e-Communication Skills A guide for primary care Edited by Louise Simpson Paul Robinson Mark Fletcher Rob Wilson Foreword by Mike Pringle Radcliffe Publishing Oxford(cid:1)Seattle CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2005 by Louise Simpson, Paul Robinson, Mark Fletcher-Brown and Rob Wilson CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20160525 International Standard Book Number-13: 978-1-138-03034-3 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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(SamuelJohnson) TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk Contents Frontispiece iii Foreword ix Abouttheauthors xi Aboutthecontributors xii Acknowledgements xiii Dedications xiv Part1: Diagnosingtheproblem 1 1 Aboute-communicationskills 3 LouiseSimpson Whatcouldbedifferent? 3 Whoisthisbookfor? 5 Howtousethisbook 5 References 5 2 Introductiontoe-communicationskills 6 LouiseSimpson Thecontext:communications 6 Thecontext:informatics 7 Whatpatientssaytheywant,andhowinformaticscanhelp 8 e-Communications:enablingshareddecision-making 9 e-Communications:enablingpatientandclinicianaccessto evidence-basedguidance 9 e-Communications:enablinginterdisciplinaryteamwork 10 Barrierstoe-communication 10 Finalthoughts 10 References 11 3 Peoplecommunicate 12 PaulRobinson Peoplecommunicate 12 Modelsofcommunication 13 vi (cid:1) Contents Thenatureofconsciousness 15 Finalthoughts 22 References 23 Part2: e-Communicationsintheclinicalsetting 24 4 e-Communicationskillsintheclinicalsetting 26 PaulRobinson Settingthescene 26 Knowledgeandexpertiseintheconsultation 27 Usingthecomputerinrealconsultations 33 Conclusion 34 References 34 5 Teamsworkinge-together 36 LouiseSimpson Settingthee-scene 36 Startingatthebeginning 37 Decision-makingfore-teams 37 Howteamsmakedecisions 38 Interpersonalplayversustaskfocus 38 Groupe-think 39 Communicationskillsfore-teams 40 Howteamsmightchange 42 Issuesfore-teams 43 Afinalthought 45 References 46 6 Informationgovernance 47 RobWilson Whatisinformationgovernance? 47 Whyisinformationgovernanceimportant? 49 Whataretheaimsofinformationgovernance? 49 Whataretherequirementsforprimarycare? 49 Howcanwedoinformationgovernanceingeneralpractice? 50 Whatresourcesareavailable? 51 Finalthoughts 51 References 52 7 Healthinequalitiesandlanguagediversity 53 MarkGibsonandPamTurpin Languagediversity,healthinequalitiesandpatient informationprovision 53 Howcantechnologyhelp? 56 Conclusion 57 References 58 Contents (cid:1) vii Part3: Practicalmatters 59 8 Diagnosingtheproblemandfindingasolution 61 MarkFletcher Whatistheproblem? 61 Whatisthelikelysolution? 62 Makingithappen 63 Atypicalreputationaudit 64 9 Writingane-communicationsstrategy 65 MarkFletcher Whatisthestartingpoint? 65 Whatcanwedoaboutit? 66 Outcomes 67 Audiences 69 Channels 74 Messages 75 Context 76 Evaluation 77 Afinalthought 77 10 e-Communicating 79 MarkFletcher Electronicsignatures 79 Thecriticaldata 81 Findingoutwhatpeoplethink 82 Theheader 83 Thebodycopy 84 Developingane-communicationspolicy 87 Reference 89 11 Thepeculiarityofe-communication 90 MarkFletcher It’sallontherecord 90 e-Gamesareentirelyacceptable 90 Managinge-risk 92 Otherwaysofassessingcommunicationrisk 93 Part4: Resourcepack 95 12 Casestudy1:Peoplewithsightloss,ofSouthAsianorigin, inBradford 97 MarkGibsonandPamTurpin Introduction 97 Theevidence 98 Discussion 100 viii (cid:1) Contents 13 Casestudy2:Thesecondarycareperspective 101 CharlotteBates Settingthescene 101 Communicationsrequirements 102 Communicationonanindividuallevel 103 Interdepartmentalcommunication 103 Communications:someproblemsandsomesolutions 104 Writtencommunication 106 Telecommunications 107 Photocopyingandfacsimile 108 Computersystemsande-communication 108 Finalthoughts 109 14 Casestudy3:DitchingthepaperinStaffordshire 110 DaiEvans Context 110 Developmentofe-working 112 AcquiringinitialfunctionalITskills:aself-helpgroupsolution 112 DisseminatingITskillsintothelocalcommunity:localuser groups 113 Particularlessonsinthedevelopmentofelectronicrecords 113 Organisationalimpactsontraining:skinningthecatanother way 114 Someexamplesofpersonalchangemanagement 115 Processmanagementinpractice:anunder-recognised requirement 116 e-Workinginthewiderhealthcommunity 117 Currentposition:computer-basedrecords–successes andholes 120 15 Findingoutmore 122 LouiseSimpson Books,papersandjournals 122 WebandCD-ROMresources 122 Organisationsandtheirwebsites 123 Othermaterials:someusefuladdresses 124 16 Glossaryofabbreviations 125 Index 127 Foreword Thoseofuswhocanrememberthedramaticimpactoftheterm‘evidence- based medicine’ when it first entered our consciousness can see ‘patient- centredcare’becomingequallydevaluedbyroutineuse.Yetbothconcepts continue to be fundamental drivers for the changes we are witnessing in clinicalcareandclinicalcommunication. Manyofusshareavisioninwhichtheindividualpatientisaninformed partner–theleadingpartner–intheircare,andinwhichgroupsofpatients support each other to use the skills of healthcare workers to the full. This requirespublicaccesstotheinformationbaseofmedicine,educationinhow tointerpretanduseit,andsupportinmakingrationalchoices. Somefearthatthiswillbethe‘endofmedicine’.Itwillcertainlyspellthe deathofpaternalistic,closedmedicaldecision-making,backedupbypoor communicationandanexpectationofunthinkingcompliance.But,formost clinicians,thisworldwillbeliberating.Doctors,nursesandotherhealthcare professionals will be able to concentrate on ensuring that patients are as well-informedastheywishtobeandaretakingasmuchcontrolovertheir healthandillnessesastheycan. This revolution is, of course, driven by technology. Lay access to infor- mationpreviouslyonlyavailableto‘insiders’,andtotheuncertaintiesand controversies that surround it, will increase patients’ knowledge of their conditions and their management. Access to medical records will help to contextualisethatknowledgeandalloweachtomonitortheeffectsoftheir healthcare choices. And new forms of communication will allow patients muchgreateraccesstothesupportofhealthcareprofessionals. Therearesignificantinherentrisks.Manypeoplewillcontinuetoprefer todelegatehealthcaredecisionsto‘professionals’;however,eventhesemay wanttoseeksecondopinionsmoreoften. Communicationisacomplexbusinessandweareveryfamiliarwiththe needtoadjustourlanguageinthelightofverbalandnon-verbalresponses.