Better measures needed on the impact of health communication

In June 2008, Lord Ara Darzi, an eminent surgeon and short-term Government health minister published High Quality Care for All.¹ The focus of this report was to bring quality back to central stage in health care design, delivery and evaluation. The three components of the ‘Darzi Quality Triangle’ were safety, clinical effectiveness and personal care. The latter of these three, personal care, being the weakest of the three, has been the focus of much attention and effort especially under the banner of ‘improving patient experience’ (IPE). Such improvements have ranged across topics such as dignity and respect, better quality food, and improved access to care. One of the key elements of these IPE initiatives has also been communication.

Communication is known to improve customers’ experience of an organization — brand recognition, reputation, loyalty, etc. but how does it apply in healthcare settings and especially in a system which is primarily public funded i.e. the majority of services come under an NHS (National Health Service) banner?

The UK's Department of Health produced a framework in late 2009 aimed at senior leaders and professional communicators to help them ‘develop world-class communication within their organisations’. The Communicating Organisation² analysed four attributes — Brand, Delivery, Leadership, Core Competence — across four perspectives — Societal, Corporate, Service User and Functional. Looking under the attribute of Delivery and taking the Service User perspective, it makes the recommendation to ensure ‘effective processes are in place to listen to service users, and to engage them in dialogue and action’.

In this we see a move away from communications being a mere transmission of information — a monologue of ‘managing the message’ — to more of a two way dialogue to mutually agree a way forward. This is the root of shared clinical decision making, of care planning, of person-centered care. The core of medicine itself perhaps? Yet despite established models of communication in medicine — such as the Calgary-Cambridge Guide To The Medical Interview^3–5 evidence continues to mount that professionals — both clinical and managerial — are seemingly forgetting to be compassionate, to communicate, to care. Initiatives such as NHS England 6C's⁶ have been established to reinvigorate professionals — in this case nursing — to reconnect with these basic components of healthcare.

This Journal, and others, regularly cite evidence showing the difference that communication can make in real practice. But these studies all too regularly seem to be ignored, trivialized or side-lined. Especially in preference to the ‘more important’ issues of safety and clinical effectiveness. How do we, as healthcare communication and engagement professionals, better illustrate to our ‘yet to be converted’ colleagues that what we are doing is not ‘soft and cuddly’ but also impacts clinical and quality of life outcomes?

One suggestion is a more universal mechanism for measuring the impact of our interventions. And a better way of collating these. We'd like to see submissions and suggestions in this very Journal on what is, or needs to happen to make these a reality.

We also need to show, given the increasing financial pressures across all health systems, how communications and engagement impacts the bottom line. Recent work from KPMG⁷ illustrates that activated patients — a model developed by Judith Hibbard et al.⁸ — can save providers between 8–21% of costs. Such an intervention is more impactful than a drug or medical device! But it takes huge cultural change to shift the system from its current ways of doing ‘to’ and ‘for’ patients to the doing ‘with’ patients approach.

Other mechanisms need to look at how systems are truly restructured around patient needs. And not just their clinical ones. Instead we need to better understand the psychology of our patients which includes their health literacy. Ground-breaking work is taking place on this topic in Australia⁹ which uses the Health Literacy Questionnaire to measure service user's experience, views and capabilities across nine areas. Knowing these data allows for the design and delivery of new interventions that address health literacy across the entire system leading to improved outcomes and a reduction in health inequalities.

Now that's something to shout about…

Disclaimer statement

Mark Duman is a Director of Monmouth Partners Ltd and MD Healthcare Consultants Ltd which conduct projects for a wide variety of public and private healthcare organizations. This article was not supported by any funds.

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Mark Duman

Mark Duman is a rare blend of clinician, management consultant and patient advocate. He works with organizations to help them realize the full benefit of their services and products, especially through the often untapped potential of patients and the public.

At the King's Fund Mark promoted shared decision making, founded the ‘Ask About Medicines’ campaign and authored ‘Producing Patient Information’. In the BBC he developed a range of behavioural change interventions to improve people's health and lifestyle. Following roles in publishing and telecoms, Mark's clients include AstraZeneca, Cancer Research UK, Care Quality Commission, Department of Health, Microsoft, NHS England, Scholl, Tunstall Group and UCB Pharma. Advisory roles include the Ministerial Industry Strategy Group on Medicines Access, NHS Alliance People Powered Innovation Group and NHS England's Insight Strategy Group. He is a Non Executive Director of the Patient Information Forum, and a full time Director at Monmouth Partners Ltd. Mark is a long term condition patient and a carer, and lives happily in Manchester, England.

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Inside commentaries are authored by members of the editorial board of the Journal of Communication in Healthcare: Strategies, Media, and Engagement in Global Health on topics within the Journal's scope and objectives, and only represent the opinion of the authors. This is an occasional section of the Journal, which only includes invited perspectives and short commentaries.