module5 unit3

Introduction

It is important to note that approaches discussed in this unit are part of the broader picture: good practice features four main areas of improvement.

1. Improvements in pathways into and through care. Covered in this unit.
2. Community engagement and partnership in healthcare services. See Unit 4: Working Together.
3. Awareness, cultural competence and communication skills training for staff. See individual training modules.
4. Collection of and action on migration information through monitoring and multiagency partnerships. See Resource Section & Unit 4: Working Together.

Improving physical layout

Improving physical layout

We showed the same images to service users and service providers who had made changes to their service. Compare the six highlighted areas on the pictures with the numbered responses below:

1. "The information on the walls is very wordy - more images and less text might be better for everyone. Or some translated posters."
2. "The waiting room seems quite exposed for someone who is feeling vulnerable. Smaller pockets of seating, not facing the entrance, might be better."
3. "The place doesn’t feel welcoming. At my son’s school, there’s a welcome sign in different languages; just a small thing to show the staff know you exist and are interested in you."
4. "Not speaking the language well means it’s difficult to communicate, but the curtain here just makes it worse - like the receptionist doesn’t want to speak to you."
5. "There is no clear information about what you should do when you come in or when you are called to see the doctor. It seems difficult to ask. It’s possible you might just go home."
6. "Training for reception staff on working without interpreters and resources like translated letters, useful pictures, language ID charts,or local support services were really important for us. Once the staff felt more aware and confident in dealing with a range of people, the better and more welcoming our service became."

Summary

Managing first contact recommendations for physical layout:

• Welcome - signage in community languages.
• Clear marking - use images to reinforce words.
• Is it possible to remove reception screens - or have a sliding window - so the screen may be open or shut?
• If not, is it possible to arrange a place where patient and receptionist consent to fill forms etc, if necessary?
• Remove other physical barriers such as leaflets etc from reception window.
• Arrange the chairs into a less exposed layout - eg: not facing the entrance.
• Information available in different languages - have a poster immediately visible in the key community language and ensure posters and images reflect the community.
• More visual cues to aid understanding: pictures, diagrams. Think about who is portrayed in the pictures.
• Training for staff to build confidence and awareness - Smile!

The physical layout of your reception area provides an important first impression to new service users. It has the capacity to aid communication, build confidence and rapport. Simple changes can, and have been shown, to make a difference.

Managing first contact

Introducing your service

As service providers you may meet service users in a range of situations. The way in which you communicate - with or without interpreters - will have a great impact on how accessible your service appears.

In this section you will look at presenting information in a way that demonstrates an awareness of the barriers and a commitment to building understanding. More information can be found in Module 2: Communication Skills.

Here is an introduction where a midwife describes her role to a new patient. As you read her words, think about

1. how clear the information is, and
2. how aware she is of the service user’s needs.

 

The introduction had a number of flaws which could have resulted in poor rapport, a lack of understanding and poor ante natal care.

So, what were the problems with the midwife’s introduction? Make a list then click the button below to see the answers

 

Good Communication Guide

 

Below is an improved version: the chunks are shorter, the information is clearer. There is no ambiguous information such as I’ll hand you over. The midwife also uses visuals or props to explain her meaning. This can aid understanding, confidence and rapport, with or without an interpreter present.

Summary

Recommendations for introducing your service:

• Start with names
• Clear examples of what you do instead of job titles/official role description
• Avoid jargon and slang
• Ask short, simple questions to include the service user and to break up the chunks of speech
• Use props/resources/visuals to aid understanding
• Give time
• Check understanding
• Be aware of the impact of experiences with authority figures in the UK and overseas
• Allow time for the service user to gather information about being checked physically

Reducing DNAs

This section looks at the kind of support needed to ensure the patient attends their appointment and considers the reasons why that might be difficult.

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• Louise has been in the UK for four months and her son is one week old.
• She has one older child who is three years old; she is not in nursery.
• Louise was discharged from hospital three days after her sons birth.
• She has a low level of English. Her husband, Samuel, is not in the UK.
• Louise has received a letter about the newborn hearing check for her son.

 

 

 

Read the letter Louise has received and then select the most likely scenario below:

 

	Louise has little experience of accessing services without the support of her husband or a family member.
	Louise could find herself with conflicting responsibilities on that day - eg: a last minute meeting with solicitor at short notice, visit from housing provider to confirm residency, etc. She will need to make a doubly stressful phone call to then explain the situation.
	The letter does not state that an interpreter will be present. Louise may worry about needing to pay for the interpreter service - as well as having the stress of making the phone call to request one.
	Louise has limited funds, so paying for the journey and potentially paying for a phone call (an 0844 number) to get support or cancel the appointment will be a significant outlay.
	Louise will need to work out the public transport options and make the journey with three young children.
	Louise does not feel confident about finding the location of the appointment, which is not at her local GP surgery / community health centre.
	Understanding the language: Louise has some English but not enough to understand specific terms; the dense format of the letter is also off-putting.
	Understanding the reason for the appointment: newborn hearing screening is not a procedure Louise is familiar with. It is also within a healthcare system she is unfamiliar with.

Planning, support, communication

So, what does this tell us about:

Planning

There are a series of considerations which could have made the situation easier for Louise and the service - and probably saved resources.

• If at all possible the hearing test should’ve been arranged in the hospital with access to an interpreter.
• Alternatively, Louise could have been briefed in hospital via the interpreter and before she left, given an appointment letter or shown a sample that she would receive.
• A note should have been made on Louise’s file stating her language needs for the purpose of the hearing screening, therefore reducing the need for Louise to call and make arrangements herself.
• If the test could not be done in the hospital, it would also be advisable to ensure that the screening appointment was via her health visitor (who could come to her home) or in her local GP surgery (known and local).

 

Improving written communication

Good letter content and leaflet

Necessary or useful support

Recommendations

The table below is available as PDF handout. Please print it out and fill in the sections on the right.
Once complete, check your answers against the filled table at the end of the handout. Click here to download it.

 

Access issues resulting in missed appointments:	What support could be useful to help service users with each of these issues?
Travel and transport costs
Finding the venue
Understanding what the appointment is for and what will happen
Accessing services alone, without support of family
Childcare for siblings during the baby’s hearing test

 

Summary

First Impressions Count

• It is important to remember that no single change or intervention will remove barriers to services across entire migrant groups; making these changes is part of the process to improve access.
• Migrants are not a homogenous group and one size does not fit all.
• However the approach and attitude to working with diverse groups remains the same: a service which is consistent in engaging community members to discuss concerns and is proactive about discussing solutions will have positive results
• It is useful to remember that many of the actions to reduce barriers are not just supportive to migrant patients but will also have a positive impact on the broader patient base.
• This is particularly relevant in the areas of social exclusion or deprivation, where literacy levels may fluctuate and service users face a broad range of additional barriers.

Download our worksheet