Tag Archive: Communication


Issues about structure are recurring matters of debate and dispute in most businesses. This is because they include matters relating to departmental and sectional groups, the pattern of reporting relationships, the cycle of meetings, information systems, and rules and procedures. A business might be structured in various ways: by function, by product, by service or by geography.

As is the case with most aspects of business, it is unlikely that there is any one ‘best’ model for structure. You would not expect businesses with a professional orientation, such as a legal or medical practice, or a not-for-profit business such as a church or theatre company with a strong values base, to have the same business or management structure as a supermarket or high street bank. The structure of a co-operative would enable the broad-based participation and involvement of its members, while a legal practice would need a more collectivist or collegiate structure. The challenge facing all types of businesses is to develop a structure that recognises what is required while still achieving an efficient use of resources and providing effective services to customers.

Whatever the business, however, structure is pivotal in the relationship between task (what the business does) and process (how the business does it). It is through the medium of its structure that the values, commitments, purposes and aspirations of the business are implemented. Structure has to translate values and processes into a practical, working reality – and to do this while delivering profit to its owners and value to its customers. Functional structures might work best when departments need regular communication with each other. However, a disadvantage may be that functions and the people who work in them may become rather insular.

Structuring by product or service can help to achieve better responsiveness to customer needs, although it might mean professional or functional expertise becomes fragmented. A geographic structure has advantages for a large international business because there are likely to be differences between the markets it serves. There are also likely to be language and cultural differences. However, structuring by location may be problematic in terms of communication and information flows, and support functions such as finance and ICT may have to be duplicated.

Experts are warning that poor communication between hospital staff and with their patients is far too common and deeply damaging. According to the findings of a confidential review patients left out of the loop and staff clocking on and off without a handover was commonplace. Change in the hospital team structure over recent years has seen individual clinicians become “transient acquaintances during a patient’s illness rather than having responsibility for continuity of care”, says the NCEPOD report. It found a co-ordinated handover of patients between night and day staff only occurred in a quarter of the teams. In 13.5% of cases lack of communication compromised continuity of patient care.

In just over half (53%) of cases there was an apparent lack of input from senior doctors “leading to delays in giving patients timely and appropriate care”, report author and surgeon Ian Martin said. And 30% of the patients were not seen by a consultant within the recommended 12 hours after admission. In a fifth of patients who were not expected to survive on admission there was no evidence of any discussion between the health care team and either the patient or relatives on treatment limitation. Many “do not attempt resuscitation” orders were signed by very junior trainee doctors. NCEPOD chairman Professor Tom Treasure said the report vividly revealed the challenge medical teams face in making the transition between saving life and allowing natural death. “It should be ensured that patients achieve the best quality of life until they die. Effective team working and communication with patients, relatives and carers are fundamental to getting this right.”

Director of the Patients Association, Katherine Murphy, said: “These findings run the risk of undermining basic confidence in the NHS. Some of the examples are shocking. “NCEPOD is the nearest the NHS has to airline ‘near miss reporting’. Its findings must be acted upon, or problems will continue to plague vulnerable patients and their families.” John Black, president of the Royal College of Surgeons, said doctors had long been concerned that the loss of team working in hospitals had fuelled the risk of poor communication, and sub-standard patient care. He said the implementation of a 48-hour working week under the European Working Time Directive almost certainly meant that the problem had got worse since the latest study was carried out. Professor Black said the only way to address the problem was to opt out of the directive.

A Department of Health spokesperson said measures had been introduced to improve care – including an end of life strategy – since the report’s survey was carried out. “We are putting in place an extensive programme of health and social care training to support end of life care provision, including pilot projects to support the development of communication skills. He added that evidence from hospitals already implementing a 48-hour week showed a drop in mortality and no evidence of harm to patients. “Working together with the local NHS and the Royal Colleges we have set up a rigorous quality assurance process to give us an accurate picture of how EWTD is being implemented and so we can provide support where it is needed.”

We all know that good communication is key but it is not always practised as the coroners reports are showing, there seems to be a high number of deaths which could have been avoided. Since the rules were changed last year, coroners have been able to write detailed reports following inquests that highlighted a risk of more deaths occurring. Coroners reported that better communication could reduce the number of deaths occurring in hospital.

Out 207 reports between July 2008 and March 2009, 58 arose from hospital deaths, 19 were classed as mental health related, 19 were associated with community healthcare and emergency services and 11 were linked to drugs and medication.

So what is good communication?
Good communication is sharing information is a clear and concise manner with everyone who is involved in the care of the patient, it is also ensuring that the patient fully understands what is going; obviously in emergency situations this is not always possible at the time but after the emergency has passed they need to be told what is going on. This will minimise the chance of the patient possibly taking the wrong medication or committing suicide because they become depressed.

There are a number of courses available which are designed to help improve communication skills. One particularly good one is done by Medicology, Communication Skills for Doctors.