Using Communities of Practice to Reduce Consultant Burden

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We consider how supporting consultants to improve their communication skills and share experiences can reduce their burden and prevent burnout.

Consultants do an amazing job. They work long hours, are dedicated to their patients and have incredibly good motives. However, they are also under a huge amount of pressure.

This means, sometimes, in giving so much of themselves, they can lose sight of a situation from a patient’s perspective. Time pressures also limit their ability to reflect on practices, share experiences with colleagues and take care of their own emotional wellbeing.

Much of adult learning is informal and rooted in the life context of the learner.  This includes work and social groups. But with increasing time pressures are consultants missing out on these opportunities?

We believe NHS organisations need to create an environment which facilitates communities of practice. Creating a more supportive learning environment for clinicians and setting a positive example for those coming up through the ranks is imperative.

What is a community of practice?

In his model for communities of practice, Wenger (1999) said the defining characteristics are:

“Conceptualised by the continual integration of learning and practice whereby members of a community are encouraged to exchange knowledge and practical wisdom for evolving routines and ways of doing things.”

During our Advanced Communication Skills training we frequently hear about the time pressures consultants are under.   Complex complaints and paperwork to referrals and double-booked clinics are such examples.

Eraut et al (2004a) found explicit and implicit learning was more likely to occur through working alongside others. Sharing experiences helps people overcome problems and develop their knowledge. Yet, an ever-increasing workload means consultants rarely get the opportunity to meet, discuss the challenges they face and reflect on clinical situations.

This goes beyond anecdotal evidence. Bate et al (2002) argue there is little scope for individuals working within the NHS to share their problems, experiences and knowledge with others or to coach each other through difficult experiences. This is, in part, because the ‘rational scientific paradigm’ prohibits such behaviour.

Building a relationship of trust

Eraut (2004b) says healthcare professionals need to establish relationships of trust with their colleagues before they are able to engage in sensitive discussions. If there is no trust, they are unlikely to disclose their concerns. Instead, they will portray an image of affinity with their colleagues to limit any form of vulnerability.

Our Advanced Communication Skills course offers consultants two days to be together to share and learn from each other’s experiences in a positive environment. One of the ways we do this is by providing descriptive feedback in role plays to ensure people feel safe rather than vulnerable or judged.

Delegates report that they value the time spent with their colleagues to be open and honest about the impact their work has on them and their own emotional wellbeing. They leave feeling that they have skills to put into practice which will make things better for their patients. But also feel encouraged in what they are doing and with a new peer-support network which they can use to reflect on their learning.

Using advanced communication skills to reduce burdens

Consultants often report a sense of being on a ‘merry-go-round’. Consequently,  it does not allow them time to listen to patients concerns. During a recent Advanced Communication Skills course, one of the surgeons could not see how he could be empathetic to patients because he was on such a tight schedule.

However, he had a lightbulb moment where he realised focusing on the patient and offering empathy actually saved him time and benefitted the patient. We timed his interaction with the patient and it took around one minute 30 seconds to:

  • Listen to what she said
  • Respond to what she was saying
  • Summarise so she knew she had been heard

They then agreed to work together to try to tackle the ways in which the patient’s illness was compromising her quality of life.

Like this example, many delegates on our training learn that being attentive, asking open questions and being empathetic can make consultations quicker and more effective.

They can also help negate complaints – a lot of which in the NHS are communication related.

Tips for improving communication with patients

There are some simple techniques to help show patients you are working with, and listening to, them:

  • Introduce yourself
  • Invite them into the room, smile and make eye contact
  • If they have brought someone with them, find out who the other people in the room are
  • Do not assume you understand – ask ‘What do you mean by that?’
  • Summarise what you hear
  • Offer an emphatic response

Remember to listen out for the words patients are using. If they use the word ‘worry’ several times when describing their situation ask what they are worried about.  You can then explore their responses.

Once you have acknowledged the patient’s feelings you can then begin to give more information and plan what you are going to do. But it is vital to spend two or three minutes engaging with patients upfront.

Facilitating and supporting advancement

We believe the NHS has a responsibility to ensure there are structures in place to support the emotional wellbeing and continued professional development of consultants within their practice.

These are highly skilled, highly trained, highly knowledgeable individuals, who are role models to the younger generation of doctors and the teams they work in. If they feel close to burnout, this is going to impact on the rest of the clinical team.

Organisations need to facilitate and support advancement and communities of practice. Such action will enable consultants to function and feel as well as they can within the demands of their work.

Healthcare Communication Matters founder Lynn Furber discusses communities of practice in more detail in her PHD thesis which you can read here.

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