Improving Communication and Clarifying Roles 1 A PROPOSAL FOR IMPROVING COMMUNICATION AND CLARIFYING ROLES AND RESPONSIBILITIES OF THE MULTIDISCIPLINARY TEAM MEMBERS INVOLVED IN THE TREATMENT AND CARE OF STROKE PATIENTS TO ENHANCE COOPERATION AND IMPROVE PATIENTS' TREATMENT OUTCOMES by Name Course Professor’s name University Date of submission Improving Communication and Clarifying Roles 2 From: NAME, Deputy Neurologist, Winston Hospital. To: John Spark, President, Winston Hospital. REPORT: A PROPOSAL FOR IMPROVING COMMUNICATION AND CLARIFYING ROLES AND RESPONSIBILITIES OF THE MULTIDISCIPLINARY TEAM MEMBERS INVOLVED IN THE TREATMENT AND CARE OF STROKE PATIENTS TO ENHANCE COOPERATION AND IMPROVE PATIENTS' TREATMENT OUTCOMES Executive Summary 1. Globally, a person gets a stroke every two seconds. 2. Stroke is the fourth single leading cause of deaths in the UK and is the leading cause of disabilities. 3. 70% of stroke survivors leave hospital with a disability. 4. 70% of stroke survivors do not get the necessary six-month assessment and social care which contributes to low treatment outcomes. 5. A study was conducted to evaluate the experiences of patients who had gone through the current treatment pathway at Winston Hospital. 6. Another study was conducted to evaluate how staff involved in the treatment of stroke patients feel about the current treatment pathway, their roles, and level of cooperation. 7. Most patients who had undergone the current treatment pathway had a positive attitude towards the overall treatment pathway but expressed disfavour regarding communication from the staff at most stages of their treatment process. 8. Staff indicated a lack of clarity on their roles and those of their colleagues as well as confusion where there seemed to be an overlap of responsibilities. 9. Staff also indicated that the current level of communication was poor and ineffective hence affecting cooperation and teamwork. Improving Communication and Clarifying Roles 3 10. NHS advise that a multidisciplinary approach is crucial to ensure high treatment outcomes for stroke patients. 11. A SWOT analysis of the current treatment and referral pathway was conducted, and several opportunities were discovered including: clarifying the roles of different staff members, improving communication between staff and between staff and their patients, reducing hospital lengths of stays, and improving overall treatment outcomes. 12. This report showcases the root cause of the low treatment outcome for stroke patients and proposes potential solutions for improving stroke treatment outcomes. 13. One of the proposed solutions will involve training of staff to clarify their roles and those of their colleagues, as well as dividing and stipulating specific roles to different staff clearly to remove the overlap of responsibilities. 14. The other solution entails improving communication and cooperation between all the stakeholder multidiscipline departments by use of regular multidisciplinary rounds and situational briefings that will be patient-centric. 15. Kotter’s 8-steps of change implementation model was settled for as the strategy that will be used to implement the proposed changes. 16. If successful, these solutions will ensure all staff members understand their responsibilities and those of their colleagues, disentangle overlapping roles to minimise service duplication and time wastage, improve communication among staff and with their patients, reduce hospital lengths of stays for stroke patients, and improve overall treatment outcomes. The rationale for the Choice of Topic According to the UK government statistics, stroke is the fourth single leading cause of death in the UK. Each year, UK reports over 100,000 strokes, which translates to around one Improving Communication and Clarifying Roles 4 stroke every five minutes. Globally, someone gets a stroke every two seconds. Stroke also happens to be the leading cause of disabilities in the UK, with almost 70% of stroke survivors leaving hospitals with a disability. Although 80% of people who are eligible for emergency clot-busting treatment thrombolysis receive it in the UK, only 30% of stroke survivors who need a six-month assessment and social care receive it (“State of the Nation,” 2017). These statistics indicate a need to improve the treatment process of stroke patients. Studies indicated that the current treatment pathway is not effective enough and stroke patients have not been receiving the best care to ensure optimum recovery especially in the rehabilitation stages of their care (Campbell, 2020). This report proposes changes that need to be implemented in the current stroke patients' treatment pathway to enhance cooperation between the multidisciplinary team involved in their treatment and care, reduce hospital lengths of stays, and improved overall treatment outcomes. Critical Discussion Unlike before, where stroke was viewed nihilistically, the condition is now considered a medical emergency with well-outlined evidence-based treatment and care pathways (Clarke and Forster, 2015). However, stroke remains to be a complex clinical condition that calls for integrated care by health professionals from different specialties. Effective treatment of stroke patients in hospitals and care of the patients in community settings requires efforts by a well-coordinated multidisciplinary team. Treating and caring for stroke patients with a multidisciplinary team ensures professionals bring together their collective knowledge and specialist skills which goes a long way in benefiting stroke patients (Clarke and Forster, 2015). Studies have shown that approaching stroke with a multidisciplinary team leads to improved outcomes. For instance, in comparison to conventional care, integrated Improving Communication and Clarifying Roles 5 multidisciplinary care has been shown to result in long-term reductions in deaths, dependency, and institutional care (Clarke and Forster, 2015). NHS advises health institutions to implement multidisciplinary and patient-centric approaches when dealing with stroke complications. According to the NHS, an effective multidisciplinary team should have blurred boundaries between professionals involved but still have clear roles and responsibilities of each staff member (NHS, 2014). Evidence has also shown that multidisciplinary teams facilitate early discharge of patients which reduces lengths of stays at hospital, and patients who have received a multidisciplinary model of care have shown high likelihoods of regaining independence in the activities that support their daily living thus resulting in fewer patients requiring long-term institutional care (Clarke and Forster, 2015). Identifying the Problem Numerous research studies have been conducted to identify a major barrier to multidisciplinary models of healthcare. Among the most common barriers are poor communication, lack of awareness of the roles of colleagues, poor working relationships, limited resources, and confusion due to overlapping roles (Rossell et al., 2018). Treatment and care of stroke patients incorporate an extended network of multidisciplinary staff that is connected right from the point where a patient is admitted to the point where they are discharged. The following list outlines the professionals involved in the treatment and care of stroke patients and a brief description of their roles. o Neurologist: Is responsible for the overall management of patients’ recovery during the acute phase of hospitalization o Nurses: they observe a patient’s condition and progress, which provides valuable information to the neurologist, as well as help the patient in eating, dressing, and bathing. Improving Communication and Clarifying Roles 6 o Social workers: They help patients and their family members in understanding the likely family, social, and financial impacts and provide advice on how to obtain assistance when needed. They also provide counseling to family members who may feel depressed as a result of their relative's stroke. o Occupational therapist; they assess the effect of the stroke on the independence of the patient and ability to carry out their daily activities. They then help the patients to adapt to their changed circumstances by designing specific activities and modifications to their home and workplace to help the patient carry out various activities without difficulties and risks of injury ("The stroke multidisciplinary team, "n.d.). o Speech therapists: evaluate the extent to which the stroke has affected a patient’s ability to communicate through speech and design a specific treatment process to help the patient in improving their speech. o Physiotherapist: they assess the effect of the stroke on the movement abilities of the patient. They then plan a rehabilitation programme to improve the patient’s abilities to make movements while taking into consideration their general health, their level of activity previously, and their interests (“Stroke Recovery Association,” n.d.). To identify the specific problem affecting this facility, we formed a team incorporating representatives from the various multidisciplinary departments. The team comprised of the head of the department and one lower staff member. Figure one outlines the derived current process map and the professional involved at each stage. Improving Communication and Clarifying Roles 7 Emergency Call Assessed by a Paramedic following an emergency call Urgent transport to Primary Care Stroke Centre Rapid Triage by a Nurse Symptoms Stroke Specialist No Yes Neurologist Acute Therapy Rehabilitation Home (Physical Therapist) (Occupational Therapist and Social Therapist) Figure 1: Current treatment and referral pathway for stroke patients Improving Communication and Clarifying Roles 8 After drawing the current referral process map and incorporating all the staff members involved, a questionnaire seeking to establish obstacles to fluid cooperation and integration of the multidisciplinary staff involved was developed and sent to each department. The questionnaire incorporated both multiple-choice and open-ended questions. At the same time, a different questionnaire was developed and sent out to stroke patients that had undergone treatment and got discharged from this facility. The study on patients aimed to establish the level of treatment outcomes and their experiences after undergoing the treatment process. The received answered questions were received and data analysed. An analysis of the data received from staff members revealed major ambiguity in roles and expected responsibilities among staff. Data collected from patients revealed low treatment outcomes due to factors like extended lengths of stays in hospital, being sent to and from between staff which had a high frustration score for stroke patients and their carer givers, and poor communication from the staff. A lack of clarity on the roles of various staff members and poor communication were identified as the major stumbling blocks for fluid integration of the multidisciplinary team and hence low treatment outcomes for patients that went through the treatment pathway. Patients indicated that they received minimal communication from staff and would sometimes be sent from one professional to the next without clarifications. Multiple patients indicated that sometimes, a staff member would send them back to the department they had been referred from or send them to a different professional on account that they should not be the ones handling that stage of treatment. Being sent to and from was indicated as highly frustrating by most patients. Following these discoveries, the team embarked on intensive discussions, analysis of the data, and brainstorming to areas of the treatment pathway where communication breakdowns were more likely to occur. It was discovered that most patients and their caregivers indicated Improving Communication and Clarifying Roles 9 receiving little communication at the emergency centre after being presented by the paramedics or family members following stroke symptoms. As per the data from the patients, nurses in this section seemed to be in an extreme hurry and were mostly brief and least friendly. Data from staff indicated that nurses in the emergency centre had immense pressure from incoming emergency cases and that could explain the reason why they were seen as brief and in a hurry from the patients’ perspective. However, it was also found that nurses from the emergency department felt that patient and their carers would get more information about the situation of the patient and the expected treatment procedure from either the stroke specialist or the neurologist. In the neurologist department, many patients indicated to have received little information about their condition. When asked, the neurologist explained that he felt it would be the duty of the stroke specialist to explain details about stroke and treatment procedure to the patient. The neurologist indicated that their duty was only to diagnose stroke and perform treatment or stroke management procedures for acute cases. The neurologist felt they would not be able to take care of the many patients that required their services as well as the new incoming cases if they spent too much time explaining details or answering questions to each patient. The neurologist also indicated he felt answering questions and explaining details could be effectively carried out by his juniors or the in the stroke specialist department. However, some junior staff explained that although they could give some information to patients regarding their condition and treatment, they lacked the specialised knowledge to answer some technical questions that only the neurologist or stroke specialist could answer. On the other hand, the stroke specialist felt their core duty was to verify the rapid triage from the emergency centre for patients where the emergency section nurses had diagnoses low stroke possibility. For patients he had been diagnosed with stroke and referred to the neurologist for specialised diagnosis and care, the stroke specialty felt such patients would receive any Improving Communication and Clarifying Roles 10 information they needed from the neurologist department as they underwent care. These discoveries indicated confusion and a lack of clarity on the roles of each staff concerning communicating and giving patients information regarding their condition. It was found that some staff felt it was the role of the next staff member or the previous one to give particular information to a patient. Following intense meetings to discuss the findings and brainstorm potential solutions, the following SWOT analysis of the current treatment and referral pathway was arrived at. Strengths • The reception in the emergency Weaknesses • section was fast. • Initial first aid and triage was fast staff members • and effective • Ambiguity on the roles of some Staff clashes due to overlapping roles The current treatment pathway had • Poor communication among staff all the necessary professionals for • Poor communication between staff effecting management of stroke and patients and their caregivers patients Opportunities • Improving the communication Threats • among staff • Clarifying the roles of staff Resistance of the proposed solutions • members Disagreements when entangling overlapping roles • Shortage of staff where there could be a need for extra staff Improving Communication and Clarifying Roles 11 • Speeding up treatment processes to • Financial constraints reduce patient lengths of stays at hospital • Improving overall treatment outcomes Figure 2. SWOT analysis of the current stroke treatment and referral pathway Proposed Solutions Following a discovery that there was a lack of clarity on the roles of various staff members, the team decided the first solution would involve defining and separating the roles of each staff member of the multidisciplinary team. All staff members would then be trained on their roles and those of their colleagues so that each team member would know what they would expect of each other. Clarifying the roles of each member of a multidisciplinary team is crucial to ensure effective inter-professional collaboration while reducing confusion and disagreements among staff members (Brault et al., 2014). Poorly defined roles lead to conflicts and frustration which reduces the effectiveness of the treatment and care of patients. Reduced effectiveness causes time wastage and thereby results in elongated hospital lengths of stays and overall poor treatment outcomes (Brault et al., 2014). The team agreed that systematic training and regular seminars will be conducted every week for the first four months of the implementation timeline. The training and seminars would be conducted first on staff that expressed the highest ambiguity of their responsibilities and then expanded to more staff until all staff expressed a clear comprehension of what was expected of them as Improving Communication and Clarifying Roles 12 well as an understanding of the roles of their colleges at each stage of the stroke patient’s treatment pathway. The other proposed solution was to improve communication among the multidisciplinary team members involved in the care and treatment of stroke patients. Effective communication among staff members of a multidisciplinary team is important as it ensures timely and accurate information is passed on to the relevant staff members (Wang et al., 2018). Getting accurate information such as treatment reports and situations of patients quickly is a prerequisite for high-treatment care (Wang et al., 2018). Poor communication creates situations where medical errors can occur (Hughes, 2018). During the roles and responsibilities training, the team agreed that staff will also be sensitized on the importance of good communication between them and with the patients. As a strategy to improve communication between all the multidisciplinary staff involved, all departments will be required to send a representative to scheduled multidisciplinary rounds and situational briefings where there will be real-time discussions of patients' plan of care, the progress of patients’ conditions, and potential referral of patients to the next departments. This strategy will always ensure that all departments are at par with the progress of all patients that have gone through their departments or are due to be referred to their departments. This strategy was chosen since it is patient-centric and will be key in pointing out cases that may require heightened or more complex care. The strategy will also improve cohesiveness between departments and further improve an understanding of each department's roles. As a way to improve communication with patients, the team proposed each department have a dedicated staff member whose role would be monitoring patients at each stage, assessing their progress, asking them questions, and communicating any vital information to the professional at the stage of treatment. Improving Communication and Clarifying Roles 13 Implementation Following the identification of the problems facing the current treatment pathway and the proposition of the ideal solution to solve the problems, the team set out to develop an implementation plan to effect the proposed changes. A good change implementation strategy should clearly define the change and align it with the organization’s mission and goals (Kotte and Schlesinger, 2008). A good change implementation strategy should also allow for measurement of the impact of the change to the organization, have a feedback mechanism, and be flexible enough to allow for fine-tuning of the changes depending on the effects it brings (Kotte and Schlesinger, 2008) to implement the changes the team proposed, Kotter’s 8-step change model was selected as the tool for implementing the solutions. Kotter’s change model has been used by numerous organisations and has shown immense effectiveness in introducing changes, measuring the effect of the change, and anchoring changes (Sidorko, 2007). Will guidance from Kotter's change implementation model, a timeline for implementing the solution was developed as illustrated in figure 3. Creating a sense of Urgency Formatio n of a Powerful Team Vision Creation 2 months Figure 3: Implementation Timeline Communi cation of the Vision Removing Obstacles 5 months Creating Short Term wins Strengthe ning the changes Anchorin g the changes 1 year Improving Communication and Clarifying Roles 14 Kotter's 8-step change implementation strategy posits that the first step in change implementation should involve creating a sense of urgency among the stakeholders involved. The team agreed the best method for creating a sense of urgency was by presenting the low treatment outcomes identified by the preliminary study on patients that had gone through the current treatment pathway. The team believed that by showcasing the study results and educating staff on the potential of improving the outcomes using the introduced changes, more staff members would find sense in the changes hence curtailing possible resistance. The team agreed it would spend the first two months of the implementation process sensitizing all staff members on the urgency of the matter. After two months, the team will then present a vision for the success of the solutions and align it with the overall mission of the organization. Afterward, the team will spend the next 3 months removing possible obstacles and ironing out any resistance to the proposed changes. The team agreed the best way to manage potential obstacles and resistance would be by involving all staff in refining the details of the implementation process and creating win-win situations such that everybody felt involved and motivated (Hon et al., 2014). For instance, the team will regularly review feedback from staff and incorporate good suggestions given by staff. After removing any possible obstacles, the team will then start creating short-term wins from the seventh month of the implementation timeline. This will involve getting anonymised feedback from patients undergoing the improved refer and treatment pathway at the end of their treatment process. The best performing departments and individuals will then be publicly recognised and rewarded. The team will then spend the rest of the year anchoring the changes into the organisational culture and if necessary, propose an alteration of the mission and vision of the organisation to properly reflect the improved aspects. Improving Communication and Clarifying Roles 15 Conclusion Stoke is currently the fourth leading cause of death in the UK and the leading cause of disabilities. Over 70% of stroke patients in the UK leave hospital with a disability. 70% of stroke patients do not undergo the full treatment process including the required six-month assessment and social care. Overall, stoke treatment outcomes are below average and this argument is supported by the study conducted on patients that had gone through the current treatment and referral pathway at Winston Hospital. Patient’s indicated poor communication from staff and little care at the later stages of their treatment which created a sense of despair, hopelessness, and depression. A study conducted on staff members showed a lack of clarity regarding the roles and responsibilities between staff which led to confusion, disagreements, and time wastage. Poor communication between staff members was also found to be a major cause of poor cooperation and integration of the multidisciplinary team that takes care of stroke patients. This report proposes strategies for clarifying the roles of staff and improving communication to enhance cooperation and treatment outcomes of stroke patients. One of the solutions will involve training of staff to clarify their roles as well as those of their colleagues and disentangling overlapping roles by assigning different responsibilities to different staff members to minimise confusion, disagreements, and time wastage. The other solution will entail improving communication ion between staff themselves and with their patients. Kotter’s 8-step change implementation strategy will be used to implement and integrate the changes to the organization mission and vision. If successful, these solutions will ensure all staff understand their responsibilities and those of their colleagues, disentangle overlapping roles to minimise service duplication and time wastage, improve communication among staff and with their patients, reduce hospital lengths of stays for stroke patients, and improve overall treatment outcomes. 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