Communicate and Work in health

Communicate and Work in health
or community services

This unit covers the skills and knowledge required to work effectively in a health setting
with clients, staff, visitors, suppliers and others to meet established work requirements.

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Table of Contents

1 Introduction ……………………………………………………………………………………….. 4
2 Communicating effectively …………………………………………………………………… 4
Promote a Positive Approach to Communication……………………………………………… 5
Medico-legal Considerations in health ……………………………………………………………… 5
Sources of the Law…………………………………………………………………………………………… 5
Mandatory Reporting ……………………………………………………………………………………….. 8
3 COMMUNICATION …………………………………………………………………………….. 10
Introduction……………………………………………………………………………………………………. 10
A Definition of Communication ………………………………………………………………………. 10
Safety and Efficiency Depends on it ……………………………………………………………….. 13
4 Collaborating and working together…………………………………………………….. 16
5 Dealing with barriers to communication ………………………………………………. 17
Barriers to Effective Communication………………………………………………………………. 17
Levels of Conflict……………………………………………………………………………………………. 21
The four stages of conflict ……………………………………………………………………………… 23
6 Completing documentation ………………………………………………………………… 26
Written Communication, correspondence and documentation ……………………….. 26
Telephone Skills …………………………………………………………………………………………….. 26
7 Problem Solving Skills & reporting these……………………………………………… 28
Introduction……………………………………………………………………………………………………. 28
What is a Problem? ………………………………………………………………………………………… 28
A Systematic Approach to Problem Solving……………………………………………………. 30
8 Introduction to Quality Systems………………………………………………………….. 34
Introduction……………………………………………………………………………………………………. 34
What is Quality Management?………………………………………………………………………… 34
The Stages of Continuous Quality Improvement …………………………………………….. 37
External Accreditation ……………………………………………………………………………………. 38
Setting Goals and Objectives …………………………………………………………………………. 39
Change Management Principles……………………………………………………………………… 40
What is a Quality System………………………………………………………………………………… 40
Customer Focus …………………………………………………………………………………………….. 43
Reporting problems to supervisor ………………………………………………………………….. 45
Performance Appraisal …………………………………………………………………………………… 48

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1 Introduction
When working within a health care setting or with community services the primary focus
of all actions must always be on the safety and well-being of the Client. Actions taken
within health care should be carefully planned and designed to fulfil a specific purpose.
They should be carried out in a way that assists all members of the team to work together
effectively and efficiently, within the legal guidelines of their individual roles.
To assist this effective functioning, it is essential that the roles and relationships of each
member are defined and understood by all other members of the team.
In all organisations large and small, there is a well-defined structure that identifies the
roles and functions of all personnel employed by the organisation. This organisation
structure should indicate the types of staff employed, the functional areas in which they
work and the lines of communication, direct and indirect, that each should follow.
When you are first inducted into the workplace you will be shown the organisational chart
in which you can identify your place in the team, the department and the whole place.
You will also be provided with a position description as part of your contract. It is at this
time you will need to identify who you will be working with on a daily basis and who you
will be communicating with. You will also need to ask yourself the following questions:
1. Which department(s) will I be working in?
2. Who do I report to?
3. Who can I ask questions of?
4. What other departments will our area be working with as internal customers?
5. Who are our clients or external customers?
6. How can we make sure we communicate effectively and work smoothly to
achieve our level of quality outcomes?

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2 Communicating effectively
Promote a Positive Approach to Communication
The principles of Client centred healthcare rests with focussing on the care of the Client
and not on the institution or staff needs. The delivery of health care aligns human
services around the needs of the Client. The success of this mode of care depends on
making services simple to understand, assisting Clients to follow the health care system,
involving family members in the care, using education to inform the Client of options on
health care and providing a flexible health care system. The end result empowers the
Client to play an active part, with the health care professional (HCP), in their own care.
A degree of anxiety is experienced by all Clients/Patients/Residents in health care
There are several factors which cause an increase in anxiety:
• the relation to their condition and possible treatments including surgery and its
outcome
• the loss of control experienced by having a health care professional look after
them and undertake tasks that they are unable to do
• in relation to the medications that they may be given and their possible reactions
including if they are sedated or anaesthetised
• the new environment of the hospital / health services
• the separation from familiar people and routines
• unpleasant memories of previous health care system experiences
• fear of saying things they would not normally say, or fear that they will not wake
up after the anaesthetic
These factors can cause the Client to feel frightened, apprehensive and alone.
All staff can assist in reducing this apprehension by talking quietly to the Client,
explaining before you do anything to them and assuring them that they will be looked
after when they are unable to do so themselves.

Medico-legal Considerations in health
Health care professionals have a number of responsibilities. Some of these relate to
reporting and documentation and all have to comply with the legal and ethical framework.
Introduction
The term medico-legal relates to both law and medicine. Potentially litigious medico-legal
problems arise from lack of practice guidelines such as policies and procedures, and
lack of knowledge about the law that guides health care practice.
It is the aim of this section to introduce HCP’s to the laws and regulations that guide their
practice.
Sources of the Law
The two main sources of the law in Australia are statute law and common law. Both of
these areas guide the practice of all HCP’s.
2.1 Statute Law

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Statute Law is the law of governments and authorities and not only embraces Acts
of Parliament but regulations drawn up in pursuance of those acts.
e.g. Occupational Health and Safety Act
Manual Handling Regulations
There are many Acts of Parliament (Legislation), state and federal, that affect all
workplaces, such as the Industrial Relations Act that is concerned with wages and
conditions of workers. There is also the Occupational Health and Safety Act which
aims to ensure a safe workplace, and in the event of a workplace accident the
Workcover Act ensures that the worker is looked after and if necessary
compensated.
Some of the statutes that are of particular interest to the HCP are:
• Privacy Act which protects the Client’s right to confidentiality, and directs
hospital employees not to disclose any confidential information about a Client
to anyone.
• Coroners Act ensures that any death in a theatre is reported to the Coroner
and nothing is removed from the Client or the theatre until this is done.
• Drugs, Poisons and Controlled Substances Act (Vic.) states who may
possess or handle and dispense, distribute or administer drugs (the
technicians are not listed for this).
• Equal Opportunity Act prohibits discrimination on the basis of age, sex,
beliefs etc.
• Manual Handling Regulations advise on safe practices that will prevent injury
to staff and Clients.
• Patient Rights and Responsibilities and the role of the health care
professional (HCP) in providing privacy and dignity.
There are many other statutes that govern the Health Industry and the HCP should
try to be as informed as possible of those that affect their practice.
2.2 Common Law
Examples of common law that relate to health care professionals (HCP’s) are:
• Law of Assault
• Law of Negligence
• Law of Vicarious Liability
• Law of Defamation
• Mandatory Reporting

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Consent
Consent is permission given by a client / patient or person for a service to look after them
or undertake treatment for them. Legally consent may be verbal, written or implied. Most
hospitals require written consent from Clients on admission to hospital. This formal
consent is quite specific and should cover the treatment required and if necessary
consent for an anaesthetic.
It is also necessary for all health care workers involved in Client care to verbally request
consent from a Client before doing anything to them e.g. the HCP must always introduce
themselves to the Client and explain exactly what they are going to do and effectively
get permission to do it.
A Client may change their mind and withdraw consent and they may also formally refuse
treatment such as refuse permission to have a blood transfusion or request “Not for
Resuscitation” orders.
In the event of an emergency, consent may be waived if it is a life threatening situation
and it is not possible to get consent from the Client or a relative.
For consent to be legally valid it must meet four requirements:
• It must be given voluntarily (no coercion)
• It must cover the act performed
• The person giving consent must be legally competent to do so. This means they
must be of the legal age of consent (this varies from state to state), not be under the
influence of drugs and be psychologically competent.
• The consent must be INFORMED to some degree.
In the case of a surgical procedure it’s the responsibility of the doctor to get an informed
consent. This means that the Client must understand the proposed treatment or
procedure, have it explained to them in a language they can understand and be
acquainted with the risks involved.
Privacy and Dignity
Patients are removed from their families and friends (their support systems) when they
come into health services (even if it is only for the day). They often have to leave behind
their possessions, their clothes and their identity. Patients may be scared and feel
vulnerable. They may be upset because of their illness or recent diagnosis. They may
be having procedures which are very private in nature and for which they may be
embarrassed about.
Health care professionals have the ability to put patients at ease and preserve their
dignity in situations where this may otherwise be compromised. This can be achieved
through diligent communication and reassurance. This can be achieved by ensuring that
patients are draped and covered as much as is possible. This is maintained by ensuring
that any personal affects which assist them to maintain their sense of self are maintained
until such time that the procedure is happening and they may be sedated or unconscious.
Negligence
“Negligence is conduct falling below the standard demanded for the protection of others
against unreasonable risk of harm. This standard of conduct is ordinarily measured by
what the reasonable man of ordinary prudence would do in the circumstances.”
(Fleming J. 1987)
1. Duty of Care – this principle is based on a person taking reasonable care
to avoid acts or omissions which would be likely to cause foreseeable harm
to any person (Wallace 2001).

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2. The HCP should only perform those tasks that he is trained to do,
attempting to do something he is unqualified for is putting the Client at risk
and could cause foreseeable harm in the eyes of the law. The HCP has a
duty of care to the Clients when transporting them to avoid any risk of injury
to them in the process. For example, a protruding limb from a trolley has
the potential for injury, by checking for this the HCP can avoid foreseeable
harm.
3. Dereliction of Duty – this is failure to live up to the appropriate standard of
care. This would be judged by what the reasonable HCP would do in a
similar situation to that of an v who has had similar training and experience.
The reasonable v is expected to understand and know the policies,
procedures and standards that are complied with in an operating suite. It is
not acceptable to claim no knowledge of such documents. It is also not
legally acceptable to knowingly contravene an existing policy or procedure.
For example, it is common practice to protect the Client’s pressure points
with padding, when positioning them for surgery. Failure to do this would be
seen as not meeting the usual standard of care.

Mandatory Reporting
Mandatory reporting is a term used to describe the legislative requirement imposed on
selected classes of people to report suspected cases of child abuse, domestic violence,
elder abuse, sexual misconduct and neglect to government authorities.
As there is a responsibility for each employee to be accountable for their own actions it
is imperative that safe working practices are adopted and that compliance of existing
policies and procedures are adhered to.
Vicarious Liability
This means that an employer (health service or hospital) may also be held legally liable
for the negligent actions of an employee, even though there may be no personal fault on
the part of the employer.
An employer has a legal responsibility to ensure that an employee is a competent,
qualified person capable of carrying out the role they’re employed to do.
The employee also has a responsibility to be aware of the scope of their employment
and only work within this. They must have a copy of their job description, know the
policies and procedures of the operating procedures and always follow these. They
should not undertake any tasks or duties for which they have not been trained.
Incident Reporting
In spite of all due care being taken, mistakes do occur and when they do it is extremely
important they are reported immediately. The correct way to formally report an incident
is by filling out an Incident Report Form which all hospitals have and ensure that an
accurate account of the incident is reported.

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The purpose of an incident report is to provide information regarding:
• the welfare of the Client
• identification of problem areas
• identification of personnel involved in an incident
• the defence of a liability
A factual incident report will include the date, time, any relevant background
information, a description of the precise incident and the location and status of the
persons involved. It should include only what you know from your own personal
knowledge of the incident, not what might have or could have happened. It should
also include any follow-up action or treatment given.
Confidentiality
A hospital Client has the right to have their health information treated confidentially and
all hospital personnel have an obligation to ensure that such information is not disclosed
to others without permission.
Confidentiality encourages Clients to fully disclose their medical history which is essential
for effective health care delivery.
A Client may sue if information about the Client is disclosed to a third party without the
consent of that person. The law of defamation exists to protect the reputation of a person
and to ensure confidentiality is maintained.
They do however have a legal right to privacy and all health care professionals (HCP’s)
must be vigilant in ensuring that confidentiality is not breached. Ways that confidentiality
may be breached are:
• By discussing the Client with people not directly involved in their care, either inside
the hospital or outside it.
• Leaving medical notes and history lying around for anyone to read.
• Repeating information overheard about the Clients condition.
• Not destroying Client slips or the O.R. list as soon as they’re finished with.
• Not keeping the O.R. lists with Client information away from the public view.
It is therefore important for the HCP to remember that all information relating to a Client
must remain private and not be disclosed to anyone who is not directly responsible for
the immediate care of that Client.
Standards available from:
• Standards Australia
• The Australian Council of Operating Room Nurses (ACORN)
• Australian Council on Health Care Standards (eQuip)
• Manufacturers specifications and guidelines for use of equipment.
• The Australian and New Zealand College of Anaesthetists.
• The National Health and Medical Research Council

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3 COMMUNICATION

Introduction
We all spend much of our time communicating with others. Whether it is at work, at home,
or during recreation, we are frequently communicating with one or more people. We
seem to manage quite well, so why should communication be any different at work? Why
is it necessary to have well developed communication skills?
As HCP’s we encourage each other in our development to reflect on the following
questions:
• What makes the difference between good communication and poor
communication?
• What influences communication, and why is communication so important for
effective team work?
• How can I communicate more effectively, particularly in difficult situations?
A Definition of Communication
In communicating, we exchange information and transmit meaning between each other.
It is a two-way process that involves not only talking, but also listening and interpreting
information we receive as nonverbal signals such as gestures, facial expressions and
voice intonation.
At work you probably spend between 50 and 60 percent of your time communicating with
those with whom you work. Most of your communication is spoken; in other words, you
spend a lot of time talking; without the ability to communicate, work would not be able to
be done.
Communication is:
• the interchange of information between one person and one or more others;
• realised in diverse ways: through talking, writing, gestures, facial expressions and
tone of voice;
• successful only when those involved in the information exchange understand the
communication.
Importance of Communication
Effective communication is essential for organisations to function. The roles of staff and
the goals of the organisation must be communicated for efficient operation. Efficient
communication can save money and increase productivity in our health agencies. If the
message communicated does not result in the correct action being taken, mistakes and
wastage can occur.
In the health services, providing the highest quality care and safety depends on the ability