Internal communications is an important aspect that has an impact on the quality of provided services. Each participant passes his or her performed work to the next person in the process, providing important information, such as the patient’s vital parameters. The information should be transferred smoothly not only within the organization unit but also horizontally, passing through each department.
Vertical communication is a contact between management and employees and vice versa. Information sent from management to subordinates most often concerns the segregation of duties, instructions and job instructions and information sent from subordinates to management includes requests, complaints, information, proposals, petitions or reports. Horizontal communication occurs between the same groups of employees, ie between nurses, doctors and administrative staff [Czerw i in. 2012]. In medical institutions occur direct and indirect contact. the direct contact consists of management communication with employees, conversations between administrative staff and medical staff, contact between medical staff, communication of medical staff with patients, communication between patients, management contact with persons unrelated to the company, ie suppliers, co-operators, competitors, there are also trainings, conferences and phone conversations. Direct contact include e-mail communications, leaflets and medical journals, boards for patients and staff, board information from patients to other patients and associations boards that provide information to patients, also letter communication, regulations and orders. By analyzing the communication process, it is possible to to identify many of its forms, which can be related to outdated and possible issues at work, it is important to identify factors that could disrupt the process. Barriers can occur on the sender side – by sending opposing signals to the receiver-due to prejudice and noise in the environment [Czerw i in. 2012].
Medical institutions may introduce brochures, flyers, and patient magazines on topics related to healthy living, nutrition and exercises. While waiting for a medical visit, the patient may read about diet, kidney disease, patient’s rights and medical ethics.
Boards as one of the indirect forms of communication can be placed in different places because of the information included on them, their degree of sensitivity as well as the different target audience. The board can contain:
- General information about reception times, insurance, services offered is located in the main lobby of the patient’s room, right at the entrance door; every person in the main lobby has access to this board.
- Information about health education of patients on dialysis and patients with kidney disease is located near the nephrological clinic. It is important that information is prepared by patients in consultation with management. This allows to present in a simple and comprehensible way the issues that every patient should know.
- Information about associations, undertaken initiatives, contact, photojournalism from events is placed on the wall at the entrance to the dialysis room.
- Information In the part reserved for the staff may be about ISO 9001 but confidential, sensitive information can be found on the tables in the doctor’s office and the medicine preparation room in the ward.
- Each patient, depending on the disease progression, has access to the selected information. Telephone communication is not enough when it is needed to convey visual information or documents.
Management can implement a modern information flow system based on the use of modern technology – intranet. It is an internal, private computer network that is adequately secured and separated from rest of the environment [slownik.infoweb 2013]. Access to information on the intranet platform may be determined by the administrator. Each employee has an individual login and password, range of content that they can view, load, edit or print, every new information on the platform is marked with a visible green color with the mention “new” or “changed”, thanks to it every employee knows the changes and can adjust to them. Information necessary for appropriate functioning, such as documents and procedures, can be accessed without additional passwords just by logging on to the computer. Any change made on the platform is identifiable. In functioning in distant units, fast communication is essential because it allow to access information at every location, ie at every unit equipped with computer with internet access, it allows to access to information at any time and by any staff member.
Access to actual information is essential to ensure proper patient care. Intranets allows to access content that improves work, sometimes it may be necessary to use the procedure entitled implementation of the patient to the medication program to be able to provide services in accordance with the contract with the National Health Fund and the rules change many times during the contract, which would require a meeting each time to discuss the changes and transfer of the modified formulas of the documents while destroying the printouts of the previous version. Patterns of medical documentation, forms or prints may be available on the intranet without memorizing or typing additional passwords (Permissions are granted by the administrator) so the nurse or doctor can use them without delay. Documents available on the intranet can be updated and each user receives information about the changes. The intranet allows standardization of procedures and documents, there are only current content in actual flow. The objective of Intranet is also to provide feedback in the form of sets, reports or statistics. For this purpose the e-mail system may also be used, particularly in the reporting from nurses to the human resources department and the management. There are also other modern forms of communication resulting from the principles of lean management of processes which should not be forgotten like shade tables in utility rooms or treatment rooms, horizontal signs on the floor indicating the storage areas for particular medical equipment such as wheelchairs. The separation of mop and wipes by coloring, the corresponding color is attributed to the type of dedicated surface to be cleaned.
Analysis of the communication process can be divided into communication on the lines of different occupational groups:
- Management – administrative staff
- Management – medical staff
- Doctors – nurses
- Management – patients
- Medical staff – patients
- Associations – patients
Incorrect co-operation between representatives of different occupational groups results in improper communication between people, as well as intergroup which may have an impact on the medical institution, the process of providing benefits which causes lower quality of functioning [Kęsy. 2012].
- Analysis of communication on management – administration staff line.
Cooperation may involve direct verbal communication and the use of internal telephone communications; when required, management may send information by e-mail, employees responsible for specific places have assigned business addresses – which allows management to direct the information to the correct addresses by controlling the availability of mail. Communication between the management and the secretariat should be smooth and carried without interruption or delay.
- Analysis of communication on management – medical staff line.
The most common form of communication is direct telephone conversation; Management can also use the intranet system to send actual communications, internal procedures and orders.
- Analysis of communication on doctors-nurses line.
Currently working doctors should have continuous contact with nursing staff. The form of communication is morning doctor’s round, during the working shifts doctors also contact by telephone and cooperate directly within the therapeutic team to perform medical services together and complete medical records as well as plan specific medical actions to the discussed patients. The formal way of communication may be the records of medical orders and confirmation of their implementation in the individual documents of patients – so-called Individual (Medical) Order Sheets.