Variations in communication during ‘staff handover’ cause a significant number of errors and “near misses” to occur, leading to adverse outcome
In medical care, a hand over (also known as hand off, sign-out or end of shift report in the USA) refers to information about a patient that is transferred by one professional or a team to another.
The primary objective of a hand over is to provide accurate information about a patient’s care, treatment and services, current condition and any recent or anticipated changes.
The number and types of handovers for any given hospital patient can vary and may involve physicians, nurses, pharmacists, transport and other services
Handovers are not simply a mechanical means for transmitting and receiving information. In medical care, a hand over requires that the sender consider a patient’s present condition and his/her likely future over the next 8-12 hours. Likewise the receiver must comprehend what is being transmitted and feel confident about the clarity and reliability of the message. In addition handover also involves the transfer of rights, duties and obligations as they relate to the meaning and interpretation of communication between one professional and another.
Interest in handovers has grown steadily over the past decade and researchers, hospital administrators, educators and policy makers have learned that variations in communication during handovers cause a significant number of errors and “near misses” to occur leading to adverse outcome
According to the Institute of Medicine (IOM) USA, up to 98000 patients die and another 15 million are harmed in US hospitals annually due to medical errors, and two-thirds of these errors are due to communication failure.
Question 1
Read the case study 1, and based on the information given; write an essay to include the answers to the following questions
Analyse the methods of internal communication you would recommend to ensure that hand over process in hospital wards is made efficiently
A patient can be cared for by five different units during one hospital stay – the operating room, postanesthesia care unit, critical care unit, step-down unit and medical/surgical unit which makes effective communication between the units all the more important. Hand offs help staff members process information, plan care and build the health care team.
The five strategies for effective hand-off communication include (a) the usage of clear language – healthcare professionals should avoid and refrain from using unclear or potentially confusing terms ( such as she is a little unstable, he is doing fine, she is lethargic). Define the terms being used and never use abbreviations or jargons that could be misinterpreted. (b) Healthcare professionals should incorporate effective communication techniques such as limit interruptions, focus on the information being exchanged, and allocate sufficient time to this important task. There is a need to implement read-back or check back techniques to make sure there is a common understanding about expectations. There is a need to encourage interactive questioning to allow for better information absorption. Keep the report patient centered and avoid irrelevant details, (c) there is a need for standardized shift-to-shift and unit-to-unit reporting. Using a consistent format increases the amount of information staff members accurately record and recall and improves their ability to plan patient care. Organize the data with a sign-out checklist, a script or an “at a glance” status display. Make sure you can provide cues of important information to pass on that is otherwise likely to be forgotten in the chaos of shift or unit changes. Keep the report concise and accurate.
What is included in hand-off communication varies by setting and discipline but can also include a summary of the patient’s current medical status, resuscitation status, recent lab values, allergies, a problem list and a to-do list for the covering physician or nurse. Get input from frontline staff to identify what should be included in the report.
Smooth hand offs between settings is possible through the transition between the settings of care such as from the hospital to home, community or long term care can be undependable. To prevent problems, communicate with the physician when a patient is admitted and update him or her whenever the patient’s status changes significant.
On discharge, provide the patient with information about discharge medications, discharge diagnoses and results of procedures and labs. A simple follow up call to the patient by a physician, nurse or pharmacist can prevent many postdischarge errors.
Assess the impacts of barriers of internal communication within the hospital to achieve effective handover
Hand off communication provides a forum for the exchange of ideas, opportunities to express concerns and a pace for offering peer support. Hand off can be a time when health care workers may find it permissible to express and communicate emotions such as grief, anxiety, loathing or amusement that must be suppressed outside the health care arena and can be particularly important for hospital staff members who are caring for terminal patients in hospital acute medical wards.
Communications among care providers, responsibility for the patient, shift-change handovers, coordination among providers and different areas of the hospital and physician- nurse interaction are just some of the problems evident in the case.
According to Anderson and Helms (1995), continuity of care is a series of interconnected patient care events within a health care institution and among multiple settings that requires coordination across time, settings and providers of health care.
In the health care setting, hand offs include nursing shift changes, temporary relief or coverage, nursing and physician hand offs from an emergency department, various transfers of information in inpatient settings and transfers to different hospitals, nursing homes and home care or community health care.
In addition to causing emotional harm such as anxiety and confusion to patients and their family members during already stressful situations, poor transition can cause physical harm to patients in which poor hand off communication lead to patient harm.
Proper communication between nurses at all points during a patient’s hospital stay can be difficult because of high patient turnover, lack of overlap between shifts and time constrains. Adding to the problem is the increasing use of agency nurses and the large number of nurses involved in each patient care4. For a number of other reason, there may be gaps in information that is handed from one nurse to the other like new admissions just prior to shift change, fragmentation of communication between physicians and nurses, time available to conduct hand offs and the lack of knowledge about an individual patient’s condition as well. Due to these barriers to effective hands off there are certain things to improve communication, (a) increase consistency in assigning nurses to the same patients over a number of shifts, (b) structure hand offs to focus on patient progress rather than on tasks (c) include physicians in the hand-off process when feasible and (d) combine the strengths from the different styles of hand-off communications strategy that meets the needs of the individual patient and the organization or unit.
Identify how to create an effective communication structure which is standardised within the hospital to improve compliance with effective handover
As part of the transition in care, hand offs transfer knowledge as well as responsibility and authority. Failures in adequate hand-off communication may result from the inability of staff members to construct a shared picture of what is going on with the patient at the time of transition, as well as expectations and plans. Standardizing hands off communication can help health care workers avoid common causes for communication failures during hand offs such as the following : (a) physicians and nurses consistently perform their rounds separately, (b) no formal tools are used to support the transition, (c) hand off communications vary greatly, with some occurring one-on-one and some in groups, (d) some sites have standard orders for handling off patients, (e) exchanges are more transactional than interactional, (f) interruptions are frequent during hand offs.
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There are multiple venues on how to create an effective communication structure which is standardised can be done through the following steps: (a) physician hand offs including resident-to-resident hand off should include information about code status for all patients, ( b) effective implementation of information technology can improve the availability of advance directive information, (c) health care organizations should have a procedure for reporting critical tests and critical results in a timely manner to the responsible licensed caregiver who ordered the test or an authorized agent of the responsible licensed caregiver, (d) physicians are responsible for tracking the results on laboratory tests they order. Checklists and other interventions aimed at decreasing lapses in concentration can prevent forgetting about ordered tests, (e) hospitals should strive for a communication environment where care team members are free to question each other’s knowledge.
Actively engage patients and their families about their care. Use effective and active communication with members of a surgical team when planning procedures based on contingencies. Healthcare worker should engage in formal mechanisms for communicating changes in patient plans such as orders, checklists and briefings including notification of relevant providers.
Using checklists, hand off cards and computerized hand offs can increase the quality, reliability and accuracy of information obtained. Verbal techniques such as “read-backs” where listeners repeats back salient issues, should be instituted as a standard part of the hand off process.
Standard information transfer protocols, such as reminder systems to cue providers to check tests, mandates that laboratories or radiology departments contact providers about critical lab values and read -backs of key verbal information, should be adopted by health care organization to prevent transitional errors.
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Case study 2
Redevelopment of the King’s College Hospital Emergency Department
King’s College Hospital Foundation Trust was investing significant resources to completely redesign its Emergency Department. The aim was to improve facilities for all its patients, in particular mental health service users, following the closure of the local mental health emergency mental health facility
A formal consultation process was necessary to gather the view of local people on its proposals.
Despite this being a redevelopment which affected the whole local community, there was a risk that not all voices would be heard and that only those who had been campaigning against the closure of the dedicated mental health facility would engage.
There was a need to give all sections of the community the opportunity to contribute
Question 2
Read the case study 2, and based on the information given write an essay to include the answers to the following questions
Analyze the methods of external communication you would use for the most effective dissemination of the information about the redevelopment at the King’s College Hospital, to all section of the community
The improvements needed for the Emergency Department by the King’s College Hospital Foundation Trust relies so much on the contribution and support of the community. Since the entire hospital would require a full gear shift in order to accommodate the influx of mental patients since a mental health facility has been brought to a closure. There is a need to gather the consensus and consult the community since it will affect the entire population with the changes in the hospital itself. There will be changes in the allocation of budget, staffing and availability of healthcare professionals. Thus, there is a need to solicit the opinion and support of the local community.
Sources of information outside the organization can provide an understanding of opportunities and challenges that the organization needs to anticipate or that it has encountered in the past. Important types of external information includes publics who come in contact with the organization, information networks linking individuals inside and outside of the healthcare organization, portrayals of the organization by key individuals and the media and information about social, economic and environmental issues related to the redevelopment of the entire Emergency Room of the hospital.
It should be the goal of the entire hospital administration to ensure the effective and full redevelopment of the Emergency department to be responsive to the dynamic local needs. There is a need to conduct a thorough consultation process in order to facilitate the proper solicitation of the opinion from the entire community. This will allow consultation initiatives which will allow the local community to air out their sentiments and opinions with regards to site analysis, opportunities and constraints related to the building form, landscape and heritage. The attitude of the community towards the redevelopment of the health facility can be examined through consultation initiatives.
The hospital should ensure that the community feedback was solicited at key project milestones and can be done through the utilization of newsletters, websites, site open day, community walks or even open forums.
Further consultation will facilitate the understanding of the community regarding the final plans with the redesigning of the Emergency department. There should be a report related to the environmental assessment for public scrutiny and exhibition. This will allow the local community to have informed decisions about the proposal for the redesigning of the Emergency department.
In this way, it will ensure the support from the various sectors of the community. It will facilitate the smooth operations of the hospital in its aim to cater the needs of mentally inflicted patients within the community.
Assess the impact of external communication barriers on relationships with various community groups
Since there is a need for the redevelopment of the Emergency Department of the King’s College Hospital, a thorough community consultation should be done.
Effective engagement and relationship with the local community can lead to better assessment and effective planning. It will ensure better and sensible decisions and more excellent outcomes which can help in the avoidance of delay in the planning and implementation of the redevelopment of the emergency room. Through the consultation with the community, it will lead to an improvement of the confidence in the fairness and credibility of the plan to redesign and develop the Emergency room into a facility which can cater the needs of the clients suffering from mental affliction.
The hospital administration expects the consultation and external communication with various community groups to be effective in order to find meaning from the planning process to enable the various groups to be reflected in the development of the proposal to redevelop the facility.
There should be a consensus from various community groups to eliminate resistance and foster acceptance of the project. Early engagement with the community groups will ensure that the views and interests of the entire group into the proposed redevelopment.
Barriers to effective external communication would be the failure of involvement in the identification and involvement of the people and the organization who are interested to focus on the engagement to further consult each other.
Failure of the healthcare facility to fulfil the requirements of the statutory community consultation. The submission of a proposal to various community groups and stakeholders will provide an avenue for the community to contribute regarding the development of the project and its planning phase.
The “stakeholders” are those with some stake or opinion in the decisions to be made in the entire community. These community groups provide the voice in behalf of the people who are affected by the decisions made.
Various community groups which can be affected by the change in health care facility are the local government, families and support groups of mentally challenged individuals, healthcare professional alliances, environmental groups and even the neighbourhood where the facility is supposed to be built.
The involvement of these stakeholders should include direct access to facilitate consultative process. The involvement of many stakeholders as possible is very important to make sure that there is effective communication to prevent resistance among the locals. Through the face-to-face dialogue there will be an increase in the likelihood that all opinions and views are taken into consideration. This is very important since the silent majority is fully involved in the process of consulting with the entire community.
Identify how to create an effective external communication structure in the hospital based on the experience of the above case study
The redevelopment of the Emergency room of the King’s College Hospital will definitely involved the entire community. Since this reorganization of the physical arrangement of the hospital is caused by the closure of a mental health institution located within the vicinity of the community. Consulting with the community will truly evoke the sentiments and opinions of the entire population.
In order to thoroughly and completely gather the insights of various community groups, information dissemination regarding the proposed organizational redevelopment. This is to make sure that the public has been informed of the plans to reorganize the hospital to further accommodate the mental health needs of the entire community. These can be done through publication of newsletters in local community papers in circulation. Local television programs and radio stations can help in informing the public for such plans related to an existing health facility. This will allow the entire community to get a bird’s eye view of what to expect and how the redevelopment of the Emergency Room should affect them.
A community dialogue can be organized by the external affairs department of the hospital in order to provide a venue for the community and the hospital administration to discuss the significance, the importance and the plans on how to make such changes in the healthcare institution.
Walk in and open house events can be done to allow community members to personally witness and assess the necessity of a redevelopment. It should include the necessary information and facts for the need to accommodate mental health patients. In this way, it will magnify the positive responses from the community itself.
There is a need for the hospital administration to ensure that they make the most comprehensive information regarding the need for such redevelopment. It will ensure a favourable response and an informed decision from the entire community.
After the first touch base with the community, the hospital administration can start planning out a proposal on how to carry out the plans for the redevelopment of the emergency room. The hospital administration should provide a proposal involving the finances to support, the needed manpower, funds and machineries for the plans to be executed. There should be proper coordination with the various departments of the hospitals to thoroughly cover staffing needs of various areas of the hospital that would be affected by the changes, budget allocations and the resettlement area for the emergency department while the redevelopment is ongoing.
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Case study 3
Reputation audit and communication support for NHS Milton Keynes
Issue
NHS Milton Keynes wanted to improve its communication with all stake holders (GPs, patients, voluntary groups, partner organisations and politicians), and raise its profile in the local media to enable it to deliver on challenging issues such as the national 18 weeks wait and public health objectives and priorities.
A strategic plan need to be implemented to achieve this objective
Read the case study 3, and based on the information given write an essay to include the answers to the following questions
Question 3
Plan an effective communications strategy to communicate with the stakeholders of the NHS Milton Keynes to raise its profile and communicate its strategic objectives
Although the benefits of having a good reputation are many and varied, they come down to one thing: a strong reputation creates a strategic advantage. Since companies are constantly competing for the support of the stakeholders, clients, local communities and employees. A good reputation creates an intangible obstacle that lesser rivals will have a tough time overcoming.
A good reputation enhances profitability because it attracts customers to the company’s product, clients and employees to its jobs. In turn, esteem inflates the price at which a public company’s securities trade. The economic value of corporate reputation can therefore be gauged by the excess market value of its securities.
To successfully manage reputation, a company must establish the programs necessary for actively relating and communicating to the stakeholders of a hospital or healthcare institution. The company must regularly audit or check into its reputational profile. There is a need to fully execute reputational auditing which would allow thorough diagnostic review of the hospital’s current identity. Images and reputation.
A reputation audit can help manage and analyse the gaps between the desired reputation, aims, roles and values of the healthcare institute. A research or survey can be conducted to effectively communicate what the stakeholders, community members regarding their priorities and perceptions in the impact and significance of the institution itself. At the end of the reputation audit, the hospital will know which are working and what organizational changes should be done to further reach out to its target population.
There should be a leadership consensus about the significant issues as well as collective dialogue. There should be thorough evaluation of the internal capabilities and available resources to support the necessary changes to improve image and reputation.
Media monitoring can be one of the ways to effectively identify the essential understanding of the concurrent reputation of the hospital. It will give a warning on the development of issues and will give you the ability to determine if news coverage is negative or positive. There should be a positive relationship with media through media training for the key players of the organization who have credibility on the issues on hand.
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Measuring the reputation of a company is a dynamic and complex process. A range of issues can be assessed and evaluated. Good reputation management is about developing high sensitivity to the concerns and expectations of all stakeholders and establishing a mature dialogue with them so that actions taken that principally affect one stakeholder group recognize the concerns and expectations of all the others. Reputation management is synonymous to risk management which involves anticipating the downside risks to the company’s reputation from losing support from any stakeholder whose personal interest might diverge from those of the institution.
Communications among organizations should be monitored in order to ensure marketing and branding activities will align with other efforts to build a better reputation for the hospital. The key point to maintain the alignment of a reputation audit. In this way, it can help the organization to determine the effectiveness in a driving engagement and achieving favourable results with external stakeholders such as the media, clients, customers and various community groups.
Discuss how you would implement your communication strategy.
Corporate communication has in recent times evolved into a full field of study, both in practice and in scientific theory. Grant (1996) has in my opinion tackled the most important issues in the area of coordination of all forms of communication. He argues that there are four mechanisms within an organization that integrate specialist knowledge (such as communication knowledge). These are: (a) rules and instructions, procedures, rules, standardized information and communication systems, (b) sequencing – the organization of the primary process in a sequential can be improved is the extent to which the story can be characterized as sustainable.
Consistency in communication is one of the crucial factors in increasing success with corporate communication. This implies the necessity of ensuring the clarity about who is responsible for what and especially about what.
Reputation acts like a resource to the company- one that is difficult to gain and difficult to imitate, and that enables the company to achieve superior levels of performance. Companies with better corporate reputations are better able to improve their operating performance over time. The higher levels of operating performance that result from a good reputation virtually guarantee that a company will receive favourable endorsements from stakeholders and the media. Charles Fombrun and Mark Shanley showed that reputations measured by Fortune’s most admired company ratings were heavily influenced by a health institution’s performance, media visibility and significance to the community, strategic behaviour heavily intertwined.(C. J. Fombrun & V. Rindova 2001).
Organizations are increasingly aware of the fact that the joint communication efforts by all specialists in this field in an organization are not always effective. Communication is sometimes fragmented or even contradictory. The magic phrase by which solutions to this problem are often looked for seems to be integration of communication.
The hospital should be able to identify which organizational activities related to external stakeholders should be analyzed. The perspectives of higher-level functional categories within the organization’s communication strategy. There should be an analysis on the branding, advertising, public relations and even maintaining online presence through a website or webpage, community management or social media strategy through facebook or twitter.
Afterwards, you can start rating your current level of effectiveness for the various categories of communicating with external stakeholders. A target audience should be consulted for each of the areas of external communication strategy, determine what you want to accomplish and if you have achieved the goals you have to improve the reputation of the health institution. The ratings will help you identify the areas by which you are supposed to concentrate and improve and develop strategies to realign them with the goals of the healthcare institution.
Corporate reputation is the entire expectations and perceptions of the stakeholders about the hospital in reference to the personal ideals of the stakeholders. Reputation of the hospital is not necessarily informed by any form of actual knowledge, form of communication or mere interaction within the company which can be communicated by various stakeholders outside the institution. Management of reputation must include managing and monitoring perceptions in order to achieve favourable response from the community, patients and other members of the community.
How would you evaluate the effectiveness of your communications strategy?
A communication strategy is a model or guide of which you can follow to help create effective messages for specific purposes. Health care communication strategies offer advice or suggestions about gaining insights into a patient’s background and health care beliefs. Strategies are also valuable in helping overcome barriers to effective communication between hospital, stakeholders, caregivers and patients.
Communicating effectively and often during a reputation improvement process is essential. Crises create unsettling ambiguities. Companies facing crisis are usually under siege from the media, the financial community, disgruntled employee, online and offline critics and in some cases the hospital administrators. Rescuing reputation and taking the first steps on the path to long term recovery require a greater level of communications than is typical in less stressful times.
Communications from the top are needed in heave doses to steady the employees who may e reeling from bad news or uncertainty.
It is the leader’s job to choose the most effective channels and the right words, and then give communications their most meaning during challenging times.
In professional organizations, developing external communication strategies that emphasize consistency and stability is very important. Internally, induction and training procedures can be usefully employed to encourage professionals to behave in standardized ways when dealing with clients. However, the need to be carefully monitored to ensure that a balance between individual creativity and firm goals is struck. The study by Covaleski et al. (1998) highlighted the problems with two such induction strategies: MBO (management by objectives) and mentoring.
Opinions research rely on polls to gauge public opinion. We may well want to construct reputational profiles and rankings of companies in quite similar ways. To determine the effectiveness of the communication strategy by the healthcare institution, there should be careful identification of each members of the constituent groups. The effectiveness of the communication strategy can be measured with the proper solicitation of feedbacks and ratings from relevant areas of the institution to specific target audience.
The better represented are all of the company’s constituents in the reputational audit, the more valid is the reputational profiles that it can generate. The main concern is with the constructing samples of constituents that will not have bias results. To achieve a representation of the population at large, political pollsters advocate random sampling- respondents are not selected because of their typicality or of their representatives.
Insofar as corporate ratings accurately reflect the multiple images of a company that are being disseminated, they provide a useful tool for assessing the company’s overall performance. For some companies, the fragmented images will converge, producing strong reputations.
Communication is used to determine who needs to know something, what they need to know and how best to interact with them. A strategic public relations program will address the audience that is relevant to the public relations and reputation improvement campaign. Research initiatives should link this understanding to the reputation improvement endeavours of the hospital. In the process, it must provide a benchmark from which to judge the impact and effectiveness of the public relations strategy utilized by the healthcare institution.
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