1. Dr Anjali Mullick Clinical Lead St Joseph’s Hospice, Hackney

2. Background and context Who I am and why I’m here Palliative care- focus on whole person Talk about sensitive information Emphasis on communication with patients and those close to them It is what I find the most challenging but most satisfying aspect of my job I train other clinicians in advanced communication skills- people don’t get better with time alone and can benefit from reviewing their own practice and the reviewing what others do

3. Aims of the day Refer to programme

4. 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

5. How do we communicate with others?

6. How we dress What we write What we say Our body language How we behave

7. 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?

8. 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

9. When communication goes wrong…

10. Listening and Learning: The Ombudsman’s review of complaint handling by the NHS in England 2011-12 October 2012

11. 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.

12. 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%.

13. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary February 2013

14. 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.

15. 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.

16. 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.

17. 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

18. 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.orgwww.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

19. Forgiving fallibility Sandy Anthony Casebook Vol.13 no.3 August 2005 www.medicalprotection.org ‘Quite a few studies have been carried out in recent years concerning patients’ attitudes to disclosure and their behaviour regarding litigation. The emerging evidence strongly suggests that they are less likely to bring a claim against a doctor or hospital if they are given a full disclosure of the error, along with a sincere expression of regret and assurances that steps are being taken to prevent a reoccurrence of the error.’ 13-15 ‘A significant percentage of patients who have resorted to litigation claim that they did so only because they were not told what had really happened; they suspected a cover-up, or they felt they were treated with a lack of respect.’11,13,14,18

20. 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)

21. 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

24. How can we improve? Put ourselves in the patient or families shoes Practice our communication skills with training where 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

25. Enjoy the rest of the day!