Imagine a world………… by Laura Lennox

 

Elaine has dysarthria (motor speech disorder):

 “I hate using the phone simply because I am so self-conscious of my speech.  And if they say “Pardon?” to me, it makes me more flustered because I automatically assume it’s my speech that’s the issue.  I would never think it could be that a noise distracted them at their end.  And the more flustered I get when trying to talk, the worse my speech becomes”.

 

“I love that some companies now have the ‘chat online’ service.  I will use that instead of the phone even though it takes longer”.

 

“The other day I saw some valuable looking equipment seemingly dumped under a bridge.  When I got home I went on to the Police Facebook page to message them, but they didn’t have messaging as an option.  I googled a contact email for them but to no avail. In the end I was forced to phone but it really is a last option for me”.

 

“I hate phoning for appointments, taxi’s, takeaways- all the things other people do without thinking about it – it’s a big issue for me and I often work myself up in to a state.  I try to remember the sound advice from my speech and language therapist to speak slowly and clearly but the minute I hear “Pardon?” I break out in a cold sweat

Last year I decided to get back into studying and registered for a three-year MSc in Advancing Healthcare Practice through the Open University.  I was asked to look at a small-scale innovation in a healthcare setting that could lead to a significant impact.  Straight away I knew what I was going to look at.  Listening to people’s stories time and time over – THE DREADED TELEPHONE!!

 

  

 

William and Bob both had throat cancer.

 

William:

“Speaking for myself, contact through email is the only way for me to go. I cannot carry a conversation by telephone due to the amount of Mucous and or phlegm talking generates.  I can listen on the phone to any conversation but can only give a limited response to any questions”. 

 

Bob:

“I do not answer the phone as usually the valve needs cleaned for me to speak clearly.  If I need to make a phone call I need to clean the valve first and tend to just phone immediate family due to other people possibly not understanding me.  It’s embarrassing answering the phone and not being able to speak.  An email is so much easier to correspond with. No embarrassment.”

 

Typically, the main or only method for contacting any public service is by telephone.  In the 21^st century we have so many more ways of communicating:

 

A Scottish Executive report published on communication support needs (Law et al, 2007) estimates there are between 1% and 2% of the population in Scotland who have complex communication needs.  Complex meaning to the degree that they cannot communicate effectively using speech, whether temporarily or permanently.  This is likely an underestimate given that the study is based only on people who were accessing speech and language therapy services.

 

If we consider the findings of this Scottish Executive report, having telephone contact as the only method of access within an organisation may be perceived as an inequality.

 

(International Communication Project, 2016)

The Scottish Government (2011) recognises the requirement for public organisations to become more inclusive of people with communication support needs and has set guidance for public authorities on Principles of Inclusive Communication.  The legislative driver for this stemming from the Equality Act (2010) and the United Nations Convention on the Rights of Disabled People (2009), Articles 9 and 21, which set out a person’s right to have access to information and communication in different forms.

 

Individuals and the wider community benefit from all people being more independent and participating in public life.

Lorraine has Aphonia (loss of voice):

 “I have difficulty with communication as my voice is a whisper and everyday there is a hurdle I have to try and jump.  One of these is appointments with NHS either hospital appointments or Dr Surgery appointments. I have lost appointments at the hospital as I can’t phone to cancel and rearrange. Also, when they send you a letter saying to phone up to arrange an appointment, I have to rely on other people to do this for me which is very hard as they work during the hours you have to phone, or they forget it’s also not very private. If you wanted to keep it private I can’t even have a phone consultation. I find it upsetting and frustrating that I have lost a lot of my independence having to rely on other people to make phone calls and appointments for me. There is a simple way to help people like me to give us part of our independence back and the answer is email. Most of us use it these days and I would have my privacy too. All they need to do is have on my records responds by email only, how hard is that? I don’t like to be one of those statistics that don’t turn up for appointments or when you don’t phone to make your appointment and think you do not need one. And that is just a small part of what I have to go through on a daily basis”.

 

Putting knowledge into action is what counts.  We could all work towards becoming more inclusive to people with complex communication needs by adding alternative options for contacting our services and departments.  It could be as simple as adding an email address to start with.

 

Now imagine if every service and department within health and social care did this then it would indeed be a giant leap towards a more inclusive communication world.

 

If you have an interest in Inclusive Communication and want more information or to become involved in any future projects, please contact:

Laura Lennox is a Speech and Language Therapist & Allied Health Professional for NHS Dumfries and Galloway

Fork Handles!!! by Helen Moores

“The single biggest problem with communication is the illusion that it has taken place” George Bernard Shaw

What is the reading age of the most popular newspaper in Scotland, The Sun?

If you were to categorise it and place it on a shelf where would you put it? 8-10 yrs? 12-14? 14-16 yrs? The answer is 8 years old.

In terms of language level, vocabulary, grammar etc. The Sun is written at the same level as a school reading book for an eight year old child. According to The Literacy Trust the average reading age in Scotland is only 9 years old. This sort of information has massive implications for the way we communicate with our patients, carers, their friends and family.  If we are producing written material or talking in a way that is too technical, medical or wordy we lose, bewilder and alienate our audience whilst thinking we have been clear. It is referred to as health literacy –  the gap between what we as professionals think we have said and what our patients have actually heard or understood or are able to access. It brings to mind the confusion in the classic Two Ronnie’s sketch where a man walks into a hardware shop and asks for Fork Handles and receives 4 candles!

October is World Health Literacy Month and the aim is to raise awareness of this gap in communication. The Health Literacy Place is a website attached to The Knowledge Network and details the Making It Easy action plan to improve Health Literacy here in Scotland. It contains some frightening statistics:

• 43% of English working age adults will struggle to understand the instructions to calculate a childhood paracetamol dose
• 26% of people in Scotland have occasional difficulties with day to day reading and numeracy
• People with lower health literacy have increased rates of emergency admissions, wait until they are sicker before visiting their GP and are less likely to engage with public health programmes eg breast screening and vaccination
• In general people remember and understand less than half of what we discuss with them

The implications for patient experience, safety and access to services are clear. This is not just a welfare or financial obligation, but a legal one. The Patient Rights (Scotland) Act 2011 states that “people should be communicated with in a way that they can understand and that healthcare staff should make sure that the patient has understood the information given.” Our skill as healthcare professionals is not only to diagnose and treat but to communicate those findings in a culturally appropriate, meaningful and memorable way.

Here in D&G it has never been more timely for us to think about these issues as we plan our own Big Move, thinking about clear signage, systems for patient appointments, e-records etc in our new home. In addition our English neighbours in Cumbria are getting to grips with the Accessible Information Standards. These legal standards were introduced into NHS England on 31^st July this year and go one step further in addressing communication needs. They stipulate that a person with a disability, impairment or sensory loss should be provided with information that they can easily read or understand with support. The Standards also state that these needs should be identified and recorded prior to a patient accessing a service.

The good news is that because of the introduction of these standards in England there are lots of resources to help us look at our practice here in Scotland. So where do we start? As a communication specialist, it’s a subject close to my heart.

If you are looking at a service audit or improvements, some handy hints include:

• to never be without a pen and paper
• to download a profession specific app or animated sequence for your phone or tablet
• sit down or be at eye level for all conversations, where possible
• order a name tag and say..”Hellomynameis…”
• attend one of the specialist workshops in the Education Centre

but also…….

“Tell me your story…”

Asking this initial interview question allows you time to tune in like a radio to the person’s wavelength. By asking this I can assess fluency, coherence, intelligibility, cognitive ability, word finding skills, language level and most importantly adjust mine accordingly .. but also assess the patient’s accuracy as a historian, their interpretation of events, what they believe the doctor said, if there’s an outstanding or unresolved issue or complaint, their mood and motivation for engaging with therapy, what is important to them, their family, goals, hobbies and start to identify any hooks that I can hang my therapy on to make it personal and meaningful and therefore increase its success. Not bad for one simple question!

 

Perform the SMOG!

The simplified measure of gobbledygook – yes it’s a real thing. Created in 1969, take any piece of written material your service routinely supplies and apply the formula to calculate a reading age. If it’s higher than 9, think again. http://prevention.sph.sc.edu/tools/SMOG.pdf

 

Access The Health Literacy Place

This NES website gives some really great tailored resources for GPs and medics, AHPs and nurses including simple techniques like Teachback, but also online courses, training and templates to re-evaluate and improve your communication personally and within your service. http://www.healthliteracyplace.org.uk/media/1360/health-literacy-month-eflyer-2.pdf

Chat to a friendly Speech & Language Therapist

But then I would say that! The Royal College has a new position paper and website to support Health Literacy or Inclusive Communication as it’s sometimes known.

And Finally……

…for a chortle and a lighter look at Health Literacy as seen from the perspective of the doctor we all love to hate, click or paste the link below…. If you can’t see it you may need to upgrade your version of Internet Explorer to 11. http://www.youtube.com/watch?v=zG2DVoRP86g

Happy Friday and happy Health Literacy Month!

#healthlitmonth

Helen Moores is a Specialist Speech and Language Therapist for Adult Service & The IDEAS Team (Interventions for Dementia, Education, Assessment & Support) at NHS D&G

Follow us @SLT_DG

Find us at NHS D&G SLT Adult

 

Health Literacy Month logo and Health Literacy Heroes illustration are reprinted with permission of Helen Osborne, founder of Health Literacy Month

Stronger through Technology by Laura Lennox

Love it or hate it we have all heard of social media sites such as Facebook and Twitter. If you do use social media you will definitely have heard of and even participated in the ‘bare face selfie’ or the ‘ice bucket challenge’ successfully raising awareness of specific conditions and increasing donations for certain charities. With this in mind, our speech and language therapy team decided to create our own department Facebook page and Twitter account in order to raise awareness of the specific speech, language, communication and swallowing needs our service users encounter and how this impacts on their lives. “How hard could it be?” we naively thought.

Several hours later the job was done and, although it was slightly harder and time consuming to do than we initially thought, our reason for sharing this experience is because we could not have predicted how successful this venture has become. If you aren’t already familiar with us, we are the small(ish) adult team made up of speech and language therapists (SLTs), SLT support workers and one A&C based at DGRI and the Galloway Community hospital. So for a small(ish) department, you can understand our excitement at the fact that we currently have over 100 Facebook and twitter followers and this number continues to grow. So we’ve come up with four reasons why we believe the use of social media in professional practice can be a positive experience.

1. If we can do it then anyone can.

I have already hinted that it was initially harder than we thought but that’s because the social media skills within our team were (and still are) pretty limited. So if you’re in a similar position, then here are a few pointers as to how we went about it. Our first step was to check in with D&G NHS Communications department to make them aware of our plans and gain advice as to how best to do this in a way that would not get us sacked or struck off the HCPC register. Joke! (I think….). The next step was to sign up to Facebook and Twitter using our generic NHS email account. For Facebook, we followed their straightforward online instructions on creating a business page (we had to google it!). The admin section allows for each SLT and support worker to be involved in managing the page and posting information. This was important to us, not only because it is less time consuming than one individual being the sole person responsible, but because we all have our own particular areas of specialist interest. (It means we can post out information that is relevant in all professional areas within speech and language therapy). We then linked our Facebook page to our Twitter account meaning our Facebook posts would also be tweeted and vice versa, saving even more time than trying to manage the two accounts. Twitter is somewhat easier and anyone with an email address can create an account.

2. Raising our profile.

Our professional body, the Royal College of Speech and Language Therapists (RCSLT), have been involved in creating a campaign called Giving Voice. The aim of the #GivingVoice campaign is to raise the profile of our speech and language therapy profession and in their words “demonstrate SLTs unique value and evidence of our efficiency and value for money in a time of financial constraints”. Very important stuff that every NHS department can relate to. We do this by sharing posts and retweeting from the relevant larger organisations social media sites such as the RCSLT, Chest Heart and Stroke Scotland (CHSS), Alzheimer Scotland, Parkinson’s UK, British Voice Association, among the many other organisations where speech, language, communication and swallowing difficulties can be a symptom of the associated medical condition they represent. But the more exciting part for us comes when trying to think up our own ideas to raise our profile.

Remember I mentioned the social media ‘ice bucket challenge’ campaign earlier? Well you have our permission to have a good laugh at this video we posted on Facebook and Twitter with the very good intention of raising awareness of our role in supporting people with communication and swallowing difficulties as symptoms of Motor Neurone Disease:

 

SLT Ice Bucket Challenge

https://www.youtube.com/watch?v=chM8NR5j32U

Definitely think our friends from domestics enjoyed this more than us!

 

 

3. Health Promotion.

Using social media has even inspired us to get creative in our approach to health promotion. A recent project at the beginning of this year was for World Voice Day, 16 April 2014. Approximately a third of people working in the UK depend on their voice to do their work. The British Voice Association estimates that the cost of voice problems (dysphonia) to the British economy is approximately £200 million a year. Not including the impact dysphonia can have on general health through associated stress and depression from potential loss of work and social isolation. We created a social media blog and video to raise awareness of the importance of our voice for work and when and how to seek help early. We uploaded the social media video on to YouTube and shared it and the blog with DGhealth and our followers on Facebook and Twitter. Over 600 people took the time to engage in our World Voice Day social media campaign. It’s hard to think of any other more effective way to reach so many people in such a short space of time

4. Social Networking

Social networking can be an innovative way to share your practice based evidence directly with the people and organisations that will be most likely to benefit from it the most. As part of NHS DG dementia champion’s project, Rebecca Kellett, our SLT #dementiachampion, created the ‘communication and mealtimes toolkit’. She has since been invited to present the toolkit at both the RCSLT and Alzheimer Scotland day and also at the European Alzheimer’s Conference. The slide below demonstrates some of the Facebook posts and @SLT_DG tweets highlighting these exciting opportunities:  

But before you think this is all about blowing our own trumpet (!) – If you look more closely at the examples given, can you see the use of # and @? The use of # ensures that anyone searching twitter for information on dementia, for example, will find this tweet. The use of @ means you are directly ensuring any relevant organisations or person’s will receive this information via their twitter notifications. And if you are really lucky, as we were in this example, then hopefully these people/organisations will retweet your message. Alzheimer Scotland retweeted the link to the toolkit to their 10,000 or so followers meaning that many carers across Scotland are now aware of this practical and useful resource for the people with dementia they are caring for.

So as we are drawing closer to the end of this blog maybe you are now hopefully feeling the love for social media a bit more? And maybe even inspired to give it a go if you haven’t already? I should say at this point that we don’t have access to these social media sites through the NHS unless requested and rightly so. But this is something that we are all happy to do out with working hours because it really doesn’t take up too much of our own time. I guess this is also a good time to say, if you are thinking of giving this a go, then stay professional at ALL times. There is no denying that the use of social media is open to abuse; no one wants to know what you are having for your tea. I keep my own personal social media accounts for this more personal information (and even then people really don’t want to know what I’m having for my tea). There is guidance on the use of social media on the intranet that you can refer to if you’re not sure what acceptable use is. You don’t even have to do what we are doing and create a department account; many people within NHS Dumfries and Galloway have their own professional social media accounts. And lastly, you don’t even have to do daft things like tipping icy cold water over your head to create interest. The example below shows how one wee tweet, every now and again, can go a long way.

We tweeted a happy world voice day message to @kendonaldson, Associate Medical Director, Renal Consultant and dghealth guru, who replied and retweeted our message. This then led to Paul Gray (CEO, NHS Scotland and Director General Health and Social Care, Scottish Government (if you didn’t already know)) joining in the conversation and retweeting also. Result! 

 

The Office of National Statistics suggests that eight out of 10 adults in the UK now use the internet on a regular basis. If you haven’t already used social media to raise your professional and service profile, then we would highly recommend it. If you have done so already, then find us, follow us, like, share and retweet us, and we will repay the compliment. We can stay stronger through technology.

 

Further Links:

• Facebook: https://www.facebook.com/SpeechandLanguageTherapyadultServiceNHSDG
• Twitter: https://twitter.com/SLT_DG
• World Voice Day: ‘The Little Mermaid’ video.

Pictured from left to right is Kim Harkness, FairyBodMother. Jade McIntyre, Fitness instructor. Laura Lennox, Speech and Language Therapist and Lynsey Swales, fitness instructor. Thanks again to FBM fitness academy and all the Fairy Bodlings who participated.

     http://www.youtube.com/watch?v=A_dqPuXpPDQ

• And, if you didn’t get the chance to read Becky Davy (SLT) World Voice Day blog first time round then here it is again:

https://dghealth.wordpress.com/2014/04/11/world-voice-day-april-16th-by-becky-davy/

• Please click on me for more information

 

Laura Lennox is a Speech and language therapist at NHS Dumfries and Galloway

World Voice Day (April 16th) by Becky Davy

The 16th of April commences WORLD VOICE DAY (dun dun duunn… cue the music) I thought I would take the opportunity to spread awareness of voice and celebrate! Feel free to pop a cork when you get home…

Before I studied to become a speech and language therapist I had little idea about what makes the voice work and what the voice box looks like. I vaguely remember picturing a little harp with lots of little strings… I’ve since found out that’s not the case.

Here’s what I learned in 4 years at uni in a nut shell: Essentially, the voice box (or larynx) is made up of two tiny flaps of tissue (vocal cords) which vibrate together to create voice. The muscles which make this process work are very intricate and small. When air comes up from the lungs it accelerates through the small space and creates a suction, which brings the vocal cords together. This process is called Bernoulli’s principle. A wee fact for your next dinner party: Bernoulli’s principle also makes planes fly!

Not all speech therapists work with ‘voice’. It’s something that I’ve always been interested in and I’ve been lucky enough to have the opportunity to exercise my enthusiasm since working in Dumfries and Galloway. I’m the newest member of the team and have been working for just over 6 months. I’ve always had aspirations to move to the countryside, so I threw the cat, the boyfriend, and all my worldly possessions in the car, drove down from Glasgow to the middle of nowhere and bought a puppy… I’m living the dream!

As a speech and language therapist I work with swallowing, language, speech, and communication.  Voice is only a small part of what I do. Essentially ‘voice’ is the quality of the sound of your speech. Is your voice husky? Breathy? Loud? Rough? Do you sound more like a Joanna Lumley or Lisa Simpson? A Rod Gilbert or a Paul O’grady?

People use their voice for different purposes. Are you a singer? The next xfactor wannabie? A shouter? A parent?! A quiet listener? The quality of your voice can depend on how you use it… and if you abuse it! Some voices are sturdier than others and can withstand more abuse, others run off at the slightest hint of a football match, or Karaoke night! Losing your voice can be a sign that you are hurting it in some way. Similarly, having a gruff or rough voice for a number of weeks without having a cold or other cause can be a sign of vocal misuse.

A lot of emotion can be held in the voice. How often have you picked up the phone to call a friend, and as they’ve answered ‘hello’ you’ve immediately said ‘what’s wrong?’ The moment you hear their voice you can tell that there’s something up. This emotional holding pen can get strained at times and begin to affect the physiology of the voice, causing tightness or soreness. Psychology and voice are interrelated and the relationship can be complex.

Not using the correct techniques when pushing the voice can sometimes cause problems. I often have to remind people that the ‘power’ of the voice comes from the breath, not the throat. If your shoulders move when you take a big breath in…. you’re doing it wrong! Breath control can produce lovely strong voice without putting any strain on the voice box. Breathing and relaxation exercises can help to keep the voice healthy. (That’s why when you pop in to the speech therapy department, you’ll find us all practising our relaxation techniques with a big slice of cake… its therapy… honest!)

There are lifestyle changes we can make to help look after our voice. I find myself giving the same advice to most of my patients having voice therapy. One of the most important is to increase our water consumption. “Gallons and gallons” I cry! “Think of how beautiful your skin will be!” I cry! No one ever listens…! Maybe it seems too easy? Too straightforward? When I recommend complex vocal exercises, people are ardent. I’d be interested to know why people find this one such a stickler to put into practice? Is it the taste? The inconvenience? Thinking it’ll make you run to the loo every 5 minutes? Please feel free to leave some comments! It’s recommended that we drink up to two litres a day, very few of us do. How much do you manage?

Some more advice that I often nag on about is throat clearing…  it’s the little seemly insignificant things that can affect the voice. “Throat clearing? HURUMGH No I never do HURUMGH that. What’s that? HURUMGH I’m doing it right now? I never HURUMGH noticed….” Don’t ask yourself if you throat clear, ask your exasperated colleague across the desk…. As well as being an annoying habit, throat clearing is bad for your voice box. Essentially creating a vicious circle; a wee tickle makes you feel like you want to clear your throat, which bangs your vocal folds together violently, which creates mucus, which causes a wee tickle… and round and round we go. Instead of clearing your throat, try sucking a sweetie, taking a sip of water or gently humming to get rid of the tickle (although that might also annoy your colleagues, there’s just no pleasing some people!)

I also find myself advising people that their voice problem could have links to the environment that they spend their time in. Air conditioning and central heating can be very drying. Sometimes it is necessary to get humidifying equipment to help to moisten the air. The vocal folds are happiest in a botanical gardens glass house. Perhaps the hospital board will consider this when planning for the new hospital? Get your pot plants at the ready people.

I’m hoping that you are reading this, first thing, with a cup of steaming beverage (followed by a glass of water, caffeine is so drying darling, don’t you know?!) and contemplating starting your working day. Before you do, before the tension, the throat clearing and the air con kicks in and throttles your little vocal folds… take 2 minutes to do a quick vocal warm up. We are all professional voice users to some degree or other, some professions use their voice as their main working tool for the whole of the day.

Be nice to your voice.

Read this in your most soothing, inner head voice (the one that says “it’s okay, have some chocolate, you deserve it”… ):

Sitting in your chair, both feet on the floor. Rotate your head all the way around, stretching the neck. Slowly and gently, both directions. Tuck your chin in, and then raise your head and look at the ceiling do this once or twice. Pull your shoulders up to your ears and let them drop again, do this a few times. Gently hum a few notes, feeling the vibration in your throat and enjoying the wide open feeling in the throat. Lastly do some soft vowels… aaaahhhh eeeeeee   ooooooohhhh.

We will have some info out in the foyer and a stall on the 16th so please pop along and say hello.

All the best, Becky.

Becky Davy is a Speech and Language Therapist at Dumfries and Galloway Royal Infirmary.