Do you remember playing the game of telephone? As kids, we would sit in a circle. One person would start the flow of communication by whispering a statement into their neighbor’s ear who in turn whispered it to their neighbor and so on until it made its way back to the original sender, often with hilarious results as the returned message was fraught with errors that only partially resembled the original utterance.
I still use that activity in the college classroom to introduce a lecture on listening. I divide the class into several lines of 6-7 students and give the head of each line the exact same written statement. The last person in each line is asked to report out loud the statement they heard, always to much laughter. It never fails to disappoint as each sentence reported out is different and all are wrong.
In this context, the errors are forgivable and fun, but that is not the case when we take this idea into our everyday lives and jobs. The same forces at play in the game of telephone are present in our healthcare organizational communication flows, underscoring the need for clear, effective communication in healthcare. Hospital physicians, staff, and volunteers must effectively communicate with the patient as well as with each other.
But what is effective communication? And what exactly is its impact on your facility’s operations? This article will answer those questions, explain the barriers, and conclude with how hospitals and healthcare organizations can experience more effective communication.
Defining Effective Communication
The National Communication Association describes communication to be “the use of messages to generate meanings within and across various contexts, and is the discipline that studies all forms, modes, and media”.
As a communication scholar and educator, I find value in the refined version of this presented by Dan Rothwell (2021) who literally wrote the textbook about communicating effectively in groups. “Communication is a transactional process of sharing meaning with others.” Communication is a process. Communication is about shared meaning.
Communication is a transactional process of sharing meaning with others.
In other words, communication is effective when both the sender and receiver reach a clear and mutual understanding of the information being exchanged
Transactional
Effective communication is transactional. The feedback the sender gets from the receiver helps the sender know whether the message is clear. But that is if we invest the time needed to obtain and decode the feedback. Too often our organizational communication workflows send communication in one way fashion, similar to my classroom activity of telephone.
Shared Meaning
Effective communication exhibits mutual understanding. This means that the message sent is received in the way it was intended. The meaning in a message lies not only in the words, but also in the attending contextual factors. Shared meaning is impossible without the transactional process.
For communication to be effective, it must be thoughtfully delivered and presented. If it’s verbal communication, tone and body language can either muddy up the information or enhance its clarity. If it’s written or digital, the format of the document and the consistency in style can have the same effect.
The Impacts of Ineffective Communication in Healthcare
According to a 2018 Joint Commission report, communication failures in United States hospitals and medical practices were responsible at least in part for 30% of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years.
Communication is central to nearly every aspect of a facility’s operations. Communication interactions, breakdowns, and silos within healthcare organizations contribute significantly to many issues. Take into consideration just three:
Readmission Rates
As noted in the aforementioned Joint Commission white paper, “Patients or family/friend caregivers sometimes receive conflicting recommendations, confusing medication regimens, and unclear instructions about follow-up care. Patients and caregivers are sometimes excluded from the planning related to the transition process. Patients may lack a sufficient understanding of the medical condition or the plan of care. As a result, they do not buy into the importance of following the care plan, or lack the knowledge or skills to do so.”
Patient Experience
Effective communication is a known trust builder between the patient and the provider. Trust can combat negative emotions and make it easier for the patient to reach a clear understanding of whatever information is being relayed.
Work Culture
To build a positive culture where employees understand and share the values of their organization, you have to establish clear and effective channels of communication. If effective communication means reaching a clear and mutual understanding of a message being exchanged, space needs to be made for that to happen.
Barriers to Effective Communication
The benefits to effective communication in healthcare are recognized, but hospital’s still fall short. Why? When debriefing the telephone game in the classroom, learners discuss the influencing factors that caused the unclear message to result. These barriers to effective communication include:
inattention
being distracted by the process
being unable to hear the person speaking to you
having the sentence said too quickly to you
hearing what you expect to hear rather than what is being said
being lazy
not understanding words in the message
Within our organizational communication flows, these same barriers are being experienced. These are sources of “noise” in the communication process that disrupt the shared meaning. Noise is anything that interferes with a receiver’s ability to attend to and understand a message.
When we extend this concept of noise to the context of patient’s experience, there are so many places for the message to go sideways as the patient is emotionally stressed. It can create noise that makes it difficult for them to also process important information about treatment and medication. If healthcare providers don’t take these things into account, communication starts to break down and the quality of care has just been compromised.
To avoid the pitfalls of ineffective communication, organizational communication practices need to make space for clear and mutual understanding of message exchanges to happen.
If the game of telephone were set up to be intentional in creating opportunities and frameworks for a transactional process to ensure shared meaning, the results would be much more accurate. The communication-based game must be played as a team sport if it is successful in achieving the goal of shared meaning.
Effective Communication in Healthcare Begins with Listening
While frameworks and protocols have been introduced in healthcare with effective communication as the end goal – think SBAR-the clarity of the communication is still challenged. Shared meaning at its core is a result of listening. As counter intuitive as it seems, listening is the most important part of the transactional communication process. It is the secret sauce to assuring mutual understanding has been achieved.
Listening is not the same as hearing. A co-worker, patient, volunteer, or visitor may hear something, but not process what they’ve heard in the same way it was intended. Providing intentional space for feedback activities such as paraphrasing, asking questions, repeating back, and similar are good practices.
Additionally, healthcare organizations need to ensure those tools work by providing interest in, training, and resources for effective listening. Listening is a learned communication skill.
Listening is focused, voluntary, and intentional.
Hearing is detached, involuntary, and effortless.
Many organizations have effective communication tools in place but have not reaped the benefits of them because they haven’t equipped the users with active listening skills. Communication skills training is mostly reserved for message sending, not message receiving. For example, organizational silos can be breached by organizational frameworks that create opportunities for departmental leaders to sit down and discuss what their goals and challenges are and to find opportunities to meet shared goals.
To fully realize those outcomes, the parties involved have to be as committed to listening for shared meaning as they are to having their own meaning listened to!
Conclusion
A patient’s experience is significantly impacted by communication at nearly every step in their journey. The parking garage signage, the initial interaction with your volunteers at the guest services desk, the conversations with their care providers, and the documents they receive detailing their diagnosis and recommended treatment — all of it is driven by communication.
If you want to reduce readmission rates, improve the patient experience, and help improve the organizational culture, start looking for places where communication can be improved. Fnding out where your breakdowns in communication is the most important insight you need to begin investing in and improving communication.
References
National Communication Association (20 What is communication. https://www.natcom.org/about-nca/what-communication
Rothwell, Dan J (2021). In mixed company: Communicating in small groups and teams. (Rev. ed.) Oxford University Press.
Joint Commission International. (2018). Communicating clearly and effectively to patients: How to overcome common communication challenges in health care [White paper]. JCI. https://store.jointcommissioninternational.org/assets/3/7/jci-wp-communicating-clearly-final_(1).pdf
Roseanna Galindo, ECBA, CAVS
Roseanna Galindo is Principal at Periscope Business Process Analysis and a champion for data literacy, the human experience in healthcare, and leaders of volunteers everywhere. Learn more about Roseanna and her blog, The Periscope Insighter, by reading the opening post, Venn The Time Is Right