| Summary: | Background It is estimated that around a fifth of all complaints dealt with within the NHS involves some element of failure of communication between doctors and patients. The underlying hypothesis was that organisational issues were as relevant to episodes of poor communication as the failure of individual doctors. " Methodology Using action learning to explore the complex issue of communication is a novel approach but one that allows the researcher to hold in tension the complexity of the underlying process as well as trying to find themes and insights which might inform practice. The use of qualitative research within medicine is still in its infancy and is not without its limitations, however in the field of communication its use has brought about new understanding and insights through the application of speech act theory, systems thinking and information processing. In doing so it maintains integrity and relevance to clinical practice which, by definition, is often complex and ill defined. Results The research included the evaluation of five study days set up and run for senior doctors within one trust. This showed that giving senior doctors time to share their clinical experience and reflect on their clinical practice improved their confidence. A survey of patients' perceptions of communication within an out-patient setting across the same acute trust demonstrated that most patients felt that communication with doctors was good. A survey of the senior doctors confirmed that most enjoy working in the out-patient setting but that time constraints limit their overall satisfaction with the quality of their interactions. Following the action / reflection cycle a new model of understanding communication based on the metaphor of the dance was developed. Conclusion The model proposes that communication episodes should be seen from an organisational standpoint. Communication should not be seen as a sequential set of steps but rather as a random dance between two parties who have to find a common understanding of the issue being addressed. In finding that common ground external pressures that are both personal (time, energy levels) and organisational (NICE, NHS, GMC) must be acknowledged. Suggestions for further work to validate and expand the model are proposed.
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