Interprofessional Change Proposal for Effective Communication in Clinical Wards

This paper discusses the process of breaking down poor communication and promoting effective communication skills by nurses in the clinical ward towards patients. It also discusses the effect of poor communication in a multidisciplinary team setting which in turn affects co-production. The paper further illustrates the change management models and the quality improvement models with respect to the health care system. Additionally, leadership theories have been discussed and proposals of change which will enhance the quality of care is suggested.

Running head: INTERPROFESSIONAL CHANGE PROPOSAL
INTERPROFESSIONAL CHANGE PROPOSAL
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Introduction
An eminent and integral part of life is communication devoid of which is not possible
to survive. Nursing aims to focus on the health needs of human. There is a requirement of
scientific knowledge in nursing practice, along with an addition in effective interpersonal
communication, intellectual and technical abilities and skills. This paper aims to critically
analyse the process of breaking down poor communication and promoting effective
communication skills by nurses in the clinical ward towards patients. The paper further
discusses the effect of poor communication in a multidisciplinary team setting which in turn
affects co-production. It also successfully illustrates the change management models and the
quality improvement models with respect to the health care system. Additionally leadership
theories have been discussed and proposals of change which will enhance the quality of care
is suggested. The paper also discusses the ways of implementing the proposed changes of
strategies of communication. In conclusion it has been seen that reforms in communication of
the nurses towards the patients in the clinical wards have helped in promoting increased
quality of health care services, thus benefitting the health system.
Background
One of the basic components of nursing is the patient-centred communication, which
increases the establishment of a positive nurse-patient relationship. This relationship
enhances the production of quality care along with the other organizational factors. Most of
the literature surveyed has reflected nurses as poor communicators. Therefore there is an
urgent need to break down the poor communication that exists in the clinical wards and
promote better communication. According to some researchers, in a nurse-patient relationship
the communication is much more than just verbal communication. It involves transmission of
feelings along with information. These feelings are recognised by the patients which it easy

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for the patients to receive the care. However it has been observed that often the nurses fail to
communicate with the patients but only approach them for the sake of administrative or
functional activities. Many researchers are of the idea this situation arises because the nurses
are not aware of the true value of the nurse-patient relationship that should ideally prevail.
Many nurses are unaware of the meaning of patient-centred communication which reflects
the idea that a communication which invites the patients to participate and encourages them
to negotiate in decision-making regarding their own care.
In order to promote awareness and focus on the importance of the effective patient-
focused communication between the care providers and patients, the “European Union” (EU)
(2004), the “Department of Health” (DH) London (2004),“World Health Organization”
(WHO) (2000), and the “National Health Service Modernization Agency” (2003) have made
efforts (Bello 2017). It has been observed that use of the nursing care outcomes have been
elevated related to the factors like satisfaction of patient, sticking to treatment procedures and
patients’ health using person-centered approach. Although ineffective communication still
continue to pose a threat in the health care sector which needs reforms and awareness. Not
only is change in communication strategies required for nurse-patient communication but
also in the communication efficiencies which in present within the multidisciplinary teams. It
is well documented in literature that there is lack of significant communication between the
physicians and the nurses. Additionally there is poor interprofessional team communication
that has an impact on the clinical wards. The leading cause of the problems that occurs in the
clinical wards due to poor team work impact is miscommunication (Bays et al. 2014.). If
reforms can be brought about in the communication strategies then it will have an increasing
positive effect on co-production as a team. Researches have shown that a multidisciplinary
team working to provide care to a patient is more effective than a single person doing all the
jobs at the same time. This is impossible without communication as each individual of the

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team should be aware of the job roles of themselves and their colleagues. Additional benefits
of breaking down poor communication within the interprofessional setting includes improved
job performance, less complications, reduced costs and increased job satisfaction (Blais et al.
2015).
The barriers of effective communication in nursing practise includes: environment, personal
characteristics, poor communication skills and personal health. The environment factors
include increased work load, insufficient time and lack of staff support, decreased valuable
resources for example computers and internet which is needed for proper documentation and
other resources such as water and light (Bramhall 2014). Deficiency of privacy and staff
support imposes pressure on the working conditions of the nurses and makes them unable to
practice effective communication. Often there is a lack of technique of proper communication
like empathy and understanding on both ends, effective listening skills and conflict
management skills. The nurses should have the ability to set boundaries, possess language
fluency, and should engage in patient-centred communication. Physical or mental illness on
the part of the nurses often cause loss of focus to listen or inability to talk which has an
adverse effect on the techniques of effective communication (Arnold and Boggs 2015).
Implementing change
Change management model
For change to occur in the health care service regarding the communication of nurses
in the clinical wards, an all over organizational change is required. This can be demonstrated
by the Kotter’s Change Management Model. Kotter believes that change in organization can
be managed using a dynamic 8-step approach that is non-linear. The steps in his model
includes increasing urgency, establishment of teams for guidance, getting the right vision,
communicating to buy-in, enabling action, short-term wins creation, not letting up and

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making it stick. These steps are further organized into three phases. The first phase is called
‘‘creating a climate for change’’ and includes steps one to three. The second phase,
‘‘engaging and enabling the whole organization,’’ consists of steps four to six. The final
phase, ‘‘implementing and sustaining the change,’’ includes steps seven and eight (Hayes
2018). According to this theory the nurses first needs to understand the urgency that is
required to bring change in way of communication with the patients. Then they need to set
goals regarding the way of implementation of the change that needs to be brought about.
During the building of the correct environment for change, the nurses need to slowly start
interacting with the patients in the medical wards on a patient centred basis. Then they should
move on to bringing the whole team rather the interprofessional team to communicate
properly with the patients. Finally the nurse should provide proper care to observe that the
change that has been brought about must be sustained.
Quality improvement model
Quality improvement model in health care uses various models among which the most
widely used model is the Plan-Do-Study-Act (PDSA) Cycle, which is a systematic series of
steps used for gaining important learning and knowledge for the continuous improvisation of
a product, service, or process (Taylor et al. 2013). Each term is described as Plan: Identifying
a window for improvement and planning an alternative or test the working within one of the
component of the clinical workflow. This includes establishment of metrics/indicators in
order to assess progression towards the goal. Do: Carrying out the plan in order to improve
any specific component of the medical workflow. The period of testing might be limited as
one day and be applicable on a small population of patients. Study: Examination of the results
and Act: this is based on the results of the testing period, including incorporation of changes
and establishment of plans to elevate quality. By using these small and rapid cycles of change

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management, it is possible to understand the tactics required for change implementation
(Kamdar et al. 2013). For improving the quality of communication with the patients in the
medical wards, proper planning must be made. This should be followed by carrying out the
plan which could include interventions like conduction of consistent and purposeful hourly
rounding in the wards. They should also report for bedside shifts. Provision of service skills
training cold also be implemented for examining the results of the pans implemented. Finally
acting on the basis of the results of the test period in order to incorporate and establish the
improvement plans.
Leadership theory
Leadership and communication skills are directly proportional. In the health care
settings effective leadership ensures a high quality of health care service that thrives to
promote efficient care, which is enhanced by better communication. It is useful for the health
care professionals to recognize the leadership skills and theories which is related to their
nursing practice. Being aware of these styles and theories enables the nurses to develop their
skills for becoming better leaders and also to improve communications with colleagues and
clients who have previously been difficult to work with. The several leadership theories
include Transformational leadership where it is reflected as a relationship between the nurses
and the patients or their colleagues in which they motivate each other to provide valuable
services. Reports have shown that the idea of transformational leadership impacts on the
satisfaction and commitment to the organization. However, inspite of its impact on outcomes
of the individuals and institution, transformational leadership can be implemented in all
organizations (Barr and Dowding 2015). In terms of communication this is quite useful since
the nurse should pay attention to the patients’ thoughts as it is imperative to recognize the
patients’ needs and concerns. The next is the participative leadership, which is also called
democratic leadership. This leadership style projects the idea that participation of the team

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members in making decisions is desired. In accordance to the guidelines for participative
leadership, the initial step is to understand the situations of decision. This is important for
bringing about proper communication as the need for the type of communication change
needs to be understood by the nurses. The second step is inspiring participation, which refers
to encouraging the patients to express their concerns, looking for paths to build on their
suggestions. This theory is also applicable to strategize better communications within the
interprofessional teams (Al-Sawai 2013).
Interprofessional team
The characteristics of a interprofessional health team is characterized by the factors
like provision of care to a general group of patients, developing common goals for the
outcomes of the patients, and working towards implementation of these goals. Effective role
is assigned to each and every member of the interprofessional team so that they could
understand each other’s roles and possess a mechanism for implementation of the plans.
Adjustments are needed to be made depending on the results of these outcomes. The major
principles of the interprofessional health care team includes effective communication with the
patients or the clients, collaboration with each and every member of the multidisciplinary
team, and mailnly contribution of ideas to each other in order to solve a common problem.
Each team member should respect each other and recognize the contributions made by every
team member. The teams work within and between the organizations therefore they have
expectations from the other team members so that they can lead roles of ambiguity, conflict
of role and role overload. The merits of interprofessional team care for the patients includes
improved care by improved service coordination; integrated health care for different health
needs; empowering of patient/clients as working partners; should be oriented to working for
patients coming from wide cultural backgrounds and increased efficient use of time (Iglehart,
J.K., 2013).

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Principles of co-production
Consumers when involved in the establishment of a service or product, resulting in
help to assess the quality and value, it is called co-production. When the consumers are able
to personalize the experience of the use of the service of an organization and is able to
undertake tasks required by the organization, the value of co-production occurs. Most of the
times health systems are also looked as producer of goods which is in the terms of health
outcomes. This health outcomes does not depend on the health care professionals solely, but
id dependent on the intermingling of the roles of the health care personnel and the total health
care system. The value of co-production in health starts when the patients and the clinicians
existing in the large system can promote or disrupt the progression towards the optimal health
care service. Batalden et al (2013), suggested a theoretical framework for co-production in
which “patients and professionals interact as participants within a healthcare system in
society”. The clinicians and patients are at the centre of this framework, clinicians looks after
the patients’ needs and values so that they can take part in clinical decisions when possible.
Implementation of strategies of communication within multidisciplinary teams
There are several possible interventions that can be implemented. These includes
implementation of daily goals of care and checklists of safety. Worksheet of daily goals, with
collaborative input from different service teams can be brought to the bedside along with the
electronic record system. With the introduction of such systems, communication within the
teams will be facilitated which in turn have a positive impact of the health care service
quality in the clinical wards. Besides this, Structured Interdisciplinary Rounds (SIDR) can be
introduced (Toussaint and Berry 2013). For this the members from different care professions
are organized and grouped together in order to take rounds in the clinical wards to address the
shared clinical purpose. This will promote better communication between the patients and the
health care personnel thus promoting patient-centred communication and care (You et al.

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2013). Team work training can also be implemented as a part of these interventions where
team training on a formal basis can be conducted, that will emphasize the major components
of successful teamwork on a daily basis can enhance communication in a team environment
that is complex.
Theoretical framework for promoting better communication with patients
A framework for assessing the challenges lying within the arena of professional
nursing practice is provided by Peplau's theory of interpersonal relations. With respect to this
theory, nursing is illustrated as an interpersonal process of therapeutic interaction between an
individual who is suffering from an illness or in need of health services. A nurse who is
trained enough, will understand and respond to the help need of the patient accordingly.
Assumptions of Peplau’s Interpersonal Relations Theory in nursing practice are: 1) free
interaction of the nurse with patient, 2) communication development due to therapeutic
interaction 3) interpersonal communication skills are the fundamental tools of nursing 4) the
nurses need to understand the need to promote the psychological growth of the patients. This
theory projects the idea that the aim of nursing is to help other individuals to find ways in
difficult situations by applying the principles of human relations (Gjerberg et al. 2015).
Enhancing quality of care by better communication
Studies have shown that promoting effective communication establishment between
the nurses and the patients have several benefits. Firstly it is helpful as it contributes to the
provision of individualised care to the patients. More the focus is given on communication,
more it will be lead to better outcomes of the patient care. Secondly, the patients with whom
the communication of the nurses are strongly established, they are more quickly able to
reveal their true feelings and symptoms to them. The patients receive more satisfaction of the
nurses are able to provide them with undivided attention. Thirdly the interpersonal
communication is able to satisfy the requirements of the patients as is represented in

9INTERPROFESSIONAL CHANGE PROPOSAL
Maslow’s hierarchy of needs (Gillespie et al. 2013). Finally, it is seen that communication
between the nurses and the patients not only benefits the patients, but also has a positive
impact on the nurses as well. The nurses who possess good communication skills towards
their co-worker are able to improve themselves in morale as well as in terms of job
satisfaction.
Means to improve effective communication in nursing settings
Four major means of integrating effective communication are therapeutic –
communication, care that is patient-centred, maintenance of boundaries with the patients and
nursing interventions. Therapeutic communication is required as effective means of
communication which helps to reduce the levels of depression and anxiety in the patients.
Empathy, trust, kindness, confidentiality and listening are the major aspects of therapeutic
communication skills which increase the rate of effective communication (Morténius,
Hildingh and Fridlund 2016). Nurses making efforts which are intentional, to build
therapeutic communication using stronger and effective communication during nursing
practice should be the main focus. Effective care is less critical to attain if patient centered
care is an integral part of the nursing process. A nurse who is concerned with patient centered
care is likely to be emotionally directed to correctly interpret both the verbal and non-verbal
gestures of the patient and accordingly respond. Nurses must be intelligent enough in an
emotional way, in order to professionally set limits of therapeutic relationship with patients to
successfully in order to achieve efficient communication. Studies also recommend that
nursing intervention are means to improve effective communication in nursing (Moore et al.
2013). In health care settings, the staff needs a greater support from the employee
organization, without which it is difficult for any healthcare provider not to provide attention
to the establishment and maintenance of effective communication.

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Conclusion
Form the above discussions it can be concluded that implementation of effective
communication skill does not only provide benefits to patients, it also positively impacts
healthcare providers. This is helpful in terms satisfaction of jobs and providing relaxation
which positively influences the health. The personal aspects of patients and nurses are the
main factors that influences the effective nurse-patient communication in the clinical wards.
The models of change and quality improvements models also play an important role in
promoting the change that takes place in communication. The discussion also highlights the
importance of team work and importance of communication within the inter-professional
setting which will facilitate better health care services thus promoting increases co-
production in terms of health outcomes.

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