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.
Improving Communication and Clarifying Roles 16
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