Communication between the X-Ray and the A&E Department - Dissertation Example

IMPROVING COMMUNICATION BETWEEN THE X-RAY DEPARTMENT AND THE A&E DEPARTMENT: By Presented to and code] [Name of the University] 27 March 2011 1. Executive summary: 1. The rationale explains the purpose of this report which is to highlight the ultimate importance of healthy inter-professional relationships in the hospitals, because the lives of many patients literally depend on effective communication skills. 2. Some of the major factors contributing to improper communication between doctors and radiographers are mentioned and analyzed in this report using SWOT analysis. 3. Developing a protocol is also stressed in the report with the help of the representatives from the x-ray and A&E department of the local hospital. The purpose of this is to establish new and better lines of communication between doctors and radiographers. 4. Improper supervision by the doctors can lead to such results that a harmed patient may be left unexposed to radiation exposure and a totally unharmed patient may be forced to go through unnecessary radiation treatment. 5. The protocol is to be implemented using a change management model since it is an effort towards improvement in quality and proficiency. Steps are to be taken which effectively help in linking planning to implementation. 6. Critical discussion is also presented in the report which underlines the major reasons why doctors and radiographers find it difficult or impossible to communicate with each other in emergency situation especially. 7. Some recommendations are also included which may help in improving the patient care and removing the deficiencies resulting primarily from bad management and poor inter-professional relationships. 2. Rationale: The main purpose of this report is to identify the major reasons that prove to be hurdles in the path of effective communication. The identification of those reasons is highly important because no problem can be solved without enumeration of the basic causes. Lack of enough time and overloading of patients along with professional prejudice prove to be major reasons of poor communication between radiographers and doctors. Ineffective communication is heavily reflective of lethal medication errors that prove to be the leading cause of unnecessary delays in patient care and treatment, insufficient radiation exposure to the patients, improper use of imaging technology facilities, prenatal deaths and injuries, and is the second leading cause for patient falls (JCAHO, 2006). A very important fact is mentioned in a report that is about how medication errors can be reduced in the hospitals according to which, “between 44,000 and 98,000 people die each year as a result of all types of medical errors.” (Patel, 2004). The ultimate importance of communication is suggested by almost every person, because it lays the foundation for good results unequivocally. Actually, the basic characteristics of good inter-professional communication need to be understood but, despite many efforts to develop healthy and bias-free relationships in the hospital setups, no research regarding the ways to develop beneficial inter-professional communication exists in the present. It is mentioned by (Wear, 1997) that the medical students are not deeply taught about ways to handle relationships with other health care professionals like technologists, radiographers etc. in their medical schools. (Zwarenstein M, Goldman J, and Reeves S, 2009) suggest that inter-professional communication (IPC) skills need to be properly taught to both doctors and radiographers, so that they may know how to practically use those skills when needed in emergency situations where immediately many x-rays one after another are required and for good x-rays, doctors must collaborate vigorously with radiographers. (Pearson, 2011) suggests that lack of verbal communication between doctors and radiographers can lead to the professionals simply forgetting some patients, which leads to chances that those patients might be left unexplored satisfactorily. The maximum benefit of imaging technology can be utilized by the vigorous efforts of radiographers of course, but they need to be approached by the physicians for advices concerning patient care because doctors have more responsibility for communicating with the radiographers. “The radiographers have no obligation to advise any particular medical practitioner of an abnormal examination.” (Smith, 2006). Even today, a radiographer has to wait for a doctor’s say-so for doing a particular x-ray and until he/she does not get any such clear instruction, which most commonly happens due to breakdown of communication, much of the diagnostic research on that patient cannot be done. “Poor communication can lead to patients receiving the wrong tests, which can lead to wasted money and unnecessarily exposing patients to radiation.” (Pearson, 2011). 3. Critical discussion: In such critical circumstances when there is simply no room for any mistakes, poor communication and rotten rapport between the radiographers and doctors evokes such pandemonium that lives of many patients may be lost owing to it. Doctors can never take good care of their patients without having to rely heavily on the radiographers. Medicine and imaging technology go along side by side in today’s world and so should the physicians and radiographers. Communication between the two professions is especially important in the Accident and Emergency (A&E) department, where even the slightest delay is potential of leading to a big catastrophe. (Gibney, et al., 1995, p. 262). When talking about alleviating the risks of bad communication in the hospitals, inter-professional help and various strategies planned by the management can bring a highly conspicuous positive change. (Schrank, 2009). It goes without saying that there is certainly no allowance of any mistakes in the hospitals, and if those problems start cropping up in huge numbers on daily basis without any responsible higher authority to keep a check on the basis of these problems, no care can be guaranteed for any patient. Radiography managers are among those health care professionals, who are criticized the most for systemic failures because they have enormous pressure on them and so they do not have enough time for effective communication. (The Society of Radiographers, 2008). Healthy communication proves to be one of the important factors forming the bedrock of any successful organization, and this becomes all the more important in the hospitals. When the doctors get unnecessarily indifferent and uncaring towards their patients, no matter whatever justification they may present for their defiant behaviors, such unpleasant circumstances result that may induce a patient to report the doctor to a medical malpractice lawyer. In most of such cases, patients report about how their doctors did not collaborate properly with the technicians or radiographers, due to which they had to suffer the worst consequences. This breakdown in communication between the doctors and radiographers proves to be especially dangerous for the patients. (medicalmalpractice.com, 2010). It is such a pity that radiographers are seldom provided with the opportunity of seeking advice from the physicians, who are almost always too busy with their own stuff. Radiographers provide service for many important departments in the hospitals like operation theaters and A&E departments, therefore “close liaison and collaboration” is hugely important with doctors. (School of Health and Social Care, 2011). Time can be taken out for collaborating with the radiographers since it is all a matter of priorities. But, very few doctors are sensitive enough to talk about certain crucial points with the busy technicians. Examples of those crucial points include details regarding which specific anatomical parts a doctors needs to see in an x-ray, and when the doctor satisfactorily details the radiographer about his/her needs, optimal results are guaranteed. Unfortunately, this tradition of communication between the doctors and radiographers is seldom practiced. It is a fact that “in 70% of 2400 severe cases studied by JCAHO, lack of effective communication was the root cause for patient harm.” (Quan, 2009). The devastating results resulting from the breakdown in communication between the doctors and radiographers in A&E department are also highlighted by (Carayon, 2007, p. 237), where it is suggested that most of the problems arise because physicians spend too much time seeking advice from fellow physicians without stopping for a moment to communicate with the active radiographers. Poor communication between radiographers and doctors leads to repeated x-rays and CT scans due to which much precious time gets wasted and the patient him/herself gets unnecessarily exposed to huge amounts of radiation for no reason at all. Moreover, if such a bad tradition is practiced heavily in the hospitals, it threatens patient care because the reliability of any health care system depends on all the health care professionals. (Dayton and Henriksen, 2007). It is also the duty of the radiographers to manage the heavy burden in A&E departments. “Radiographers are part of the front line when it comes to identifying potential abuse victims; they need to remain aware of this at all times.” (Bower, cited in The Society of Radiographers, 2009). For solving the problem of poor communication, the involvement of management is extremely important. Any kind of problem-solving involves the decision making process, which is highly dependent on the managerial team. Implementation of a change management model by the management team helps in the identification of various resistances to changes. It is told by (Golden 2011) that bringing and managing changes in the healthcare field for the betterment of communication is one of the most difficult tasks because of different professions working together in a hospital and stakeholders (e.g. patients and government). There are many resistances faced by the healthcare managers for handling changes like facing disparate skateholder groups, multiple missions, and lack of information needed to manage changes. According to Lewin’s change management model, motivation is necessary before implementing a change. Then it should be shown by the management team to all the employees that why the implementation of any change is necessary, so that mutual understanding could be ensured. The number of people benefiting from the change should be compared with the number of people harmed, so that future conflicts could be avoided and managed beforehand. The model also stresses on the need of communication, because time and communication happen to be the most important factors in the process of change implementation. It is also the responsibility of the management team to make all the people feel connected to the organization so that they may get concerned and motivated. 4. SWOT analysis and protocol designing: SWOT analysis is highly helpful in regards to establishing the main factors of poor communication and identifying the important solutions for this problem. It helps enumerating the strengths and weaknesses encountered by the health care professionals, while introducing the open opportunities and threats faced by the professionals in the hospital settings. Strengths include the number of loyal and motivated employees working in any hospital setup. The high number of motivated and professional employees is a major strength of any organization that can help fight the demanding competition. This strength should be assessed carefully because if any hospital has many devoted health care professionals including doctors, radiographers, and nurse, it can help fighting the overload of patients in the x-ray and emergency departments. Such production methods should be implemented that would reduce cost while improving the quality of health care. That can be achieved by increasing the rate of employment. It is a fact that the management team in many hospitals fears to employ more radiographers because of financial crisis. Still, the overload of patients especially demands more radiographers. Strong connections among radiographers and doctors is also a major strength of any hospital. The importance of inter-professional communication is such an indisputable fact that without realizing this reality, many patients’ lives are put in clear danger. In A&E situations especially, where speed and rapid communication hold ultimate importance under greater pressures, even the slightest delay, carelessness, and breakdown of communication present lethal results later on. It is mentioned by (British Geriatrics Society, 2008) that “each year, patients make over 15 million visits to Accident & Emergency (A&E) departments in the United Kingdom, and about 20% are admitted.” That is why, the presence of motivated staff and better communication is an important strength of any hospital and should be improved. On the other hand, main weaknesses that should be identified include absence of a solid reputation and lagging technology, that should be balanced with communicated, as mentioned in the report above. Reputation maintenance should be especially considered by all health care professionals, because bad reputation seriously affects the patient health care. Another weakness includes staff problems like tardiness and lack of professionalism. It is mentioned in the report that problematic issues occur in the hospital setups because many professionals are not present on their posts. The major opportunity that should be availed by the hospital administration is employment of new and fast technology. Technology is essential to the field of health care and so are technologists and radiographers, but that technology needs to be balanced with “human-to-human communication”, as suggested by (Fritzsche, 2005, pp. 13-14). Threats include major obstacles in the path of achieving the targets and improper communication is the major threat to all the hospitals. Reasons of this threat are already explained in the report above, and proper amendments in regard to those reasons can help improving the patient care. (Friesen, Hughes, and Zorn, 2007) suggest that providing patients satisfactorily with the care and treatment they want in emergency situations presents a major threat for health care professionals, especially the doctors and radiographers. Designing a protocol for establishing lines of communication is also highly important. Both doctors and radiographers agree on the point that poor inter-professional communication is the cause of professional stress and bad results like repeated x-rays. (Campeau & Fleitz, 2009, p. 494). Therefore, this protocol was designed by inviting representatives from x-ray and emergency departments of a local hospital. Two doctors and two radiographers participated in this process. This protocol went in accordance with the needs of the patients because it emphasized on the deliverance of quality patient care. It was stressed by the doctors and radiographers that for establishing proper communication, both professions need to interpret and evaluate the inter-professional relationships. Most of the times, it so happens that strategies are planned without involving both of these parties due to which certain crucial matters are left unobserved. Unequivocally, biases and unjustified discrimination sometimes forms the root cause of poor communication. So, such negative emotions should be eradicated within the hospital premises for the betterment of patients. This would lead to a bias-free environment that would encourage every health care professional to communicate with each other. Research suggests that half of the radiographers do not communicate with the doctors about how to handle the heavy burden of x-rays and CT scans in A&E departments, and almost the same proportion of radiographers also appear late in the operation theatres. (You, Levinson, and Laupacis, 2009, pp. 54-65). This identifies that teaching importance of communication and professionalism to the radiographers can be highly beneficial for fast service and this was an important feature of the protocol. 5. Recommendations: (NHS London, 2011) lays emphasis on the need of teamwork in hospitals by suggesting that practically effective inter-professional communication and collaboration can have direct ramifications for patient care. Where poor communication between doctors and radiographers presents lethal results for the patients which may leave them insufficiently explored, healthy inter-professional relationships are strongly predictive of positive patient outcomes. (Verhovsek, Byington, and Deshkulkarni, 2010). Therefore, teamwork should always be present in the hospital setups because it is potentially capable of improving the communication between radiographers and doctors, which is highly needed in emergency areas. Whenever the health care professionals fail to work together in the emergency situations, tragic consequences for the individuals are ensured within hospitals. According to the Victoria Climbé inquiry (Department of Health, 2003 cited in NHS London, 2011), the need to work together while maintaining healthy and effective communication forms the foundation of inter-professional relationships in health care. Another important recommendation is that the radiographers and doctors should be given freedom in the decision making process and this opportunity should not be restricted to the high level management team alone. Health care professionals often tend to dislike the prejudices decisions made by the higher authority, so they should be given enough freedom to bring positive changes in different departments, where fast service is required. Both doctors and radiographers cannot move on without having to collaborate with each other, which ensures high quality end-of-life care for which effective multidisciplinary teamwork and interprofessional communication is required. (Mahmood-Yousuf, Munday, King, and Dale, 2008, p. 231). 6. Conclusion: From the discussion above and the results of the survey analysis, this much becomes clear that the heavily strained communication between doctors and radiographers in situations of emergency proves to be markedly hazardous for the patients. There is also lack of understanding about the significance and importance of inter-personal communication and good managerial skills, due to which occupational stress results and chaos is produced in the hospitals. There do exist some strategies like “VoIP Telephony and wireless communications” for modernizing the communication capability between the health care professionals. (AVAYA, 2010). For proper and person-to-person communication between doctors and radiographers, wireless communication must be ensured in all the hospitals. Moreover, both doctors and radiographers should be especially educated about the ways to handle the important burden of patients in A&E departments and OTs for improving the patient care. References: AVAYA. (2010). Unified Communications for Healthcare: the Right Information, Always on Call. [online]. [Accessed 27 March 2011]. Available at: British Geriatrics Society. (2008). The Older Person in the Accident & Emergency Department. [online]. 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Attitudes of Family Physicians, Specialists and Radiologists about the Use of Computed Tomography and Magnetic Resonance Imaging in Ontario. Healthcare Policy, vol. 12, no. 1, pp. 54-65. [online]. [Accessed 05 April 2011]. Available at: Zwarenstein M, Goldman J, & Reeves S. (2009). Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, vol. 3. DOI: 10.1002/14651858.CD000072.pub2 Read More