As we have touched on before in previous articles: staff engagement and collaborative working in healthcare can really make a positive difference to patient outcomes. If you can introduce teamwork in your Quality Improvement (QI) activities, this can be equally beneficial, while good communication also plays a big part in the success of a QI project by fostering teamwork and helping build an empowered team.
In this article, we’re going to look at collaborative working in healthcare, the importance of efficient communication, and how you can be successful in both.
Why is collaborative working in healthcare important?
Evidence has shown that teamwork and collaboration are important if you want to create a successful QI experience. Creating a collaborative working environment is one of the building blocks needed for improvement projects. In other words, if you can build collaborative teams, you are on the road to QI success.
Robert Sweezey et al described collaborative working in healthcare as ‘two or more people who interact interdependently with a common purpose, working toward measurable goals that benefit from leadership, that maintains stability while encouraging honest discussion and problem solving' . The authors go on to say that you can achieve teamwork in healthcare by combining collaboration and great communication. These two elements help teams work towards a common goal and make decisions as a team, while having the added benefit of expanding and enhancing the traditional roles associated with healthcare staff.
In their article about teamwork ‘Health care professional development: Working as a team to improve patient care‘, the authors put forward that: ‘effective teamwork can immediately and positively affect patient safety and outcomes'. This really can be the case. Effective teams use effective communications, which can be particularly important during a time where patients may be looked after multiple care providers.
Advantages of collaborative working in healthcare QI teams
There are many advantages of collaborative working in healthcare QI teams. We’ve touched on effective communications as being especially important – and evidence has shown that people in a collaborative working environment can be particularly successful in providing enhanced patient care.
The East London NHS Foundation Trust (ELFT), for example, have worked really hard to foster teamwork and have done some great patient safety work in a collaborative format. The trust’s QI programme began in 2014 and the trust went on to achieve an Outstanding rating from the Care Quality Commission (CQC) in September 2016. By developing the ‘ELFT QI method’ the team enabled multidisciplinary teams, patients and carers to focus on quality issues that mattered to them. As a result of collaborative working, the team has gone on to train over 3,500 people in four years at many different levels of the organisation.
Keeping the team well-informed: how to improve communication across your organisation
Improving communication does not need to be a big hurdle for you and your team, and it can actually be an excellent collaborative working tool.
Firstly, you will need to decide on the best communication channels for your project: how are you going to reach the people you need to reach? Will you use email? Video? Social media? Or face to face? You might need to do a bit of research and experience a bit of trial and error to find out what is going to work best for you and your team. You may also need to ask around and see what works best for others – one method might be better than another for your particular purposes.
Once you’ve decided on your methods of communication and trialled these, you also need to focus on maintaining continuity – how often are people going to receive communications? What works best for them? And how regularly will you need to engage with your target audience? All these answers will come to you while trialling your communications campaigns.
You also need to decide on what your story actually is: what’s the narrative? How are you going to tell your story? We’ll be looking at that later on in the article and you may also want to look at our piece: ‘Securing wider organisational buy-in and creating a vision for improvement culture’, where we look in detail at creating, sharing and communicating improvement visions.
You can also use tools to help you communicate well across QI projects. Tools such as Life QI can help teams communicate. As Anne Allison, Associate Director of Quality Improvement at Lancashire Care NHS Foundation Trust LCFT says: “Life QI prompts and harnesses communication across teams and networks that wouldn’t have ordinarily been there."
So, keeping your team well-informed is really important and a vital step in the QI process. As you will be engaging with people across job roles and disciplines in order to get people on board – you could even be forgiven for overcommunicating! With good communication and staff engagement you can encourage collaborative working and foster teamwork.
Tailor your communications – what your team/staff really need to know…
Tailoring your communications to your audience is important. But what exactly do your team or staff really need to know? What will they want to hear? Can you streamline your communications so the salient information is front and centre and can you articulate your messages well?
In the article ‘Exploring the role of communications in quality improvement’, the authors recognise that effective communication is crucial to successful change, but point out that - in their experience - communications strategies are not necessarily automatically incorporated into QI frameworks. This is something that may be worth considering in your QI work.
In the CQC report ‘Quality improvement in hospital trusts: Sharing learning from trusts on a journey of QI', the authors say: ‘Leaders are strategic in how to spread and reinforce QI – we have seen regular learning and sharing events to celebrate improvement work, which includes learning from less successful activity. These sit alongside formal support for the spread and recognition of improvement throughout the organisation, such as through newsletters, social media, posters and journal articles. There is a training and development strategy for improvement and innovation, with active monitoring, such as numbers of staff and patients taking part in improvement projects, and attendances at training events.’
The report looks at the Midlands Partnership NHS Foundation Trust who holds Friday afternoon ‘report outs’ to share success from a range of QI activities. Their examples show real thought and attention to detail in terms of tailoring their communications and communications’ channels as: ‘the events are filmed and streamed live throughout the organisation. Stories are developed for use on the trust screensaver, and are incorporated into the trust newsletter. Consideration is made on how best to communicate any learning from huddles and improvement work, to be shared across the organisation – for example, huddles must decide on the key communication ‘tweet’ and updates from previous improvement work'. A good example of how communication can be tailored to share success.
In their ‘1000 Lives’ campaign in Wales, the team created a communications strategy to guide communications, which was specifically designed to engage the hearts and minds of NHS staff and promote awareness. By using qualitative and quantitative methods to measure outputs they found that the strategy enabled clear and consistent framing of campaign messages. They used this strategy to reaffirm the value of the campaign and promote sustained engagement, and were successful in building up the profile of the campaign internally and with the media. They developed a communications bundle of six core components - and would recommend this be added to QI methodology. Their conclusion is clear: 'Systematic and structured communications can support and enhance QI initiatives.'
The use of storytelling to engage staff
As we’ve explored in this article, a key component of QI success is communication. Motivation is another key area, as it can unlock creativity and collaboration. Storytelling is another useful medium in bringing about transformational change. EFLT talk about storytelling thus: ‘Skilful storytelling helps listeners understand the essence of complex concepts and ideas in meaningful and often personal ways.’ They explain why scientists now embrace storytelling as a means to connect with their audiences.
Trusts like ELFT have used pictorial storytelling as a means of telling their story in a joyous way. They regularly use a ‘creative doodler’ called Sonia Sparkles (who also happens to be passionate about QI and her day job is a senior healthcare manager!) to help unlock people’s creativity. But there are many other popular and useful frameworks for storytelling, including the ‘Pixar Pitch’.
The team at ELFT have co-created an ‘Illustrated guide to Quality Improvement’ which is a fun, interactive picture book that helps the reader to understand ‘What is QI?’ and think about how to improve the health of populations.
To finish with wise words from the article: ‘Training healthcare professionals in quality improvement,’ seems to sum up quite nicely the importance of communication and collaborative working in healthcare. The report recommends that QI become a basic skill: ‘like cardiopulmonary resuscitation; one that all health professionals acquire early in their training as an integral part of their future work. When everyone shares this basic understanding, communication and collaboration become easier, and continuous improvement throughout the workplace becomes habit. The skills themselves are transferrable across any discipline. Creating capability and capacity so that staff are able and encouraged to ask and respond to the question ‘what can I do to make a difference?’ without having to wait to be asked, has the power to empower and counteract the feeling of ‘learned helplessness’ and enable us to rediscover the joy in our work.’