Dr Anjali Mullick
Clinical Lead
St Joseph’s Hospice, Hackney
Aims of the day
 Refer to programme
Aims of the next hour
 Focus attention on the power of communication
 Backdrop to the rest of the programme ahead
 Share 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 dress
 What we write
 What we say
 Our body language
 How 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 care
 Gives more patients more power and choice
 Patients more satisfied
 Staff more satisfied-negotiated decision making
 Lower level of complaints
 Patients 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 2011-12
October 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 data
 Complaints 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 summary
February 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.
Recommendations
 Openness, transparency and candour in all the system’s
business; (electronic notes
 Information 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.
Recommendations
 Complaints, 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 study
 Young man with advanced cancer
 New diagnosis- had surgery which showed advanced
disease inside abdomen
 Overheard 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 Anthony
Casebook 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 forget
 Reflect on your own experience with communication
in the healthcare system, good and bad
 (my experience as a junior palliative care registrar)
Current challenges
 Fragmented healthcare services
 Multiple agencies or professionals involved
 Limited time and limited physical resources
 Uncertainty and changing healthcare environment
 Greater expectations from users
 Little central funding for training
 Public mistrust of healthcare professionals
How can we improve?
 Put ourselves in the patient or families shoes
 Practice our communication skills with training where
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possible
Prepare and plan if we can
Reflect on how it went, what we have done well, what
we might do differently
Seek feedback from others
Be open to learning new things
Don’t beat yourself up if it doesn’t go the way that you
had hoped
 Enjoy the rest of the day!