The role of comms in transforming healthcare
In conversation with:
Michelle Dixon, Director of Engagement and Experience, Imperial College Healthcare NHS Trust
From her first job on a pharmaceuticals trade magazine, Michelle has worked her way through comms roles at a host of high-profile health organisations. Today, she is on the executive team of one of the largest NHS trusts in England, in a role that combines her passion for communication with user insight and design.
How has your background shaped your work?
I surprised everyone, including myself, by pursuing a microbiology degree after doing well in science at school. I went to the sort of school where they didn’t expect pupils to go to university, so arts definitely wasn’t considered a practical option and I was encouraged to do science.
During my final-year thesis, on antimicrobial resistance, I found I really enjoyed the writing. After I graduated, I started working on a trade magazine for pharmaceuticals, which really allowed me to develop my communication skills.
I then did a brief spell in a regional health authority, where I had a fantastic manager who taught me a lot about the structure of writing and other comms things you don’t necessary get taught, which still resonate now.
Why did you make the switch to health communicator?
As my career developed, I moved to working in communications in the charity sector, then to the Royal College of Nursing and on to The King’s Fund. I left there after seven years, intending to have a short career break and explore freelance but ended up accepting an interim role as Director of Communications at the Cabinet Office.
After that, I continued in house, as Director of Communications for the British Medical Association and then to Imperial College Healthcare NHS Trust.
Since moving to the Trust in 2014, my role has really evolved. Two years ago, I became Director of Engagement and Experience, taking on complaints and PALS and integrating them with a new user insight and design function.
Incrementally, through these roles, I gained a wider view of how communications works and the importance of understanding and involving key stakeholders throughout. I became increasingly interested in gaining clarity – not just on what you want to say but, crucially, why. That’s often the element that’s harder to pin down.
What is the most important principle for you when developing health content?
Having worked previously in policy organisations, when I started at Imperial I saw the gulf between that world and what staff and patients actually experience. It was very clear to me how beneficial it would be if they were much more connected.
In my current role, I’m very focused on trying to connect all the different insights we gather – or should gather – about what our users (including patients, staff, GPs and more) think about what we do, what matters most to them and how they behave.
This is so we can develop genuinely user-focused approaches that are integrated into everything we do: our services, policies, communications, patient information and admin systems. Doing this requires the commitment, tools and time to understand user needs and collaboration.
In terms of communications, I think establishing a clear and shared narrative is key because it helps us get to the heart of what we’re trying to achieve. Often, people think they’re saying the same thing as each other, but when you actually write it down you realise they mean quite different things.
What trends are you seeing in health communication?
In the Trust, we’re making a significant move towards gathering and analysing user insights in a range of ways (such as making much more of the Friends and Family Test free text comments and commissioning specific research) – and connecting them into everything we’re doing, including of course in to our communications and patient information. This requires a huge cultural shift and is a big challenge.
We’re particularly trying to respond to changes in the ways that people consume information and content. Like much of the NHS, we’re still too focused on traditional, written information, often in hard copy, as a discrete communication rather than as part of an overall pathway or relationship, and with no opportunity for engagement.
And, if we’re to serve patients, communities and staff effectively, rather than just doing what we’ve always done or reacting when something doesn’t work, we need to build ongoing relationships with our workforce and communities. Engagement and genuine co-design, particularly involving people with lived experience, are essential to understanding needs and identifying improvements.
What are the biggest misconceptions you see in your work?
One misconception is that communications is simply about creating good content. You can create lovely leaflets but if they don’t connect with the right person, at the right time, they become pointless.
So, for patient information, the first task has to be to understand the overall care pathway, where the patient is in it, what that means for them and what matters to them. We can then use those insights to create really effective, relevant messaging, offered in the right place, at the right time, to make a genuine difference.
A related misconception is that we can assume that we know what will work. For example, we’ve recently carried out some quite deep engagement with communities on why people miss their outpatient appointment. We found that for a significant number of people from lower socio-economic areas, there were some unexpected drivers, including fear of losing benefits or pay from insecure jobs that would tip them over the edge in terms of being able to manage financially.
The only way to discover what’s really going on – and what will work – is to take a first-principle approach to understanding patient and wider user needs and views.
What’s on the horizon for you?
Further development of our integrated communications and engagement and user insight and experience functions. I especially want to work with colleagues across our organisation to work out how best we can support services to build their capacity and capability for gathering and using insights and for patient and public involvement and co-design.
We’re supporting two big programmes currently that have user insights and design at their core – reviewing our cancer care pathways and outpatient improvement – and we’re starting to see some great impacts. In particular, there are some exciting opportunities for trying new approaches with patient information.
I’m also starting to work with colleagues on exploring the potential for an organisation-wide customer relationship management system. There’s a growing consensus that having a holistic view of our patients – their needs, preferences and interactions – could really help us progress all our goals, not just improve patient experience.
In both of these areas, I know there’s much more to learn from what others have done or are doing. So, I’m trying to get out and about a bit more, to share what we’ve been trying and get more ideas and advice.
Three tips for future comms leaders:
1. Don’t be afraid to keep asking questions. You can’t do a good job if you don’t understand. And, if you don’t understand, chances are that others won’t either. So be curious, and don’t be afraid to challenge the status quo.
2. Really learn about your ‘users’ and your wider stakeholders and what matters to them, and remember that solutions are rarely straightforward and often require careful trade-offs.
3. Don’t get too caught up on hierarchy. Focus on your authenticity and what drives you to do better for staff, patients, local communities or whoever is your ‘user’. Genuinely improving services for patients in a sustainable way requires doggedness and user focus, regardless of your position in the chain.
Find out more about Michelle and her work
Connect with Michelle Dixon on LinkedIn.