Having led small and large improvement efforts for over ten years, I realise that it took me a while to appreciate the importance of communication.
‘Communication’ usually takes pole position on any list of managerial qualities or characteristics of a good strategy, but it so often lacks substance: it has become a truism which is hard to refute. On the other hand, communication is so much a part of what we do, there is a danger that it is overlooked and not emphasised or studied sufficiently.
The Health Foundation’s recent report, Constructive Comfort, lists seven success factors for change in the NHS. Communication is not one of them, but it does feature in several sections and is implied throughout. Indeed, the Health Foundation has established its credentials in communications and devotes considerable resource to it.
In our case in NHS Wales, it was only when we designed and ran the 1000 Lives Campaign that we really put structure and resource to the idea. Our actions were greatly influenced by the work of the Institute for Healthcare Improvement and their emphasis on communication. We were also strengthened by having the good fortune to appoint Andrew Cooper, an excellent leader in the field who developed a multi-faceted approach to the use of communications for the campaign and subsequent work.
We have just had a paper published on the subject, Exploring the role of communications in quality improvement, which proposes the strategic use of communication in all quality improvement activity.
For us, the benefits have been like applying an exponential in maths. The impact and sustainability of improvement efforts are multiplied many times when there is wide understanding of the improvement culture, when people see their work recognised and when teams are able to learn about one another and share findings across organisational boundaries.
But communication is not just an amorphous resource. It needs skill, method and, as we grow, we need to gather learning. That is the point of the paper.
Coincidentally, I have just read Frank Davidoff and colleagues’ excellent paper extolling the use of theory in improvement work. Put simply, basing improvement work on reasoning makes for better work and easier evaluation. Put even more simply, we should design what we do based on some scientific knowledge and learn from what happens using the same framework. The same paper analyses the possible uses of theory in an improvement project.
The paper refers to communication theory as a support for designing the giving of messages within social change. But implicitly, it is also wrapped up in many of the other elements: peer pressure, buy in, team behaviour, social networks and influence for instance.
Our experience and our paper support a similar argument. We believe there is a case for formalising, integrating and expanding the role of communications within the design of any improvement intervention. The dividend is radically to extend scope and longevity of effect. Too often we see communications being done as an afterthought by folk who are expert in other fields or it is the preserve of specialists who are isolated from clinical work. We hope that our paper will be a positive contribution, building a theory base to ensure that we are explicit about theories being applied and rigorous about learning.
Without such a change in approach, there is a danger that communication theory will continue to be a poor relation to other aspects of improvement science and that we will miss the chance to achieve potential impact.
Alan is a member of the Health Foundation’s International Science Development Group and former director of the 1000 Lives Improvement service in NHS Wales, www.twitter.com/dralanwillson.
For more on using communications approaches to spread improvment, download the Health Foundation's new practical guide.
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