Art & science | staff interaction

Improving communication between emergency department staff Kate Moore describes the development of an interactive website on which staff can check the roster and communicate with each other Correspondence [email protected] Kate Moore is a business support manager at Brighton and Sussex University Hospitals NHS Trust Date submitted October 29 2013 Date accepted April 7 2014 Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines en.rcnpublishing.com

EMERGENCY NURSE

Abstract During redevelopment of the emergency department at the Royal Sussex County Hospital, Brighton, it was deemed vital that its internal communication system should be as effective as possible. An audit of staff perceptions of the existing communication system and a relevant literature review were undertaken, therefore, to inform a proposal for the development of a new online system. This article describes the development and implementation of the system. Keywords Online communication, staff engagement, internet THE EMERGENCY department (ED) at the Royal Sussex County Hospital, Brighton, which became a regional major trauma centre in April 2012, is the only full-sized trauma centre in the south east region of England. It has a multidisciplinary workforce of more than 200 medical, nursing and clerical staff, who treat 120,000 patients a year. Work streams in the ED are constantly being changed as national guidelines are updated, and a forthcoming redevelopment of the department is expected to cause disruption to clinical processes and workflows. As Kotter (1996) points out, such changes require the understanding and commitment of staff, which in turn require the development of ‘an open communications culture’ (Hooper and Potter 2000). It was clear that, to ensure such a culture was established, an effective internal communication system was needed in the ED. Staff at Sussex University Hospitals NHS Trust communicate by email through an intranet system but, until the new communication system was set up, most ED staff had no opportunities to use computers

or enough time to access the trust’s email account. The author, as the business support manager, and a secretary and a matron in the ED would print trust emails and place them on noticeboards in staff areas but, due to changes in shift patterns and workload, some staff would not see them until the information in the emails was out of date. It was decided to review the effectiveness of internal communication in the ED, and to improve how ED staff receive information and communicate with each other. This review comprised a literature review and a survey of staff opinion.

Literature review Method A literature search using the University of Brighton library catalogue was conducted. The subjects of the search were ‘business and management’ and ‘media and communications’, and inclusion criteria were articles or books in English that had been published over the previous ten years and, initially, that contained combinations of the keywords ‘internal’, and either ‘communication’ or ‘communications’. These criteria were found to be too broad, however, and a second search using combinations of these and the additional keywords ‘impact’, ‘benefit’ or ‘benefits’, ‘negative’ and ‘important’ was conducted. As a result, 30 research articles were identified and printed. References to other apparently relevant publications in these articles were sought by name in the University of Brighton library catalogue and five of these were also identified and printed. Findings Welch (2012) states that internal communication ‘underpins organisational effectiveness’ and ‘contributes to positive internal relationships by enabling communication between senior managers and employees’. May 2014 | Volume 22 | Number 2 29

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Art & science | staff interaction Figure 1 Conceptual model of corporate internal communication

Voice ‘I have regular opportunities to have a say and what I say is treated seriously’

Strategy, goals and values ‘I am well informed about what is going on and what is being planned, and my line manager is committed to the organisation’

Support ‘The organisation provides plenty of support for people’

Engagement

Performance ‘I know how I am doing and have good development opportunities’

Role ‘I know what my job responsibilities are, and how they contribute to the team and organisation’

Identification ‘I identify with the organisation’s values and am an advocate of what it does’

(Adapted from Ruck and Welch 2012)

Quirke (2008) suggests it ‘is vital to success’ and can ‘provide strategic advantage through aligning employee efforts, sharing their knowledge and engaging their passion’. According to Truss et al (2006), such engagement is important because it ensures that employees: ■■ Have opportunities to communicate their views to more senior staff. ■■ Are well informed about what is happening in their organisations. ■■ Can see that managers are committed to the organisation. MacLeod and Clarke (2009) argue that staff engagement, or participation, is enhanced by good internal communication, while poor communication causes disengagement. Many of the articles identified by the author in her literature search concern ways to measure the quality of internal communication. Pophal (2009), for example, highlights the importance of drawing up formal internal communication plans, and objectives against which the success of these plans can be measured. Pophal (2009) also discusses the 30 May 2014 | Volume 22 | Number 2

steps involved in developing an effective internal communication plan. Quirke (2008) is also an advocate of communication plans, and suggests that organisations place them high on their agenda to ensure that they are effective and consistent, and that employees do not become disengaged by receiving too much information. In a review of 12 academic and consultancy studies of internal communication processes, Ruck and Welch (2012) found though that most of them have been devised to suit managers rather than employees, whose satisfaction or dissatisfaction with their organisations’ communication practices is generally ignored. These findings indicate that assessments of internal communication systems should address their value to employees as well as to organisational objectives. Ruck and Welch (2012) also produced an updated conceptual model of corporate internal communication (Figure 1) that illustrates the importance of employees’ opinions about the subject, and shows how internal communication can enhance employee engagement and organisational effectiveness. In exploring the attributes of internal communication, Welch (2012) describes each of them as a continuum. Three of these attributes, namely controllability, forms of dissemination and ease of use, have been adapted for Figure 2. The controllability of internal communication depends on its type, whereby a newsletter is described as ‘controlled’ because its content and format have been decided by the staff who produced it, and a blog is described as ‘uncontrolled’ because its content and, to some extent, format is changed constantly by all those who contribute to it. Forms of dissemination are described as ‘push’, ‘pull’ or ‘blended’, whereby push dissemination can involve sending information directly to staff, pull dissemination can involve making the information available to staff, and blended dissemination can involve alerting staff to the availability of the information. Ease of use of internal communication systems can be high, medium or low, often depending on the technology involved. Welch (2012) also carried out a qualitative survey of employees’ opinions about internal media formats. Results show that only 2% of participants preferred paper copies of a newsletter to its electronic version, while 69% were concerned about the cost involved in printing newsletters on glossy, colour paper. However, employees were also concerned about difficulties in navigating the intranet, which suggests they would prefer push dissemination of information. It should be noted that Welch (2012) based her study on findings from EMERGENCY NURSE

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a questionnaire sent to employees with computer access; had the views of staff without computer access been gathered too, its findings may have been different. The NHS adopts a traditional method of communication, in which information is fed from managers at the top of the organisation, down through each tier of staff until it reaches front line employees. As a result, information is rarely misinterpreted and decisions are usually consistent, but the method also stifles initiative and prevents employee involvement. Where more informal communication methods have been adopted, staff tend to be more loyal and happy, and experience less stress (Khan and Khan 2011). Bennett et al (2010) claim that social networking sites, which offer formal and informal forms of communication, change communication from ‘information gathering’ to ‘information participation’, and so engage people who use them. In response to the rise of social networking, fast-food chain McDonald’s created an informal social networking website called StationM, with which managers can encourage staff to participate in change (Deng 2009). After completing the literature review, the author conducted an audit that involved interviewing the ED’s practice educator (PE), and surveying ED staff

views on existing internal communication methods and what they would like to see changed.

Audit Interview The PE is responsible for teaching ED nurses, and offering them guidance and support. He also provides a link between the ED and the local higher education institution. As such, internal communication is an important part of the PE’s role and, to gather his opinions on the subject, the author interviewed him. She asked him open questions to encourage him to give extensive answers and closed questions to obtain specific information. The interview was transcribed in full soon after it was completed to control bias and produce reliable data (Saunders et al 2009). The transcription is available on the Emergency Nurse website. During the interview, the PE raised four issues: ■■ Sending important information to staff by email is ineffective because many staff members do not check their email accounts regularly. ■■ Advertising training courses on posters in corridors is deemed unfair to staff who, due to their shift patterns, are away from the department for long periods of time and do not see the posters.

Figure 2 Attributes and examples of internal communication media Attribute Continuum

Controllability Controlled

Partially controlled

Newsletter or videocast of a corporate strategy

Examples

Attribute Continuum

E-zine sent to employees as an email attachment

Attribute Continuum

Internal blog that includes a manager’s interpretation of corporate issues

Forms of dissemination Blended

Push

Examples

Team briefing in which a corporate vision is expressed

Uncontrolled

Email with a link to the e-zine sent to employees

Pull

E-zine that has been made available on the intranet

Ease of use High

Medium

Employees can find intranet information quickly and easily

Examples

Accessibility of information on intranet is variable

Low

Intranet search facility is slow and ineffective

(Adapted from Welch 2012)

EMERGENCY NURSE

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Art & science | staff interaction Figure 3 Questionnaire on internal communication in the emergency department Job title:..................................................................................................................................................... Statement

Response: tick one box Strongly Disagree disagree

Agree

Strongly Not agree applicable

Internal communication in the department is adequate Internal communication should be improved An online noticeboard would be useful Online access to annual leave records and the ability to request annual leave online would be useful Online access to the off-duty roster would be useful An area for staff to discuss the off-duty roster in confidence would be useful Internal communication affects staff morale Question

Yes

No

Do you check emails to your work address? Do you have access to the internet at home? Do you have a smartphone? If there was a department online communication system, what information would you like it to contain?................ ................................................................................................................................................................. ................................................................................................................................................................. ................................................................................................................................................................. ................................................................................................................................................................. ................................................................................................................................................................. ■■ When the roster is displayed in corridors staff must copy it down, and some do so incorrectly and turn up for the wrong shifts. This could be prevented if the roster were displayed online so that staff could access it from home, or by using their smartphones or tablets. The PE agreed that these problems could be solved, and staff morale improved, if an internal communication system were to be introduced. Survey The author drew up a questionnaire comprising seven statements to which staff could give one of five responses to indicate the extent of their agreement, three questions to which they could answer yes or no, and one open question to 32 May 2014 | Volume 22 | Number 2

collect qualitative data. The questionnaire has been adapted for Figure 3. Approval for conducting the audit and distributing the questionnaire to staff was gained from the head of nursing. Electronic copies of the questionnaire and an explanation of why it was being conducted were emailed to 88 medical, nursing and clerical staff in the department. Recipients were also told that the audit was voluntary and anonymous, but that it would be helpful if they included their job titles when completing the questionnaire, and that they should complete it within four weeks of receiving it. In addition, paper copies of the questionnaire were left in the staff room in case any of the staff contacted had failed to check their emails. EMERGENCY NURSE

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Results Forty members of the 88 staff, representing 45% of those contacted by email, completed and returned questionnaires. The numbers and percentages of different staff categories of respondent are shown in Table 1. Although the ED workforce includes junior doctors, registrars, receptionists and members of specialty teams, such as those working in mental health care, the respondents included only ED nurses, ED consultant doctors and administrative staff. To some extent the low response rate illustrates how differing shift patterns and a lack of procedure in the ED can raise problems with communication. It should be noted, however, that the junior doctors and registrars included in the audit had only recently joined the ED as part of their training programmes, while the specialty team members are employed by a different trust from all other members of staff in the ED. All of these professionals may have felt inhibited from taking part in the audit by their lack of experience of the department’s internal communication system. The results of the questionnaires were collated manually. Quantitative data (Table 2, page 34, and Table 3, page 35) were set out on a spreadsheet and added up, while qualitative data were analysed, summarised into key points and the results compiled. Of the 40 respondents, 32 (80%) said they disagree or strongly disagree that internal communication in the ED is adequate, and the same number said that staff morale was affected by the internal communication system. Seventeen (42%) respondents agreed and 21 (53%) strongly agreed with the statement that internal communication in the ED could be improved. Only one respondent, a medic, disagreed with the statement, possibly because the medical team has access to a dedicated computer, and protected time for paperwork and management duties. Eight (20%) agreed and 28 (70%) strongly agreed that an online roster would be useful. Thirty one (78%) said they would like online access to their annual leave records and the opportunity to request leave online. Thirty four (85%) agreed and three (8%) disagreed that an online, interactive site in which staff could swap of off-duty periods and discuss other confidential work issues would be useful. Only 21 (53%) respondents said they check their work emails regularly, which suggests that almost half of ED staff do not. Nevertheless, 38 (95%) respondents said they have access to the internet at home and 17 (93%) that they have smartphones. Overall, 35 (88%) agreed that an online noticeboard would be useful, although five (20%) added ‘only if it is accessible from home’. EMERGENCY NURSE

In the final question, respondents were asked what information they would like an online communication system to include. The numbers of staff giving different responses to this question are shown in Table 4, page 35. Two respondents said they would like the system to be easy to access and to be accessible from home, one said it should allow staff members to leave confidential messages for individual colleagues to see, and one warned that the system should not be overloaded with information. Data from the literature review, interview with the PE and the questionnaires indicate that the ED’s internal, online communication system was inadequate, and that a new system was needed to ensure information reaches staff at all levels. In October last year, a senior doctor with the relevant experience agreed to develop an interactive website accessible from smartphones and tablets during his protected management time, thereby ensuring no additional costs for the ED.

Website The website, which was launched in January, includes a newsfeed, or whiteboard, to announce changes to the department, trust policies and practice guidelines, and a separate section with information about the roster. It also has a page of information about training and development that offers access to course application forms, and links to training manuals and competencies. Managers are responsible for keeping the website up to date so that staff receive the relevant information. To ensure the proposed website would adhere to trust clinical governance policies, it is accessible only to staff with the correct usernames and passwords, which are deactivated when the staff concerned leave the ED. Users are told not to discuss patient demographics or examples of clinical work. Table 1

Participants by staff category

Staff category

Participants

Total staff numbers

Number

Percentage

Medical

7

50

14

Nursing

25

42

60

Senior nursing

6

60

10

Administrative

2

50

4

Total

40

45

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Art & science | staff interaction Table 2

Results from staff questionnaire

Statement

Internal communication in the department is adequate

Internal communication should be improved

An online noticeboard would be useful

Online access to annual leave records and the ability to request annual leave online would be useful

Online access to the off-duty roster would be useful

An area for staff to discuss the off-duty roster in confidence would be useful

Internal communication affects staff morale

34 May 2014 | Volume 22 | Number 2

Staff category

Number of staff

Response Strongly agree

Agree

Disagree

Medical

7

3

4

Nursing

25

4

18 2

Strongly disagree

Not applicable

2

1

Senior nursing

6

Administrative

2

4

Total

40

0

7

24

8

1

Percentage of total

0

17

60

20

3

1

2

Medical

7

2

4

Nursing

25

12

12 1

Senior nursing

6

5

Administrative

2

2

Total

1

40

21

17

1

0

1

Percentage of total

52

42

3

0

3

Medical

7

1

3

2

1

Nursing

25

9

14

1

1

Senior nursing

6

2

4

Administrative

2

1

1

Total

40

13

22

3

1

1

Percentage of total

32

55

7

3

3

1

1

4

Medical

7

1

Nursing

25

16

9 2

Senior nursing

6

3

Administrative

2

2

Total

40

22

11

1

1

5

Percentage of total

55

27

3

3

12

Medical

7

5

1

Nursing

25

17

7 2

1

1 1

Senior nursing

6

4

Administrative

2

2

Total

40

28

10

1

1

0

Percentage of total

70

25

3

2

0

1

3

Medical

7

Nursing

25

13

10

3 2

1

1

Senior nursing

6

4

Administrative

2

2

Total

40

19

15

1

2

3

Percentage of total

47

37

3

5

8

Medical

7

3

4

Nursing

25

2

19

3

2

1

Senior nursing

6

4

Administrative

2

2

Total

40

8

24

7

0

1

Percentage of total

20

60

17

3

0

EMERGENCY NURSE

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Data from the interview and questionnaires indicate that staff wanted to be able to post comments for colleagues on the communication board but it was decided that, because such a facility would have to be monitored regularly, it will not be made available until guidelines for its use have been developed. It is expected that these guidelines will be similar to those on social networking drawn up by the Nursing and Midwifery Council (2013), which state: ‘Do not share confidential information online, post inappropriate comments about colleagues or patients, use social networking sites to bully or intimidate colleagues, pursue Table 3

Table 4

Responses to the open question

Subjects respondents would like to see covered on a staff website

Number of respondents

Forthcoming events, such as fundraisers

5

Shift swaps

3

Online learning and training

6

A timetable of training days

1

Practice guideline updates

6

Changes to trust policies

4

The off-duty roster

3

Redevelopment of the emergency department

3

Annual leave records and requests

2

Bed status

2

Meetings

1

Good news stories

1

Results from staff questionnaire

Question

Do you check emails to your work address?

Staff category

Number of staff

Response Yes

No

Medical

7

6

1

Nursing

25

9

16

Senior nursing

6

5

1

Administrative

2

1

1

Total

40

21

19

Percentage of total

52

48

Medical

7

7

Nursing

25

24

1

Senior nursing

6

5

1

Administrative

2

2

Total

40

38

2

Percentage of total

95

5

Medical

7

6

1

Nursing

25

23

2

Senior nursing

6

6

Administrative

2

2

Total

40

37

3

Percentage of total

92

8

Do you have access to the internet at home?

Do you have a smartphone?

EMERGENCY NURSE

personal relationships with patients or service users, distribute sexually explicit material or use social networking sites in any way which is unlawful.’ The system is deemed to be an equitable way of disseminating information because extrapolation of survey figures indicates that almost all staff in the ED have access to the internet at home, or by smartphone or tablet, while those who do not can access it from the ED’s computer. To advertise the new system, posters about it were displayed in the department, and texts and emails sent to all staff. Mandatory staff training days that include distribution of passwords and a description of how the website should be used have been introduced.

Conclusion Staff have begun to use the website but there has been insufficient time to measure its effects on communication in the ED. However, there are plans for monthly reviews of the number of times staff log on to the website to assess whether important information is being viewed. If these reviews show that too few staff visit the site, research will be undertaken to find out why. May 2014 | Volume 22 | Number 2 35

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Art & science | staff interaction In addition, staff will be asked to complete an evaluation questionnaire similar to the one initially sent to staff by the author and also based on Ruck and Welch’s (2012) conceptual model of corporate internal communication. In this survey, respondents will be asked to indicate the extent of their agreement with a series of statements, including: ■■ I am well informed about what is going on and what is being planned, and my line manager is committed to the organisation. ■■ I have regular opportunities to have a say and what I say is treated seriously. ■■ I know how I am doing and have good development opportunities.

■■ I identify with the organisation’s values and am an advocate of what it does. ■■ I know what my job responsibilities are, and how they contribute to the team and organisation. Participation in this and other staff surveys may be increased by ensuring staff are given copies of questionnaires by hand and more time to complete them.

Online archive

Find out more The interview with the practice educator mentioned in this article is available on the Emergency Nurse website, at rcnpublishing.com/r/moore

For related information, visit our online archive and search using the keywords Conflict of interest None declared

References Bennett J, Owers M, Pitt M et al (2010) Workplace impact of social networking. Property Management. 28, 3, 138-148. Deng T (2009) McDonald’s new communication strategy on changing attitudes and lifestyles. International Journal of Marketing Studies. 1, 1, 37-42. Hooper A, Potter J (2000) Intelligent Leadership: Creating a Passion for Change. Random House, London. Khan J, Khan R (2011) Informal communication styles benefit McDonald’s and Ford. Human

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Resource Management International Digest. 19, 7, 27-29. Kotter J (1996) Leading Change. Harvard Business Publishing, Watertown MA. MacLeod D, Clarke N (2009) Engaging for Success: Enhancing Performance through Employee Engagement. Department for Business, Innovation and Skills, London. Nursing and Midwifery Council (2013) Regulation in Practice: Social Networking Sites. tinyurl.com/p8pyj5y (Last accessed: April 10 2014.)

Pophal L (2009) An 8-Step Process for Creating Effective Internal Communication Plans. tinyurl.com/oav5mfh (Last accessed: April 10 2014.)

Saunders M, Lewis P, Thornhill A (2009) Research Methods for Business Students. Fifth edition. Pearson Education, Harlow, Essex.

Quirke B (2008) Making the Connections: Using Internal Communication to Turn Strategy into Action. Second edition. Gower Publishing, Farnham, Surrey.

Truss C, Soane E, Edwards C et al (2006) Working Life: Employee Attitudes and Engagement 2006. Research Report. Chartered Institute of Personnel and Development, London.

Ruck K, Welch M (2012) Valuing internal communication: management and employee perspectives. Public Relations Review. 38, 2, 294-302.

Welch M (2012) Appropriateness and acceptability: employee perspectives of internal communication. Public Relations Review. 38, 2, 246-254.

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Improving communication between emergency department staff.

During redevelopment of the emergency department at the Royal Sussex County Hospital, Brighton, it was deemed vital that its internal communication sy...
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