INDEX

Introduction Findings External Communications Internal Communications Communicational Barriers Recommendations & its Implementations

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INTRODUCTION

For the purpose of this assignment, the Inner City Mental Health Team (ICMHT) will be subject to a thorough exploration of its communication channels. The ICMHT is a multidisciplinary team aimed to provide support to sufferers of mental health problems in the Central area of Bristol. The Team comprises a wide range of clinical and non-clinical staff performing different activities and roles in order to achieve the multidisciplinary side of the service. ICMHT is formed by 8 Community Psychiatric Nurses, 6 Social Workers, 4 Community Care Workers, 1 Occupational Therapist, 1 Art Therapist, 4 Psychologists and 8 Administrative staff. In the hierarchic structure one find both, clinical and non-clinical in managerial roles. See chart below:

Bristol Inner City CMHT

1 Sector Manager
Social Worker

1 Team Manager
Social Worker

1 Admin Manager
Non-clinical

(Clinical Staff) 8 Community Psychiatric Nurses 1 Occupational Therapist | 6 Social Workers 4 Community Care Workers 1 Art Therapist

(Non-Clinical Staff) 1 Co-ordinator 1 Medical Secretary

4 Psychologists

1Team Secretary 4 Administratives

As you can see, conveniently, managers have the same clinical and/or non-clinical background as the people they manage. In this report Ill be exploring this teams internal and external communication channels as well as the communicational barriers it encounters as a result of the above hierarchical structure. I will also attempt to make recommendations on how the teams communication can be improved and suggest implementation pathways for its improvement.

FINDINGS

External Communications Because of the nature of the organisation, and as far as external communication channels is concerned I would say that the ICMHT has robust protocols to rely upon. From its origins, it has been stressed the importance of having efficient, reliable and speedy two-way systems in place considering the importance and sensitiveness of information about service users thats being transmitted amongst different organisations. The main methods of external communication are the telephone and the facsimile (fax). The fax allows members of the team to confirm the recipes of messages transmitted, though as part of the protocol, the sender is to telephone the receiver to double check the document is being received in good conditions. When choosing the phone to emit or receive information there is also a system in place as part of the protocol. For incoming calls from GPs, carers, service users, police or hospitals for example, there are a number of forms to complete. This reduces the possibility of information being lost or misunderstood. Using these forms allows staff to know what to ask and to record the information clearly and in an organised way. It is generally acknowledged that these processes are very time consuming for members of the team, but because of national guidelines, they cannot be changed or modified. Its also important to stress that at the moment the Trust does not accept e-mails as a valid tool of external communication. For example, if in the case of an audit regarding a service user e-mails have been used to transmit alerts or other highly important information, then this will count as negligence on behalf of the team. Also and because of the Data Protection Act, e-mails are not considered secure way to transmit sensitive information about service users, and doing so consists in a violation of the DPA. In terms of feedback and evaluation of the external communication channels, monthly meetings are held between the team and its stakeholders groups. Theyre aimed to improve the existing external communication channels and implementations routes. These meetings are neatly and carefully recorded in the way of minutes by an experienced minutes taker.

Internal Communications In terms of the tools used for internal communication, there are various to consider and I will analyse those in a much more schematic way. 3

- E-mails: Within the team, e-mails are the preferred tool. Even up to a silly extent where staff arranges the time they would go out for lunch even when theyre only a few feet away from each other. However, and to be understandable about this, I should say that the sitting arrangements for staff does not help. All clinicians are sat on an open space together and the use of e-mails allows them to maintain their conversations private. The same happens with administrative staff that is also sharing an open space. In terms of management, the use of e-mails for non-work related matters is very much reduced, but this is not only because they could be more professional in their approach to the working culture, but because they have theyre own rooms where they can meet with different members of staff to discuss any issues. This leads us to other communication tool, meetings. - Meetings: As mentioned above, having meetings happens more in the managerial level than in any other stratum. Of course this is not only because they have the space available to have them but because of the nature of the meetings overall. If we see it from other perspective, clinical staffs, such as community psychiatric nurses for example, dont have the need to discuss service users issues on a private basis. Quite the opposite. They prefer to discuss their concerns, progresses or set backs regarding service users in front of other clinicians where they can gain much more feedback and support from the team. However, and for the same purpose, there are weekly meetings where clinical workers can expose their concerns, etc, to their team manager. These meetings are a much more formal approach to seeking advice or support and like all meetings, these are carefully recorded in the way of minutes. In relation to administrative staff, having meetings works slightly different since there is no clinical information involved. The theme of these meetings is usually about improving the working practices, setting up new systems and overall enhancing the unity of the administrative team. These meetings are not as regular as the clinical ones and neither as formal nor structured, and they occur when the need arises. This is partially because when these meetings happen, all administrative staff is to attend leaving the reception uncovered and with no administrative staff to respond to the needs of the rest of the team. Even though its my believe that is quite feasible to set up a robust system in place where the team is able to function without administrative support for maybe 2 hours every fortnight, this goes against the teams culture and it will prove difficult to organise. This will be explored further in the Recommendations section. - Notices Boards: Well, this tool is not very much utilised by the ICMHT. There are about 7 big notices boards, but staff has been using them to pin jokes or maybe leaflets from other agencies, but no one really accesses them. All the relevant information about the Trusts updates or changes is sent to the individual e-mails so no one really sees those notices boards. - Memos: Originally these where used for transmitting important information only and its a oneway type of communication, from managers to subordinates and not the other way around. The problem here is that theres no room for recorded feedback in memos. Say for example someone wants to argue against it and because this is usually done face-to-face, its not recorded. It could very well happen that after a minor discussion with management, someone stays extent from what the memo says/or enforces and for this person only, the memo gets overruled. This usually generates a lot of confusion between team members and becomes a matter of I said. He said. We agreed etc. Lately, and due to a Trust cutting exercise, memos are not printed out (hard copy) any more, but are circulated via e-mail instead. Over the past two months this has proven to be a problem for two main reasons. First is the fact that not all clinicians are IT literate, so they do not access their e-mail accounts and they miss out important information. The second reason is that staff usually receives 4

many e-mails a day and the chances that an important memo is read and not lost in the bulk of junk is quite high. - Appraisals/Supervision: The Trust has a very positive, flexible and innovative approach in regards to one-to-one sessions such as appraisals, supervisions, counselling, etc. Managers are constantly undergoing training to improve their skills. I believe this comes from the Trusts commitment to the well being of its employees and generally works quite well. There is however a distinction between clinical and non-clinical staff. Clinicians are exposed to a greater deal of sensitive information and even though theyre trained for it, its considered very important to closely monitor workers mental and emotional health. In terms of administrative staff, national guidelines stipulate that they should have at least one appraisal and one supervision a year. However, in reality this does not apply. The truth is that administrative staff is also exposed to the written sensitive information (when typing for example) and that theyre not trained to develop coping mechanisms against it. Unfortunately is up to every managers discretion to evaluate when theres a need for supervision and the fact that managers rotate constantly disrupts the team dynamics and morale.

Communication Barriers So far, weve analysed the external types of communication in the ICMH and also the way that the sub-teams (clinical and non-clinical staff) communicate internally. I think the main barrier impairing the team to work effectively as a whole is lack of systems or tools to enable these two sub-teams to communicate between each other. Ive established how clinicians hold their weekly meetings and how administrative staff has meetings when the need arises, but in terms of sitting them down altogether in a general/team meeting there is definitely room for improvement. Culturally, these two sub-teams remained very separated and theres no concept of an ICMH Team as such. Historically administrative staff was submitted to clinicians needs but now, administrative team possesses much more ownership in terms of the administrative procedures to be followed by clinicians to enable procedures to run smoothly. The inability to communicate between sub-teams has transformed the ICMHT operational systems into a constant struggle for every single member of the team. Nowadays, clinicians and administrative staff have to be able to work closely to enhance the optimisation of procedures that should ease the processes of the day-to-day workload and overall improve the working conditions for everybody within the team.

RECOMMENDATIONS & ITS IMPLEMENTATIONS

Re: Administratives Meetings. 5

This is simply a question of organising a fortnightly meeting when the team is less busy. Usually, Fridays is a very quiet day for the ICMT with no exception. On this particular day, the clinical staff attendance reduces dramatically and thats why it makes it an ideal day. Also, and coinciding with another meeting between managers and GPs, Fridays afternoon are practical since managers are away from their desks and dont require that much administrative support. My suggestion is that the meeting should tackle issues such as working procedures, filling systems, enforcement routes for new protocols and any other businesses relating the general well being of the members of the administrative team. On the short-term, this should enhance the administrative sense/notion of teamwork as well as produce valuable ideas in on how to improve the responsiveness of the administrative workload. Re: Memos As mentioned above, memos are currently subject to be missed out by some members of staff for various reasons. Theres also the fact that hardcopies are not an option anymore. For this, I would suggest the use of one of the notice boards thats currently not being used. If a single memo is printed out and placed on that notice board which due to its location is impossible to miss, then staff would be able to access it and recur to it as many times as they want throughout a stipulated period of time. In order to implement this, I would suggest sharing this new procedure in the clinical meeting that clinicians have on a weekly basis. As managers attend to these meetings, clinical staff will automatically see management on board and in agreement of this new initiative. Re: Team Meeting In terms of having a team meeting where action plans can be drawn to implement new working procedures between clinical and administrative staff, I believe that a few things need to happen before in order to achieve the desired results. First and from the clinicians sub-team, theres a need to acknowledge the importance of the administrative role in their day-to-day work. Clinicians need to understand that its everyones responsibility not to loose files for example and that working jointly with the administrative staff and establishing clear communication channels could will improve the way things are done. How to do this is not a subject for this report, but one can refer to the Leadership Assignment handed previously. Once the clinicians culture changes in regards to this, the following step would be nominating representatives to attend to the team meeting. From the administrative point of view there are also a few things to consider. First, an administrative meeting needs to be set up on a regular basis (as said above) in order to evaluate the situations or working procedures that need to be changed or can be improved. These have to be subject to prioritisation since its impossible to change everything overnight so this scrutiny has to be done very carefully. Once issues are identified then possible solutions need to be put up over the table and and subject to scrutiny since these are the ones that will be put forward in the team meeting for further discussion in terms of implementation. Once everything is in place, and the objectives for the team meetings are clear, then its all about monitoring the progress of implementation, to see if communication channels have really been opened between clinical and non-clinical staff and if the result of this is a good impact in the 6

working procedures of the day-to-day work. Just to see how all the above constitutes a feasible way forward, lets set an example which by seeing it all the way through will give us a clear picture of how things could be implemented, monitored and timed. Example: Misplaced Files. One of the issues that needs to be addressed and as a matter of urgency is that of the files currently being constantly misplaced and not filed away in the correct place by clinical staff. This has proven to be a major problem not only to the administrative staff that needs to file letters or any other documentation in those files and they cant find them, but also for clinicians themselves when answering queries from stakeholders (GPs, for example) and they also cannot locate the files and access the information they require. This sometimes is even worst for clinical staff than for administrative personnel since the fist ones are dealing with urgent calls, for example, regarding a service user that has been recently admitted to hospital, and cannot access the service users file to check the medication he/she is on. This is a clear example on how clinical staff relies on what should be effective, solid and responsive administrative team. Once more, the importance of having a regular administrative meeting where issues like this can came out in the open and a way towards solution can be seen in practice. The administrative meeting should came up with a few possibilities, I.e. nominating a specific clinical or non-clinical person (maybe on a rotational basis) to collect the files from workers desks and move them to a more suitable place where the admin team can access easily and file them away. This can be done half an hour before the working day is over for example. Lets say the above suggestion is the agreed solution to be discussed on the team meeting. Here, the clinical representatives could either agree on this or input with more solutions. After reached a pathway of procedure, then the administrative team could assign a files supervisor (also on a rotational basis) that will be in charge of closely monitoring if the new measures are occurring or not, and to feedback the meeting on the progress. Administrative staff already has a record of every file that goes missing within the remit of the team, so, we could match against that list the percentages before and after the system is in place. I think it would be sensitive to monitor this on a monthly basis and once this system is accepted and working naturally and as part of the teams culture, then the administrative team would be ready to jump to the next challenge. Overall, I think that with this report I was able to establish not only a broad description of the existing communication channels used by the ICMHT but also to show how big is the impact on the workload when communication fails its aim.