Communication Within the Nhs

1. The National Health Service (NHS) is a publicly funded service, providing free health care for all British citizens. ‘Since its launch in 1948, the NHS has grown to become the world’s largest publicly funded health service’ together with one of the largest employers in the world’. However throughout the past decade the demand for health care has been rising radically and with the continuous need to be accountable for public spending the NHS has been put under immense pressure to be cost effective at the same time as achieving their prime objective of improving the standard of care (NHS Choices, 2010). . 1 Human resource management is crucial to the success of this goal since it identifies the increasing recognition that health care delivery relies fundamentally on the capacity and capabilities of the workforce. In centring the attention on efficient communication throughout the organization, HRM can ensure employee satisfaction, thus improving the performance standards and providing optimal productivity.

Efficient communication is the bedrock to any organization wishing to achieve such means, thus through obtaining relevant information on the techniques and barriers, which can affect the flow of good communication, managers are guided within the decision process, thus avoiding situations that may arise as a result of poor interaction, (Hyde etl, 2006). 2. Communication is defined by Rollinson (2005, P576) as ‘a process in which information and its meaning is conveyed by a sender to a receiver’.

This definition draws upon the fundamental principle that for information to be exchanged efficiently the receiver and the sender must attribute the message with the same meaning. Shannon and Weaver’s communication model (figure 1) is based on eight basic constituents that not only explain how communication happens, but why communication sometimes fails. An understanding of this is vital, since inadequate or ineffective communication impacts negatively on employees causing frustration and misconceptions to arise, consequently lowering working standards along with damaging employee morale.

In organisations, such as the NHS, where employees are under intense pressure to do more with less, employee morale is one of management’s most utmost concerns. Low morale has a detrimental effect on the organisation, gradually destroying worker’s commitment, the service they offer, and thus alienating the patients they serve, (BNET Editorial, 2010). 2. 2 As with all communication skills, the goal of communication in the NHS should be, to achieve mutual understanding of a message either being given or received, so efficient tasks ensue as a result (yourcommunicationskills. om, 2007). However it is fundamental to realise that the communication process can regularly be made difficult or sometimes impossible due to barriers affecting the coding process. These are individual’s characteristics, predispositions and preoccupations which divert their attention elsewhere. (Huczynski and Buchanan, 2007). Differences in people’s perceptual filters can affect the way in which a message is decoded. . In relation to the Shannon-Weaver model this is what is referred to as noise.

This is not just other people talking or background noise; it comprises of anything that interferes with the way in the message being transmitted. Huczynski and Buchanan (2007) describe five significant attributes, which can disturb the effective exchange of information. These include: language and cultural diversity, power differences, gender differences, physical surroundings. 3. The NHS is a multicultural society, so the need to consider various values and beliefs is a necessity. Within each medical, nursing, management, and many other professions various identities, cultures and subcultures exist (Hyde etl, 2006).

This consequently leads to the possibility for information to be misinterpreted, thus lowering the working standards and employee morale. A numerous amount of NHS employees originate from outside the UK. They bring with them a variety of cultural and linguistic differences that need consideration. Ignorance of these differences may lead to offending an employee, leading to unintentional discrimination and poor relationships. It would therefore be beneficial for human resource management to understand culture disparities that may affect the way in which a message is perceived (Culturaldiversisty. org, 2008).

Cultural diversity not only causes interferences within verbal communication but also in the way non-verbal communication is perceived. In relation to the cultural variations within non-verbal communication, body language is often misconstrued. For example when the British are talking face to face they ‘tend to look away spasmodically’, in contrast to this the Norwegians ‘typically look people steadily in their eyes without altering their gaze,’ thus a British individual communicating with a Norwegian could portray this eye contact as threatening and a wrong perception of that person may be perceived (Mullins, 2005, p231). . 1 As the prime objective of the NHS care system is to provide optimal care for all UK citizens, and with a multicultural country as our own, cultural competence ought to be manifested at every level within the NHS organization to ensure there are no damaging effects. Missunderstandings may lead to missdiagonosis, thus practitioners and nurses along with managers should all be culturaly aware. (Cultural diversisty. org, 2007) Portsmouth hospital’s NHS trust’s ethnic health coordinator highlights this importance, recognising touch as one of the most natural gestures that a nurse will use to ensure comfort and care.

However touching an orthodox Jew of the opposite sex, may be perceived as offensive since this kind of comfort is not welcome in Judaism,(Mullins, 2007, p233). With awareness to such differences the chance to offend a patient or employee is minimized. 4. Non-verbal communication can be described as the transition of meaning through behaviours, such as facial expression and body gestures. ‘ When we interact with others face to face, we are constantly sending and receiving messages through the signs, expressions, postures and vocal mannerisms that we seem to adopt unconsciously’,( Huczynski and Bachnana, 2007, p192).

This non-verbal behaviour is referred to by Muareen Guirdham (2002, p184 cited Huczynski and Bachnana, 2007) as a ‘relationship language’ in which trust, disagreement, and friendship can be communicated without verbalising. Having awareness of this context can aid human resource management in building strong collaborative relationships between the employees within the workforce. This is important in the NHS since the staff particular involved in the care for patients must work collaboratively together to provide the service needed.

Trusting relationships not only improve the contentment of employees but can create a positive atmosphere within the care unit, thus improving the quality and hospital experience of the patients. 4. 1 New NHS recruits become part of a complex team of professionals. Sensitive interpersonal communication requires highly developed perceptive skills so that the individual can expertly decode verbal and non- verbal information liasing coherently and emphatically with staff and patients.

A poor bedside manner, along with a lack of tact or understanding for colleague and patient’s needs, will probably result in dissatisfied customers and an uncooperative team. 4. 2 So when employing new recruits the implications of an individual’s non-verbal communication needs particular consideration as poor body language or eye contact along with insensitive paralanguage could lead to hostility between staff and patients. Paralanguage is an important aspect to non-verbal communication, since the tone and pitch of the voice can vary the meaning of the message extensively and contradict what is actually being stated.

It is critical to comprehend that when verbal and non-verbal communication contradict each other, there is often a greater emphasis placed upon the non-verbal message. However verbal communication can as well influence the way in which information is communicated. 5. Information is exchanged through the use of questions; these questions can either seek a simple response of ‘yes’ or ‘no’ or encourage a person to respond with further information. The basic distinction between these is the use of open or closed questions.

Although closed messages are limited they can often avoid a person disclosing information that we did not want to know, (Huczynski and Buchanan, 2007) In managing the control of hospital activities, information is often required straight away. By adopting the use of closed question managers can coordinate tasks and activities that are required to be exchanged quickly. This is particularly relevant when life risking decisions and actions need to be made and timely information is needed.

In addition to this the NHS human resource team may wish to use closed questions at the start of the interviewing process, as it establishes the conversation pattern of ‘I ask the question, you give the answer’. However to maintain rapport with existing employees the HRM of NHS may benefit in using open-ended questions to invite the disclosure of further information along with providing an open forum for discussing procedures or problems. This is particularly useful in establishing the feelings and emotions of individuals involved in achieving the organisational goals. Huczynski and Bachanun, 2007, p184). 5. 1 The need for direct and assertive language is imperative in today’s society. According to the research by Deborah Tannen (1990, 1995 cited Huczynski and Buchanan) different genders often use different linguistics. These can range from pronunciation or morphology to the vocabulary used (Bayer and Nemati, 2007 ) If this is the case then there are serious gender consequences, as it would seem that the language used by the vast majority of women is jeopardizing their career development.

Research indicates that women are more likely to use language of connection and intimacy in comparison to men who tend to think more in hierarchical terms. Since men strive in retaining power they often put people down, and jump at the chance of criticisms thus giving negative feedback quickly (Huczynski and Buchanan, 2007). 5. 2 These linguistic differences are a result of differing peer relationships between boys and girls that have a significant influence on gender behaviour and use of language in latter years.

These essentially different cultural differences are blamed as the cause for social gender inequalities. Behaviour patterns and language development, such as the boy’s need to dominate and stand out in their large groups as opposed to the conformity of girls in their closed peer groups are seen as the dominating factors to adult behaviour and use of language, linking atypical female language as being subordinate, (Huczynski and Buchanan, 2007) However in an ever-changing society perhaps the emphasis should not be on stereotyping genders but talking about powerful and powerless language.

Whilst there are still examples of ‘women’s language’ there are an increasing number of women who are holding down good managerial posts as they have mastered powerful language and have thus become more assertive (Robert Lakoff, ‘Language & Women’s Place’, 1975). 5. 3 ‘Effective leadership is critical to guide a change toward an improvement oriented clinical practice setting’. Good leadership of management and nurses increases the capacity to teach and promote development of their peers together with having a direct, positive impact on health care quality (Hyrkas, K, Harvey, K, 2010).

By training staff in the use of power talking techniques they can help them to become more assertive and motivational. In controlling the way in which we communicate we can influence the way in which people perceive us. Conscious command of our verbal and non-verbal messages can increase the ability to manipulate and control others, whilst gaining respect and authority. This is an advantage to the organisation as they can therefore provide better efficiency and quality of care.

On the other hand ‘women’s language’ has its place on the wards where a softer more sympathetic approach is sometimes more appropriate. 6. In relation to power disparity there has been significant research to indicate that the various levels in organisation hierarchy have a tendency to be a contributing cause of message distortion. This is because as messages are transmitted up or down the different levels of hierarchy information is often filtered, dropped or added thus distorting the original information source (Shortell and Kaluzny, 1997).

Throughout a large multi organisation such as the National Health Service, establishing a clear directional flow of the transition of information is essential for facilitating the co ordination of activities throughout the numerous departments, (NHS summary, 2010). While organisational communication flows in the four directions of upwards, downwards, horizontally and diagonally, the majority of communication originates at the highest level before being conveyed down, (Rollinson, 2005). 6. Superiors use the downward flow to provide information, instructions, policies and a guideline, which in turn keeps subordinate employees up to date with departmental procedures. Using this flow efficiently can promote understanding throughout the workforce of the tasks in which they are required to achieve. However although there is evidence to suggest that individuals perform better when receiving information from above, problems can arise if there is no provision for the opposite flow of information. Neglecting employee’s opinions and ignoring their voices can lead to hostilities, resulting in low morale, (Shortell and Kaluzny, 1997). Nurses who perceived that they were valued by the organization reported better health than those who felt undervalued’ (Bradley and Cartwright, 2002 cited Hyde etl). 6. 2Employee loyalty and enthusiasm should be a priority within HRM, thus adopting and promoting an upward flow of communication, employee satisfaction can be improved. Since the upward flow of communication allows those with less authority to express their opinions and perceptions to their superiors, in doing so it gives the subordinates a sense of purpose, whilst providing managers with information for decision-making and performance evaluation.

Receiving open and honest views of those individuals from various areas within the organisation enables the chance for any problems to be highlighted, which may otherwise have not been made apparent, thus effectively allowing improvements to be made. It also aids the development of trusting relationships, making the employees feel more worthy and part of a collaborative team. When employees are not included in the decision making process they may pay less attention to procedures and become wary and distrustful of decisions that have been made behind their backs, leading to a lack of communication and cooperation.

It is thus advantageous to encourage this line of communication through such means as opinion surveys and suggestion schemes, (Rollinson, 2005). ‘Employment relationships of The Psychological Contract in the NHS is an example of context-specific HRM where a closer relationship between people at the top of an organization and staff is crucial to enhanced performance’ (Caulkin, 2003; Purvis and Cropley,2003 cited Hyde etl). 6. 3 In regard to upward communication, ‘ Informal communication can be a rich source of information about performance, ideas, feeling and attitudes’ (Shortell and Kaluzny, 1997, p245).

This can be used to the advantage of the NHS, since it can be a valuable resource of feedback about how the employees perceive the actions and decisions of the management. This form of communication is a powerful means, and although it is not officially recognised it operates in nearly every organisation. It can be particularly useful for the NHS where information is needed quickly, this because informal communication is often much faster at carrying information than formal communication (Rollison, 2005). 6. 4 Furthermore, horizontal flows of communication, i. worker to worker and manager to manager enables a direct flow of information to concerned parties within the department. Within the huge network of the NHS it is essential that the right information be passed on efficiently to all concerned parties. Whereas the downward flow of communication brings into play the responsibility of managers to keep employees enlightened with all up to date material, the flexible models of circular and all channel networks often provide a speedier more accurate line of communication.

However due to the nature of this line of communication being non authoritative, the problem of accountability occurs. If important decisions have to be made there is no leader to take control so inevitable the responsibility can be passed from person to person with no one taken ultimate responsibility. Managers therefore need to decide which type of flow of communication is appropriate. (Shortell and Kaluzny) 7. Physical surroundings are another barrier to communication.

The NHS with its vast number of interconnected private and public sectors, and its diversity of personnel and stakeholders demands a highly organised network of communication, good relationships and cooperation. Whilst horizontal flows of communication are generally effective, upward and downward flows are hampered by various constraints such as workload, ever changing shifts, unavailability of doctors or senior staff as they are visiting different sites, inexperienced staff that lack the confidence to ask essential questions (Rollinson, 2005).

As the vast majority of information is passed on via written reports personal interaction tends to be limited. Stephen Pincock (2004) reports that ‘poor communication lies at the heart of the NHS’. Investigations by Health Service ombudsman Ann Abraham highlighted poor handling of complaints, poor nursing care and the lack of liaison between services as being the main reasons for grievance. There seems to be a serious lack of communication between some staff and patients, illustrating a need for staff to be given time and training to enable them o listen more carefully to patients and their carers, making notes of conversations so that any disputes can be radically reduced. Although the NHS has tried to improve public relations by meeting deadlines and communicating to the masses via television and the Internet (Direct NHS) internal and external communication between professionals still seems to be an issue. 8. To conclude, in an organisation such as the NHS, good communication is vital.

The difficulty of managing human resources amongst such a multi-cultural and diverse staff is immense. Therefore a thorough understanding of the complexities of verbal and non-verbal communication is essential so that the potential of all staff, regardless of their gender, cultural background or status within the NHS can reach their full potential. Where there is an overemphasis on downward flows of information, some staff may feel intimidated and inadequate, afraid to ask questions in case they look ignorant.

By means of more flexible approaches to the directions of communication trust and integrity will be nurtured. With an ever-increasing use of migrant workers language can be restrictive and mistakes made due to language differences. By gaining a deeper awareness of the communication process and barriers within that process staff can become more perceptive and sensitive to the needs of their patients and colleagues. However without skilled communicators to cope with the increasing demands of the NHS standards will stagnate and mistakes will be costly.