The Barriers To Effective Communication

We all understand that in large and complex organisations like the

NHS, good communication is key to delivering great patient services.

While it there is the obvious need for great communication between

patient and doctor, the scope of communication is much wider than
just clinical professional to patient.

Every discipline, including Finance has an important role to play in

communication.

Why Is Communication So Important In The NHS?

Relationship Building

Strong and effective relationships provide the basis for ensuring that
the best quality of service is delivered. When things don’t go as well
as one would like, the chances are that some form of breakdown in
relationships is at least a partial contributor to this less than optimal
outcome.

For example when I was a Finance Director in the NHS I had to take
my turn on the Directors on call rota every 5 weeks. I often saw
situations where hostility between the A&E department and a ward
was getting in the way of the smooth transfer of patients.

You might well be familiar with situations where there were tensions
between different parts of the health system regarding patient
discharges or over resource allocation.

Team Working

Individuals in the NHS tend to give their very best. Sometimes

however different parts of the NHS fall into the trap of working in silos.
This can even happen within single organisations.
When we have good communications people are more ready and
willing to stand back and understand and appreciate different
perspectives.

That’s not to say that there will never be points of disagreement. They
may at times decide to agree to disagree after a dialogue has taken
place. The major difference is that people will have had the
opportunity to air their points of view which is more likely to result in
agreement or consensus.

Education

Finance staff have a huge role to play in educating budget holders, non
executive and executive directors and the public at large on the
financial issues.

They have to train and educate them through written communications,

procedures, briefings and training sessions.

Problem Solving

In any large organisation there are going to be problems that arise

from time to time. Communication helps with discussing the issues
and options and can help avoid misunderstandings or wrong
assumptions.

Decision Making

As Finance professionals you know that in the NHS there are always
going to be greater demand than resources available. Engaging in
good dialogue can facilitate the best decisions being taken from the
options available.

Planning

With austerity being the big issue for the foreseeable future agreeing
priorities around use of resources and influencing are going to be key
elements of planning.

Reflecting and Learning

Things will go wrong from time to time. Reviewing, listening and

agreeing changes or things that will be done differently all depend on
open communication.
Setting Expectations

Those managing and leading teams within Finance need to set

expectations for individual team members and teams as a whole.
They also have to make expectations of individual budget holders,
general managers and clinical directors clear too.

Delivering Better Services

Delivering better services will of course require different tools and

techniques like lean and six sigma. It will also necessitate getting the
contributions of multiple stakeholders, including patients and clients as
well as clinical professionals.

Martin Shovel of CreativityWorks says that “communication is

considered (metaphorically) a soft skill, but this is misleading because
communication is the lifeblood of every organisation. Poor
communication can bring an organisation to its knees, while good
communication can help an organisation keep one step ahead.”

Making Change

Change and the desire for change and modernisation is high on the
agenda. As many as 70% of changes fail to deliver the expected
outcomes. Communication is at the heart of securing the buy-in and
providing the support that is so vital to achieving change.

According to Jo Ann Sweeney of Sweeney Communications the best

laid plans will never come to fruition without the active support of
employees.

Securing Engagement

Finance staff know as well as anyone just how important securing

engagement is. While Finance might report on financial performance,
the reality is that the amount of resource they spend directly in
miniscule relative to the total spend. That is why engagement and
communication with those outside of Finance is so vital.

When I worked in Finance my view always that the financial results

merely tell you what is or is not happening in an organisation in a
common currency called money.
Negotiating

In the ideal world there would be enough to do everything. A lot of

negotiation has to take place around things like making efficiency or
cost improvements.

Risk

According to communications expert and author of Successful NLP,

Jeremy Lazarus, the larger the organisation, the greater risk of the
messages communicated not being what was intended.

Reflection Question

Think about why communication matters in your organisation. You

may even want to discuss this at one of your Finance Team meetings.

What Impact Does Poor Communication Have?

Productivity Drops

The demands to work efficiently and effectively in all parts of the NHS
have never been greater, especially when we are faced with a period
of reduced growth in funding and reductions in real terms.

When all parties don’t know what is expected of them or one part of
the system does not deliver their part of the process, productivity
drops.

Morale and Motivation

Poor communication impacts on morale. People like to be involved,

have the opportunity to put their points across and contribute. In a
large and complex organisation like the NHS the engagement of staff
is vitally important. At the same time there are often big differences
in the level of engagement between the best and not so good
performing organisations.

Mistakes

Many instances where mistakes are made can at least in part be linked
to poor communication. Sometimes these are small scale but can
potentially be catastrophic.
Delays

We all know that in the NHS it is in the best interests of the patient
and the organisation to minimise the time people spend in hospital. At
the same time in many hospitals delays in discharge of patients arise.
In some cases these delays are due to the fact that one part of the
service does not communicate effectively with the other prior to a
patient admission. As a result discharge planning does not start early
enough, especially when patients need care packages at home.

Waste

An example I will use here is theatre capacity being lost due to a

patient not being brought to theatre on time.

Safety

We all understand just how important patient safety is. At the same
time safety issues when investigated can at times be tracked back to a
communication breakdown.

Trust

Without trust it is difficult to achieve anything. When you don’t

communicate or in the case of Finance communicate the wrong
message it has a huge impact on the level of trust others have in you
or your function.

Satisfaction

Communication and contribution leads to greater satisfaction among

patients and other stakeholders or in the case of Finance internal
clients. Conversely a lack of communication impacts on satisfaction.

Performance

The NHS and the Finance function ultimately exists to deliver results.
Knowing what is expected and keeping people informed is key to
effective performance.

Reflection Question

What other impacts is poor communication having in your team,

function or organisation?
What Gets In The Way Of Effective Communication

Wrong Focus

Communications that are not tailored to the preferences of the

recipients of the information get in the way of effective
communication. Some people just want the big picture. Others want
the detail. Some like words, others like graphics.

Action Point

Consider some the key people you communicate with. To what extent
do you know or understand their communication preferences? If you
are unclear, check with them rather than assuming you know.

Jargon

The NHS as a whole is full of acronyms. Within each professional

group there are acronyms and Finance is no exception. You need to
be alert to jargon being used or over used.

Wrong Medium

In some cases it is simply down to the wrong medium being used.

Take for example documents like Standing Orders and Standing
Financial Instructions.

They are often issued to managers or staff in written format or made

available as a long winded document on the intranet. At the same time
this might not work for the majority and perhaps a short video or
audio might be more appropriate.

Information Overload

I recently heard an NHS non executive director speak at an event I

was facilitating about the fact that the package of board papers was so
huge that they would not fit through the letterbox. The ease with
which we can produce information means it is easy to fall into the trap
of just adding in a bit more.

Action Point

Do you or your team get the balance right when it comes to providing
information? Check this with the recipients of information.
Big Mouth Small Eyes and Small Ears

This is something I came across in a recent HFMA webinar where a

CEO was talking about the importance of listening and being alert to
what is going on around you.

Often what happens in teams is that everyone is so obsessed with

getting their point across that speaking is far exceeding listening

Action Point

Next time you are in a meeting pay attention to the proportion of time
people are speaking compared to listening.

Complexity

Sometimes the challenge is to make something that is pretty complex

simple. Using metaphors or every day comparisons can make a big
difference.

Lack of Preparation

This is a particular issue when you have to communicate something

that is contentious or difficult. You know the saying failing to plan is
planning to fail. You can never be over prepared.

Reflection Question

Think about how you prepare for communicating difficult issues, how
would you rate yourself on a scale of 1 to 10, where 1 means you do
little or no preparation and 10 means you always fully prepare.

Jumping to Conclusions

You might be familiar with the scenario where someone is talking

about something and before the person has finished someone jumps in
claiming they understood or draws conclusions before hearing the
whole story.
Stereotyping or Perceptions

By this I mean making a judgement on the validity of what is being

said based on the job they do rather than accepting the fact that
people are not their job title.

Confidence

Sometimes people lack confidence to speak up, often because of

worries around what they have to say will be received or worry about
it coming across in the right way.

Point To Note

You can do your best to get the message across in the best possible
way and sometimes you will get it wrong

Expert Insights On The Barriers To Effective Communication

Senior management losing touch of what it is like at the coalface

Senior management not creating an open communication culture
Suspicion of motives
People not keeping their word
Management not walking their talk
A reactive approach to communications
Senior managers failing to value the contributions of staff

How To Overcome The Barriers To Effective Communication

Planning

Whenever you are entering into any communication make sure that
you:

 Are clear about the objectives or outcomes you want from that
communication
 Step into the shoes of the other party or parties who will be the
recipients of the communication and consider their needs
 Present or deliver the communication in a way that focuses
100% on their needs
Keep It Simple

Write in short sentences. Try whenever you can to avoid jargon. If

jargon has to be used explain what it means. You might even have to
include a glossary in some cases. Be precise.

Decide On The Best Medium

This will be something you do on a situation by situation basis. At a

most basic level you have a choice between written and verbal and if
written what format you will use.

Write For All Audiences

As we mentioned earlier some are big picture and some love detail. To
address this have an upfront summary and appendices as detail.

Listen More Speak Less

Don’t fall into the trap of assuming you know. Use questions to clarify
and deepen your understanding.

Treat People As Individuals

Don’t get caught up in putting people into box based on their job role
or job title.

After all contrary to public belief not all accountants love the numbers
and are introverted.

Find Common Ground

This is particularly important when you are dealing with a difficult issue
like a conversation around quality, operational and financial targets.
In this type of conversation it is often to use patients (or service
users) as the common ground as ultimately that is who the NHS is for
at the end of the day.

The Bottom Line: While we all understand the importance of

communication, no one ever gets it perfect all of the time. The key is
to plan, do, study the impact and adjust.