Communication breakdown

By Christina Lowe BPharm, MBA

This week I received one e-mail starting “I hope this now gets through ... ” plus four e-mails via my private address, all because of glitches with the NHS system. Therefore it was with relief that I read in the DiZone.news service (www.druginfozone.org), that a top priority over the next nine months for the NHS Information Authority (NHSIA) is to sort out the NHS’s fragmented e-mail system. The NHSIA is examining the possibility of contracting for a national e-mail service to overcome the problems associated with having over 5,000 separate message transfer agents (MTAs), with differently configured mail servers running different software. The plan is to adopt the e-government interoperability framework (e-GIF) standard of simple mail transfer protocol. This may be the only way to achieve the Government targets of connecting 100 per cent of clinicians to desktop e-mail and web-browsing by March, 2002, and all NHS staff by March, 2003.

E-mail has the potential for efficient communication but access to the NHS system is patchy and currently the service is unreliable and not fail-safe. On days when the service is lost locally, I resort to a free web-based e-mail service as a back-up, an option not available to those without web access. One frustration is that it is possible to access the system during failures and apparently to send mail, thus careful attention to the status icons is required.

It is not the failure of e-mail transmission so much as the occasional, unpredictable absence of failure messages that causes me most problems. If e-mail bounces or otherwise fails, the sender should receive an automatic warning message so that there is an opportunity to send again, either by fax ’phone or post. We cannot rely on failure messages: the absence of a warning does not indicate message delivery. An opposite failure mode can also occur: I once re-sent several separate e-mails upon IT advice when after a few days the system continued to indicate “pending”. Three rather tetchy replies remarked that not only had I sent the request before, but that it had been answered. No answers had got through, so I needed to e-mail again to ask for re-transmission. I now tend to ask for confirmation of receipt, but this increases the volume of traffic and so strains the system and individuals. I once turned up to a meeting to find myself ill-prepared, as extra documents had been circulated which never reached me.

So why do I persist in using e-mail? — simply because when it works, it is so much better than the alternatives. It puts me in control and improves my productivity and effectiveness. I was a comparatively late starter with e-mail but now use it extensively at work and at home for career, professional and leisure purposes.

Communication becomes more efficient through e-mail. The majority of pharmacists are not office-bound and days can be wasted returning calls before speaking directly to the intended person. Corresponding by e-mail is much easier than by letter. In addition to the speedy mechanics of the process, brevity and informality are acceptable. Where a formal report is required, this can be dispatched speedily as an attachment. Increasingly, committee documents and newsletters are distributed electronically, and with a few key strokes, papers can be saved, printed out and forwarded along the line. Much group work can be achieved without meeting or even speaking. Courses have been put together, speakers contacted, programmes distributed and even application forms returned, using e-mail. It may seem impersonal but the informality of the medium mitigates against this. Moreover, when the bulk of communication is by e-mail, the residual telephone and personal contacts can be more fruitful.

Much e-mail traffic concerns distribution of information within groups rather than one-to-one communication. Posting to multiple recipients can breach the privacy of those recipients; this risk deters some people from using e-mail. E-mail contact lists are therefore best managed using address groups (if allowed by your e-mail software) or the blind carbon copy (bcc) facility. Both options achieve the same privacy objective; each recipient can see only their own address in the “To:” field and cannot harvest the address list. Harvesting has the potential for abuse. Unsolicited e-mail is known as spam and advertisers are prime culprits. I stopped using one free web-based e-mail service because of a spate of unwanted and highly undesirable e-mails, which apparently originated within academia.

Discussion lists can be a powerful tool for communication and problem solving because a wide distribution and rapid response can be achieved. Lists need to be targeted, with wide participation but sharp focus within a specialist area of practice. Successful lists can avoid degenerating into irrelevancy by spawning new, more specific lists as necessary, not forgetting the value of adding a chat forum for the more discursive participants. Where sensitive information is shared, this is best done by replying off the list to the individual; their e-mail address can usually be found in the message or header. I moderate compounding@yahoogroups.com on behalf of the compounding interest group of the Guild of Healthcare Pharmacists. This list was introduced to improve communication between quality control and production pharmacists, reducing isolation and duplication of effort. The members-only archive can be searched or viewed chronologically or by discussion thread. The list has remained technical with minimal chat and just a few mistaken postings, mainly from those who have failed to suspend list mailings before turning on their out-of-office reply. Off-list replies are necessary for attachments because attachment facilities are disabled to protect against virus attack.

Although it is irritating to come back from leave to find someone has helpfully printed out a box file full of my e-mails, I have yet to be persuaded of the need to be connected on the move. Let’s face it though, I am technologically backward: I have had a mobile for only a couple of years and have not yet mastered text messaging! The service is improving with fewer, shorter failures and access is becoming more widespread. The final radiopharmacist in Wales was recently connected but there is still a long way to go. Only half of the GHP Compounding Interest Group contacts are using e-mail, many of them only through home accounts. So, I am looking forward to the NHS IT strategy delivering widespread and improved quality access, then we will all have the opportunity to share in the benefits afforded by e-mail with confidence.

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Ms Lowe is quality assurance and control pharmacist and radiopharmacist, Swansea NHS Trust, chairman of the compounding interest group of the Guild of Healthcare Pharmacists and secretary of the Morgannwg branch of the RPSGB. The views expressed in the article are personal but derive from her experience in these roles