Improving patient outcomes through better conversation
Sue Kennard, Head of Employee Wellbeing Service at Barts Health NHS Trust, writes for Hospital Times. Here Sue discusses how the trust is equipping its’ Occupational Health team with the skills in listening to reach the root causes of problems and provide more effective forms of support.
With 17,000 staff across the trust, one would be forgiven for thinking that the sheer number of referrals would pose a significant challenge for Barts Health. But volume is not the real challenge. The team of 12 in occupational help (OH) are dealing with an average of 260 referrals per week, but it is the complexity and variety that poses the team the biggest challenge.
A variety of challenge
Barts encompasses four different hospital sites, each with its own structures and work cultures. To add to this, the Occupational Health function also services external customers in the public sector: employees from GP surgeries, schools and even maintenance staff from contractor Serco.
When I joined the NHS Trust in 2016, there were inconsistencies that needed to be addressed. The information managers regarding referrals could often be poor. It was likely to give the reason as “stress”, without being clear as to whether the employee was still in work or not, how long that might have been for; or whether the cause was thought to be work-related. Without more guidance on the OH role and processes, line managers had got into a routine of jotting out a cursory note. That was one end of the problem.
The other was how the one-hour referral sessions were being run. Staff would, as a rule, hear about needs and then produce a report. It was an inflexible process that could often lead to issues only being discussed at a surface level. An employee might summarise a situation as how they’re just not getting on with their manager, or the pressure of the job has recently escalated and they’re not coping. But there may well be underlying issues that need to be understood in order to reach more effective and longer-term solutions. OH need to know about all the issues that can be influenced in order to have any chance of having an impact.
It was clear we needed to re-examine the whole process to find out how it could be improved for both clients and customers. That was the beginning of implementing a case management process designed to provide consistency. We set about building new attitudes and understanding of OH through information campaigns such as resources for individual audiences about what information was needed from a referral, what to consider, what to expect, ensuring all the different needs from the service were being met.
Delivering quality conversation
At the heart of the change was the quality of the conversations, what’s known as ‘Conversational Intelligence’ (CI). We made use of the expertise of CMP, a workplace relationships specialist, to deliver training across the team. It was not a case of questioning the team’s level of clinical knowledge or their counselling skills – but going back to essentials. This included core soft skills, ways to widen discussions without being overly assertive. How to have better quality conversations that would work better for both sides, reach better outcomes.
CI is about being equipped to have conversations in which we do not make assumptions. We are curious about different views, experiences, approaches. It’s when we listen in a reflective way and are conscious of the need to empathise with views that might be different from our own. Critically, having CI means being able to create a sense of safety, so that the staff member feels able to be entirely open rather than giving expected answers, following the path of least resistance.
Improved communication, better results
The one-day training programme focuses on building an awareness of the role of conversations in relationships, how the quality of conversations changes dynamics, the huge influence they have on the outcome of situations, particularly those most difficult of conversations where we’re most likely to want to rush to the easiest conclusions. Core skills for CI include ‘situational awareness’, the essential practice of ‘curiosity’, ‘reflective listening’, ‘empathy’, and ‘self-awareness’ – so not just listening outwardly but inwardly, how your own ‘inner state’ is impacting on the flow of the conversation.
One very experienced member of the team was sceptical about the training programme and needed some persuasion to take part. They didn’t make it explicit that they thought they knew it all already, but the implication was there. I wanted the whole team to be part of the experience, to learn together and share their experiences, so it wouldn’t work without them. A day after the training, that senior team member was raving about the training to everyone: they’d learnt a great deal about themselves and were going to re-think their entire approach as a result. They’d seen just how much our personal thoughts, feelings and prejudices were entering into conversations and acting as a blocker to better outcomes.
Outcomes of the CI training
All the staff who took part in the CI training have reported benefits to them as individuals. In terms of the overall service, the package of changes involved in moving to a case management approach has transformed the nature of the services. CI was important for that: the quality of reports has improved, with more insights, more purposeful ways forward. Importantly, the employee wellbeing service has been able to deliver higher quality information back to HR, upping the level of relationship. The team itself has become more engaged in the regular team meetings, looking at processes, being more self-reflective, contributing more, and focusing on fairness and consistency across the diverse range of customers.
Barts Health has plans to keep CI skills at the centre of “how we do things around here”, not necessarily to repeat training but looking to continually develop levels. We also plan to look at the harder evaluation of the impact of changes, monitoring for absence, and getting more feedback from HR.