Practice Nurse

Communicating with the practice team

Teams cannot be effective without good communication between team members. Although few people would disagree with this statement, many who work in teams would add that it is often easier said than done! Good communication is the key to effective team working within the practice, while poor communication can have a range of potentially disastrous consequences. This module will help you consider ways to identify communication problems and explore strategies to resolve them.

This resource, consisting of five assessment questions at basic level, tests your understanding of the skills needed to communicate effectively within the team. Complete the resource, including the recommended reading and some or all of the activities to obtain a certificate for one hour of continuing professional development to include in your revalidation portfolio.

After completing this module you will have:

Examined the range of communication methods available

Considered the diversity of how people give and receive information, and how to adapt your approach to make the best use of their preferences

Reflected on the impact and consequences of ineffective and effective planning of communication

Explored the appropriate use of electronic communication

Susannah has just started her early morning clinic when she receives a text from Julia who should be in the practice to run the Well Woman clinic in an hour’s time. Julia’s son is running a high temperature and she needs to take him to the doctor so she can’t say when she will be able to get to work. She has tried to ring reception but the phone is always engaged.

What method of communication is least likely to be useful as she responds to this situation?

Despite one’s first instincts, quickly phoning someone else in the practice can have unpredictable consequences. Susannah cannot see who is at the front desk and what might be happening. Face to face discussion and brief planning with the person whose role it is to lead on day-to-day appointments is the first step. This action will lead to the disseminating key information in a way that can be managed appropriately by other members of the team, and is much less likely to cause duplication of effort, patient irritation or trouble for Julia when she does arrive.

Public Health Action Support Team. Principles, theories and methods of effective communication (written and oral) in general, and in a management context, 2011. 

http://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5a-understanding-itd/effective-communication

Identify events in the last week where you think information has been relayed in an unhelpful way. What might have worked better?

Plan with representatives of the nursing and reception teams together how to respond to a similar scenario, and draw up the results of your discussion into a small number of bullet points that are circulated to the whole team. Focussed communication between key groups in the practice improves efficiency and staff relations.

Question 1

A significant number of people with asthma have not turned up for their annual reviews, according to the most recent search. All the nursing team receive a brief email in the middle of the morning from the data manager with an attached list of patients that need contacting in the next week. What would be the most effective response?

The nursing team needs to know details of the task, but not immediately. Instructions are easier to respond to accurately when written down, particularly if that is the method already in use. Challenging the request by going over the data manager’s head, or allowing the task to slip into ‘spare time’ are both likely to cause friction without a useful result.

What was your first response to the question above? It may be linked to your learning style (Honey and Mumford, 1992) which suggested that some people need to reflect on the detail of a situation before responding (reflectors) while others want to try out a solution as soon as possible (pragmatists) – or even if they haven’t thought it through (activists). Knowing that people handle information in different ways, and prepare for action differently, can help you to choose the most efficient method of getting the best response from each member of the team. Some people like information in writing with time for reflection; others respond more positively to a personal encounter and request for help. You can find a brief summary of learning styles at 

http://www.pd-how2.org/doing/learning-styles/

Question 2

The CCG is piloting a new way of delivering diabetes reviews in order to improve care planning and the patient experience. Anne has volunteered to be a practice representative on the initial training before it is implemented.

After training, Anne’s role is to introduce the scheme into her practice. There are a range of early initiatives suggested – which of those below could she omit without adversely affecting her progress?

Introducing new ways of working into a complex workplace happens more smoothly if the concepts have time to be considered and debated before the details are decided. In fact, discussing detailed changes before the overall strategy has been considered can be counterproductive and generate confusion.

A brief description of why the change is proposed and what it will look like in practice can be followed by a forum for staff to explore the best way for it to happen in their workplace. A colleague who understands the process and supports it can really make a difference to the adoption of the scheme, particularly if he or she is from a different discipline.

The RCN’s ‘Team effectiveness guide’ has a section on effective team meetings to get the best from time together.

RCN (2007) Developing and sustaining effective teams: Guide 5 Effective team meetings 

https://www.rcn.org.uk/__data/assets/pdf_file/0003/78735/003115.pdf

Think back to a new idea being introduced into your practice. What helped its progress? What might have been communicated better? What might you and others in your team suggest next time?

Question 3

Graham has learning difficulties, and he also has COPD. Today he seems to be more short of breath than usual, and Dot isn’t sure whether it is because he is not using his inhalers regularly, because he has an exacerbation or because there is another disease process going on such as heart failure. She is not trained in physical examination and would like the help of a medical colleague.

There are a variety of possible options, and within your practice you may have a well-defined structure in this situation, but many nurses just make a decision when the occasion arises. Graham does not seem ill enough to interrupt a consultation, but there may be a new event that requires diagnosis and he may not come to a separate appointment. Standing waiting in a corridor involves leaving Graham, and many people do not like being interrupted when they are completing a record after a consultation. A brief request that a doctor will notice between patients is much less confrontational than either a phone call or ‘popping in’.

Ideally, there is an important conversation to be had between the medical and nursing teams: how do they see similar occasions being optimally managed? It is of huge value hearing everyone’s concerns and suggestions, and then deciding on a workable plan that the practice agrees, and that is then emailed round to the whole team, trialled and reviewed.

There are tools to improve communication between clinicians; for example, read the article on the SBAR tool for giving concise, organised information, and follow some of the links if you want to use it yourself.

1. Dawda P, Jenkins R, Varnam R. (2011) Improving communication skills with your colleagues. GPonline January 27th available at: 

http://www.gponline.com/improving-communication-skills-colleagues/article/1050179

When your current process does not work well, it may signal the opportunity for an audit – just as relevant for ways in which the practice works as for clinical issues. Look at the page on Patient UK that describes audit and the audit cycle, and decide if there is a communication topic that you could nominate (

http://patient.info/doctor/audit-and-audit-cycle)

Question 4

Dr Abraham is having a bad afternoon. Some complicated visits means that she started afternoon clinic late, her computer ‘froze’ during a care plan so that she has to retype the whole template, a small child was sick over her skirt and when she requests an urgent ECG at 4.30pm, a receptionist tells her that there is no one to do it because the health care assistant (HCA) went home early. In frustration she dashes off an angry email to the nurse team lead, copying in the practice manager and the senior partner. The nurse team lead is summoned to see the practice manager first thing the following morning by an urgent note on her appointment screen.

How should the nurse team lead handle the situation?

The nurse team lead will defuse the situation swiftly by speaking briefly to the practice manager and then finding time to talk to both members of staff involved. Any other response leaves at least one person out of the loop, and the practice manager – who has overall responsibility for day-to-day efficiency – completely in the dark. Until there is a workable plan to provide an ECG service within specified hours, Susannah can’t promise the doctor that it won’t happen again.

Clear roles and responsibilities are key to avoiding this situation. What was the HCA’s responsibility that afternoon? Whose role was it to ensure ECG cover – and was it appropriate for Dr Abraham to involve three members of staff at this stage? Mistakes will happen but when staff know how and who to notify, the damage is minimised.

NHS Education for Scotland (2011) Significant event analysis; guidance for primary care teams available at 

http://www.nes.scot.nhs.uk/media/346578/sea_-_full_guide_-_2011.pdf

RCGP General Practice Foundation (2011) General Practice Nursing, available at: 

http://www.rcgp.org.uk/membership/practice-teams-nurses-and-managers/~/media/Files/Practice-teams/General-Practice-Nursing.ashx

How might Dr Abraham have handled the situation better? What information might have helped her? How might the receptionist have helped diffuse the situation? Discuss this scenario with a colleague, examining critically roles and communication pathways in your own practice.

Communicating with the practice team

title

title

title

title

title

title