-centred approach is – and the tools and practices required to deliver it
• understand and reflect on daily work, values, and identify and name any gaps in knowledge
• build action plans, have goals, and make these integral to every-day work
• undertake experiential learning, and apply and develop new skills in the workplace – recognising the reality of the work environment and the challenges to embedding this way of working.

You may be able to identify useful learning relative to your job at e-learning for Healthcare, but opportunities for learning from everyday practice will present themselves at work.

e-Learning for Healthcare (e-LfH) is a Health Education England (HEE) Programme working in partnership with the NHS and professional bodies to support patient care by providing e-learning to educate and train the health and social care workforce.