In the wake of the Francis Report in England and Trusted to Care here in Wales, getting improvement and patient safety messages across to all healthcare staff is essential.
We need to communicate these both as national priorities and within individual health organisations. But doing it is a challenge.
Exploring the role of communications in quality improvement is a new paper from colleagues who were involved in the 1000 Lives Campaign. It describes the importance of large campaigns (in this case, a national campaign) and a framework for communications to support those initiatives.
The importance of campaigns like the 1000 Lives Campaign is that they reflect and clarify national priorities for everyone. They influence internal agendas for health boards and trusts, support a movement for change and create a momentum for action.
Almost every enquiry into serious incidents I have read has referred to problems in communication and information sharing between disciplines, at handovers and between agencies as a significant factor in what is often a tragic outcome. However what reviewers or inspectors mean by this is often obscure and not amenable to measure. Obviously there is much to be done regarding communication at an individual level – but what about at an organisational level?
The action plan that is usually the response to reports into serious incidents or failings in care will often include a new protocol or procedure. And yes, my gut feeling is that little really changes. SO, how do we actually make people aware of the new way of working? How do we actually make them apply the lessons from the report?
This is where Exploring the role of communications in quality improvement comes in. The NHS is getting better at public health campaigns which try to nudge people to change their behaviours. Getting messages to all staff in large and complex health boards or trusts is equally important and changing behaviour is equally difficult, particularly around improvement and safety.
If a Board wants to deliver a message to the organisation our current methods are: a) e-mail – I doubt anyone would see that as reliable and effective; b) electronic briefings – we know many clinicians don’t read them; or c) through 4 or 5 layers of line management – we know the latter is extremely unreliable and worse, messages often get unhelpfully adulterated on their way through the system.
If we want to influence the culture, behaviours and practices of large medical, surgical or primary care directorates we need campaigns to ensure everyone knows and understands why change is needed and how to approach change. Good campaigns are the vehicle for ensuring these messages and actions are simple, structured and consistent.
From my perspective running an improvement centre in a large health board, national campaigns give us the opportunity to translate those messages into local actions and shape the clinical discussions. We can also use the national structure for communication to develop and adapt a campaign strategy for local consumption.
The communications and campaign strategies in the various incarnations of 1000 Lives Improvement have helped to develop a shared agenda between patients and professionals. An example of this is the Ask about Clots campaign. The language engages the whole community, gives permission for patients to take ownership for their health, helps to focus the minds of clinicians but more importantly creates an agenda for dialogue between patient and clinician.
Developing and delivering an effective campaign is a skill. Any organisation which sees itself as one where change is part of the day job needs to have that skill set. Campaigns need to be used judiciously, we don’t want a new one every week, but we do need to be receptive to them and ready to respond.
Dr Danny Antebi is the director of the Aneurin Bevan Continuous Improvement (ABCi) centre in Aneurin Bevan University Health Board. He is also the chair of the 1000 Lives Improvement steering group.
What are your thoughts on communication in quality improvement? Leave your comments below or Tweet us @1000LivesPlus, @ABCiAb and @dantebi5.