Communication Compact

The aim of this Communication Agreement is to make patients feel safer and improve staff well-being. We can achieve this by means of clear, effective, warm and positive communication. This Agreement applies to all those working at the hospital, irrespective of position or profession.
It is based on close to 900 cases of personal interactions reported by some 700 employees of the hospital at fifty development meetings in the spring of 2018. These cases included both positive examples and examples of what could be improved in communications at the hospital. They involved professional channels of communication, personal interaction and conduct, as well as communications between hospital staff. This Agreement is therefore based on real-life experiences of staff in all fields. The specific content of the cases examined are presented in eight sections, which make up the text of the Agreement. Each section sets out what should and should not be done.
All staff have a part to play in implementing this Agreement. We are all important when it comes to the dynamics of the hospital. Mutual respect, empathy and clear interactions and channels of communication improve safety and well-being in the workplace and lead to better patient service.
Many people have asked what happens if the Agreement is breached. It is important to take all breaches seriously, while obviously tailoring our response to each individual case. At the end of this booklet, there is a list of possible responses open to staff if they consider that there has been a breach of the Agreement.
I trust that, in the future, we will all have this Agreement in mind in our conduct and interactions with patients, relatives and colleagues. We must make every effort to work together and create an atmosphere of safety, trust and good will.

 

Páll Matthíasson, CEO

We should always be welcoming to patients, relatives and colleagues. We should remember that first impressions or the start of each new day affect everything which comes afterwards. We should be warm, considerate and helpful from the outset. Politeness costs nothing.

#samskipti

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“We should always say ‘Good morning’. It is a positive habit and makes for a good start to the day.”

WE SHOULD ALWAYS:

• Show people consideration and warmth
• Say ‘Good morning’ every morning
• Greet, smile and offer assistance
• Introduce ourselves with our name and job title when speaking to new people
• Explain our professional role to people we have not worked with before
• Use people’s names and establish eye contact
• Be punctual
• Be welcoming to trainees and new staff and guide them in a positive manner

„A smile can make a bad day into a good one and a good day into an even better one.”

WE SHOULD NEVER:

• Bring negativity or grievances from our personal life to the workplace
• Look the other way to avoid helping people who need help
• Neglect people or fail to provide explanations
• Answer questions as if we are being disturbed
• Start a telephone conversation without introducing ourselves or end a telephone conversation without saying goodbye
• Behave in a manner which is gruff or brusque, even if others do
• Talk in a negative way about co workers, other units or divisions
• Get annoyed by colleagues or new recruits who approach us seeking information or help

“We should treat people with respect – remembering that first impressions last.”

Everybody deserves respect and to be taken seriously. Everybody should have their voice heard, and all links in the chain are important. This applies equally to patients, relatives and all colleagues.

#samskipti

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“Good co-operation, positivity and respect for everybody yields results.”

WE SHOULD ALWAYS:

• Introduce ourselves to patients with our name and job title
• Let somebody know if we are running late or will be unable to perform our tasks
• Explain to patients what we are doing with them and obtain their permission
• Remain calm and be polite, level-headed and professional
• Appreciate the contribution and expertise of other staff members and departments
• Learn the names of the people we are working with, whatever their profession or origins
• Spread joy through all professions and participate in social events in the workplace
• Step aside to allow others to pass in the corridor and hold doors open for others

“We should appreciate and respect things which are done well.”

WE SHOULD NEVER:

• Raise our voice, shout, hang up on people on the telephone or tell people off
• Talk down to people, interrupt, be bossy or discuss the problems of patients or colleagues in a joking manner
• Roll our eyes, snort or sigh
• Talk about patients or colleagues in the third person or use inappropriate nicknames
• Treat patients as medical cases rather than as people
• Talk about unrelated matters with colleagues while dealing with a patient
• Criticise staff members or question their competence in front of others

"Confine ourselves to talking to colleagues from our own profession"

 

We are professionals. We should be in the habit of conducting ourselves in a level-headed and professional manner and foster trust between colleagues, departments and fields and between staff and patients. We should properly familiarise ourselves with cases, allow others to participate in what we are doing, answer questions and respect confidentiality. #samskipti

 

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“Good, harmonious communication depends on appreciating the circumstances of others and understanding that it is not always possible to get one’s own way.”

WE SHOULD ALWAYS:

• Familiarise ourselves with a given case before drawing conclusions or giving our opinion
• Respect confidentiality and keep to a minimum those who hear our conversations or receive information about a patient
• Watch how we express and conduct ourselves, especially when we have bad news to give
• Involve the patient and their relatives in conversations on the next steps to take and endeavour to respect their wishes
• Be smart in our appearance and follow rules on clothing, washing hands and infection control
• Reply to e-mails and requests, answer our telephone and ring back when we are asked to do so
• Pass on information, expertise and skills to other staff members to improve results
• Take responsibility for our conduct and remedy any cases of poor communication as soon as possible

“As professionals, we must allow relatives to get involved and not be merely spectators, and we must empathise with relatives who have known the patient for many years.”

WE SHOULD NEVER:

• Give opinions or conclusions before familiarising ourselves with the case at hand
• Discuss staff or personal matters in earshot of outside persons
• Allow patients to witness tensions between professionals or allow them to hear us criticise colleagues, other departments, fields, professions or health institutions
• Raise unrealistic expectations or refer to services which are not available 
• Take our annoyance or tiredness out on colleagues
• Forget the promises we have made
• Take credit for the work of others or understate their contribution
• Send e-mails containing negative messages when it would be better to talk

 

We should be considerate and sympathetic in our communications. We should bear in mind that patients may be suffering and that colleagues may be dealing with their own problems. We should put ourselves in the shoes of others and show them understanding and consideration.

#samskipti

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“It is good to feel that we are all on the same team and are there to help each other.”

WE SHOULD ALWAYS:

• Acknowledge the feelings, pain and concerns of patients and colleagues who are unhappy
• Put ourselves in the shoes of patients and treat them as we would wish our relatives to be treated
• Show colleagues support and good will and consult each other
• Monitor the well-being of patients, relatives and colleagues and take action where needed
  Take care in how we express ourselves – not everybody has the same sense of humour
• Be positive, friendly, warm, reassuring and calming
• Discuss difficult cases in a considerate and kind manner

“We should treat people with patience and kindness. We will be repaid many times over.”

WE SHOULD NEVER:

• Trivialise the pain or suffering the patient is in or make fun of why they came in
• Trivialise the experiences or feelings of others
• Raise our voices angrily with colleagues, patients or relatives
• Reveal sensitive information about a patient or colleague’s case within earshot of a large number of people or people who do not need to know
• Deal with people in a robotic manner or be distracted when communicating
• Forget patients
• Enter patient spaces unannounced or disturb their rest unnecessarily
• Expect others to prioritise around our needs
  
  

We should take the time to listen and ask questions. This helps us to better understand cases before taking decisions and giving advice. We should inform people clearly to avoid all confusion.

#samskipti

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“Nobody knows everything or is involved in everything, so it is important to talk and listen and make use of the expertise and experience of others.”

WE SHOULD ALWAYS:

• Listen, so we can understand and respond to what the patient or colleague is saying
• Use open-ended questions to gain a better understanding of the case and avoid one-syllable answers
• Familiarise ourselves fully with new cases when we take them on and listen to the advice of colleagues
• Give clear information – either orally or in writing – when handing over responsibility for a case to a colleague and ensure that it has been understood
• Use everyday language, adapt our speed and volume of speech to the needs of the listener and use supporting material and drawings where necessary, e.g. to overcome a language barrier
• Ensure that everybody has understood information in the same way
• Allow patients to follow the progress of their case and inform them of the advantages and disadvantages of treatment and of the next steps
• Inform patients of their rights

“Giving everybody in the team a voice leads to better work and service, to the benefit of the patient.”

WE SHOULD NEVER:

• Interrupt people or prevent them from explaining something
• Assume that we know everything that there is to know
• Assume that others in the team or those taking over from us have all the necessary information
• Expect patients to have to repeat the same story again and again
• Use professional jargon, abbreviations or acronyms with patients
• Make patients wait without giving them information on their case
• Use close-ended questions, e.g. “Don’t you feel much better now?”
• Send an e-mail to save time when a telephone call or conversation would be better

We should follow standard procedures and communicate clearly and effectively to guarantee the safe handling of cases. We should write in the incident book where appropriate and ensure that the service chain does not break following our intervention.

#samskipti

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“We often work in difficult circumstances and are confronted with all sorts of situations – it is therefore important to be able to trust our colleagues.”

WE SHOULD ALWAYS:  

• Be professional in our conduct and promise only that which can be delivered
• Use accepted forms of communication to pass on information so that everybody is on the same page
• Follow up on issues and answer when asked a question
• Follow standard working procedures and encourage others to do so
• Speak up on behalf of the patient where necessary or in order to secure the appropriate resources
• Register incidents when something goes wrong
• Apologise straight away when we make a mistake
  

“We all make mistakes, but it is important to apologise when we do. It is good for the soul.”

WE SHOULD NEVER:

• Talk about unrelated matters when colleagues need to be concentrating on the patient
• Disturb colleagues when they are concentrating on something, except when absolutely necessary
• Jump to conclusions before familiarising ourselves with the case at hand or following standard procedures
• Assume patients are informed of the situation
• Criticise those who mention patient safety or correct working procedures
• Tell people that we are too busy to deal with their concerns
• Omit to register incidents or fail to flag up things which go wrong
• Shift responsibility onto others when a difficult situation arises
  
  
  

We should speak up when a patient’s safety or treatment is compromised or when the well-being of colleagues is in jeopardy. We should not keep quiet. We should present any criticism in an objective manner and say thank you when given advice. We should give praise when things are done well.

#samskipti

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“Talk – particularly when you are unhappy, it is vital to talk to find a solution.”

WE SHOULD ALWAYS:

• Present advice and criticism in a balanced and constructive way, without making it personal
• Give advice directly to the person concerned, preferably in private – not to other people
• Speak up when we feel that patient safety is in jeopardy or that the correct working procedures are not being followed
• Explain to people when there are delays or when things do not progress as expected
• Receive advice happily and say thank you – this is how we learn
• Intervene when we witness unpleasant attacks, bullying or harassment
• Praise each other for a job well done
• Apologise straight away when we make a mistake

“I was tired and had had a bad day. A colleague of mine praised me on my performance and this cheered me up. Often, not much is needed to make others feel better.”

WE SHOULD NEVER:

• Downplay the advice and concerns of others
• Take feedback and advice personally or take offence
• Be complicit in bullying, violence or harassment
• React negatively when it is pointed out that we are not following the correct working procedures
• Force our opinions on others and always need to have the last word
• Judge colleagues when things go wrong before seeking explanations
• Talk behind the backs of patients and colleagues

“We must be able to take criticism on board and talk to each other if we feel that communication could be improved.”

We should ensure equality in our interactions and service. We should enforce rules in the same way for everybody, irrespective of background, profession or position. Disrespect, arrogance, harassment, bullying and all other types of unacceptable behaviour have no place at Landspítali.

#samskipti

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“All links in the chain are important – the hospital cannot function without cleaners or without doctors.”

WE SHOULD ALWAYS:

• Bear in mind that we are all different, from different backgrounds and with different experience.
• Treat all patients and colleagues equally, irrespective of age, gender, nationality, religion, sexual orientation or any other ground
  Treat all patients with same respect, regardless of their illness or symptoms.
• Celebrate diversity and respect different cultures and religions
  Treat everybody equally when, for instance, applying to hospital rules.
• Respect the boundaries of others and avoid coarse language or a conduct that may be interpreted as harassment

“Sometimes we need to put our job title to one side and do what needs to be done. When it comes down to it, we are all working together for the patient’s well-being.”

WE SHOULD NEVER:

• Bully others, engage in gender-based or sexual harassment, or be complicit in any such conduct
• Tolerate any prejudice of people of foreign origin
• Make ‘jokes’ which may be interpreted as harassment or malice
• Allow friendships or family connections to affect our conduct
• Be arrogant or forget our manners, even if we are under pressure
• Pass around gossip, engage in slander or tell tales at the workplace
• Interrupt or raise our voice when others are talking

If you experience a breach of this Agreement, it is very important to let the person involved know as soon as possible. We cannot change our conduct if nobody helps us to see what could be improved.
#samskipti

 

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“A good friend is not afraid to tell us our faults.”

STEP 1

It is best to respond immediately and give feedback directly to the person in question:

• Give a non-verbal signal

 - Point to the Agreement on the wall or on a pocket card
 - Make a heart shape with your fingers
 - Give a time-out signal with your hands

• Or say something, such as:

“Is everybody clear on communication?”
“Is this in line with the Communication Agreement?”
“Can we confine ourselves to good, objective communication?”
“Manners cost nothing.”
“You remember the Communication Agreement!”
“I found these interactions to go against our Agreement.”
“Aren’t you forgetting something?”

• Or say something, such as:

“I think we might be getting a bit lost here.”
“We have agreed to be an exemplary department when it comes to communication...”
“This is not OK and goes against the Agreement.”
“I felt bad when you said that.”
“That was not acceptable and not in line with the Agreement.”
“You went a little too far there.”
“I have to stop you here, because what you said and how you said it goes against our Agreement.”
“May I point out to you something that I have noticed?”
“May I point out to you an opportunity for improvement?”
“May I give you some feedback regarding communication?”
“Hmm, I think we went a little wrong there, communication-wise...”
“I am uncomfortable with you saying/doing X and it goes against our Agreement.”

Point out: 

• It is best to say things such as these with a light tone and a smile.
• They may be said on-the-spot or after asking the person in question to step to one side with you.
• You may also ask a third party (e.g. another colleague or a shop steward) to accompany you if you feel uncomfortable speaking to the person in question alone..

Taking advice... when it is given to you

• “Have you got an ear for good communication?”
• “Oh, thank you. I’m sorry!”
• “Thank you for pointing that out. I was out of line.”
• “Yes, that is quite right. I’m sorry.”
• “Thank you for the advice.”
• “Thank you for pointing that out, but I’m afraid I disagree.”
• “Thank you for reminding me of that.”
• “Oh, sorry! I really didn’t mean it like that.”

STEP 2 

On top of these first responses – or instead of them – you can take the following steps:

• Ask a manager to talk to the person in question (or to the person-in-question’s manager, where appropriate).
• Bear in mind that this could be time-consuming and lead to misunderstanding.
• Ask a third party or somebody neutral to have a word.
• Enter the incident in the staff incident registration system.

STEP 3

Serious or repeated breaches should generally be taken to a manager or reported via a formal complaints procedure:

• To lodge a formal complaint about bullying: http://innri.lsh.is/starfsmadurinn/heilsa-oryggi-og-vinnuumhverfi/einelti-ofbeldi-kynferdisleg-areitni/formleg-kvortun-um-meint-einelti-a-landspitala/
• Breaches may lead to a caution or reprimand (cf. Law No. 70/1996).
• A course or training for the person involved.