“Everybody’s talkin’ and no one says a word” – John Lennon

Communicating with members of your practice can send your temperature rising rapidly, particularly when you hear the words “Nobody told me”. As the number of people working in a practice increases, it becomes more and more difficult to make sure a message has been transmitted, received and understood. In an office containing 60 staff, I found there were always around five people off each day, with at least one on long-term absence. Therefore, it’s essential to find systems that are fit for purpose.

What is your message?

Consider this matrix and analyse what your message is intended to do. What is your message?

Examples:

Here are just a few examples of the type of information you may wish to impart:

• Change to the daytime on-call rota
• Doctor off sick or attending a meeting – surgery cancelled
• Hand over information from one shift to another
• Warning about ‘drug addict’ or ‘violent patient’
• Deadline for ‘overtime’ claims
• Next Protected Time Meeting (training)
• New clinical or administrative protocol/policy/procedure
• Warning about a CQC inspection
• Introducing new staff
• Promoting successes (QOF, awards, savings)
• Reminders about ‘security’ and ‘use of smartcards/passwords’

Delivering that message

Walkabout

“Just say a few words” – Bob Monkhouse

I always made a point of saying hello to each person each day and of popping into the doctors’ common room especially when biscuits and cakes were present. If I had a message to impart, it would be a short and simple one. The method is more commonly known as ‘Power by Walkabout’. At the opposite end of the scale, I once needed to get across an important message to each member of staff personally. The subject was bullying. It took me a week to speak in confidence to each person. Messages delivered by walkabout probably should be restricted to good news imparted with a warm smile rather than anything contentious.

Memo King!

Once my method of communication was based on memos, until I found one member of staff had decorated his office wall with my copious memos. Unbeknown to me, I had become known as the ‘Memo King’. I soon changed my ways. For a time I tried a round-robin memo which eventually found its way back to me initialled by the readers. But it took far too long.

GP intranets and surgery websites

Nowadays, various message systems are available. Some are based within the GP clinical system whilst others are based within intranets or the surgery website. The decision to use any of these systems depends on the importance and urgency of the material to be imparted. One of my colleagues insisted that all doctors, nurses and staff read and initialled a ‘hard copy’ of every policy, protocol and procedure that had been prepared in the practice. Some documents ran to 100 pages. But were they relevant to each individual and was it actually possible to absorb and understand the content? I think not.

Message boards

Maybe you need a mixture of systems. For instance, for immediate and urgent messages, the message system housed within the clinical system might be used. The practice might also have a central computer filing system for documents. The chosen system might be housed on an intranet or in a controlled access section of the surgery website. There is nothing wrong with using whiteboards for important changes to, say, on-call arrangements or to remind people of a weekly meeting. Of course, confidential matters should never be on display. Some computer systems will display an on-screen message for all to see, but it may disappear once a key on the keyboard is touched. Ideally an internal message system should allow the sender to know when the message has been read.

Clarity and précis

“If you can’t explain it, you don’t understand it” – Albert Einstein

In all communications, clarity is essential. I have found that with emails, readers are not prepared to read the whole thing. A clear heading helps. One sentence or no more than one paragraph also helps. Maybe add a deadline or target date (i.e. to be read by) and if necessary add a simply worded summary of the main points. I have found that if you ask too many questions in an email, many go unanswered. Try writing a message in 100 words. It’s actually quite a skill.

Those ‘darned’ emails

The last time I set foot in my office as a practice manager, I was faced with several different types of email address. Two were part of the NHS system; one used the practice number as part of the address; another used the .nhs.net ending. I came across one colleague who failed to deal with reams of ‘junk’ and ‘spam’ emails which just clogged up the system. Perhaps those managing practices and leading partnerships should impose a requirement to use one NHS system of emails and stick to it.

Communication is an illusion

So, in summary, use a simple message system for non-urgent communications. For confidential messages, use an agreed, encrypted email system. For larger documents, use an intranet and keep a hard copy library of manuals. Hold regular meetings and ensure that you have systems to capture absentees. Keep messages and documents short, avoiding business language, abbreviations and jargon. George Bernard Shaw said that the biggest problem about communication is the illusion that it has taken place!