Honing the Fine Art of Communication

The most valuable leadership tool is effective communication. In addition to mastering personal communication skills, physician leaders also should ensure the physicians for whom they’re responsible are given appropriate communication skills mentoring.

A simple definition of communication is the act or process of using words, sounds, signs or behaviors to express ideas, thoughts and feelings to someone else.(1) Effective communication not only entails expressing your desires to others, but it also requires responses from others. The act of communication sounds easy, but it is difficult for physician leaders to effectively communicate messages to other physicians, because physicians are inundated with information on a daily basis. Therefore, many physicians do not know who or what to listen to.(2)

Critical messages to physicians very often become part of the “communication noise” that confronts most physicians and physician leaders today.(2) Good communication must include both the transfer of information and an understanding of its meaning.(3)

Communication serves four major functions within groups or organizations.(3) They are:

• Control, which allows organizations to communicate job requirements, goals and objectives, etc.

• Motivation, which allows organizations to clarify what employees must do and how to improve.

• Emotional expression, which allows employees to express feelings and to fulfill social needs.

• Information, which allows for information to be transmitted to facilitate decision-making.

Therefore, communication is at the heart of individual and organizational learning and functioning.

In addition to developing their own expertise in communication, physician leaders should also assist their physician colleagues in developing effective communication skills. Successful dialogue between physicians is essential for patient coordination and good patient care.(4) In 2010, the Joint Commission noted that the most frequent reason given for the root cause of sentinel events is a communication barrier between physicians.(5) Also, physicians have recognized that there is a link between timely communication and the quality of care provided to patients.(4)

The leading barrier to timely physician communication is the lack of reimbursement for the time spent speaking with physician colleagues about a patient’s care.(4,6) Finally, increased physical distances between physicians might contribute to the lack of effective communication among physicians.(4,7)

Physician leaders should develop effective strategies to encourage and teach their colleagues good communication skills.

Barriers to Communication

Whether it is via an individual or a group, communication of a message occurs through multiple channels.(3) These channels include written, oral or body language. The message being sent is formatted and encoded by the sender, who selects which channel the message is to be sent over (written, oral, etc.). The receiver of the message must decode the message, remove any additional noise that may accompany the message, and provide feedback. Any break in this series of steps will distort the message.

The fundamental elements of achieving an adequate message is to consider that the meaning of a message is determined only 7 percent of the time by the actual words used. On the other hand, the tone of voice determines the meaning 38 percent of the time, and, more important, nonverbal communication influences message interpretation 55 percent of the time. Out of this 55 percent, eye contact comprises up to half of nonverbal communication.(8)

In addition to the components that make up a message, direct barriers can affect interpretation. These barriers include selective filtering of the message by the recipient, information overload, recognizing that emotions might occur from communication, language barriers that distort the message, awkward periods of silence, gender communication differences and political correctness.(3)

Filtering is a technique a sender might use to frame a message so a recipient will receive it more favorably. Filtering tends to be used more frequently when there is a status difference between two individuals or when there are multiple layers of hierarchy in an organization. Physician leaders need to be on alert for this filtering effect when they receive messages from others.(3)

Selective perception also can occur during an exchange of information. As humans, we are all influenced by our emotions, past experiences, motivations, individual expectations and personal interests. These factors often color how an individual will interpret the message being received.(3)

Up, Down and Across

Within organizations, information flows in one of three directions:

• Upward, from employees to leaders.

• Downward, from leaders to employees.

• Laterally, from person to person.

In many respects, thanks to our digital world, there can be information overload in any of those directions,(3) which can seriously distort a message. This is because the person who is overloaded will select, ignore or forget the information. Keep your messaging simple and straightforward. Bullet points are better than long paragraphs.

Emotions also play a significant role in how individuals interpret messages,(3) leaving us prone to irrational thinking. What might be a positive message could be interpreted negatively by someone in an emotional state.

Language itself plays an important role in how people interpret messages.(3) Similar words can mean different things to different individuals. Age and context are the biggest factors in how individuals interpret a message. The lesson is, if you are sending out the same message to different generations, be aware of the words that you use, to avoid potential confusion of what you mean.

Gender also plays a role in the interpretation of the message.(3) It is well-accepted that men and women communicate differently,(9) with many reasons behind the difference. Physician leaders should consider having a colleague of the opposite sex review any important messages that need to be sent out to a mixed audience.

Communication barriers also exist between cultures,(3) caused by semantics or by connotations. Semantics means that a word means different things to different people, while connotations means that a word has the same definition between people but different contexts. Also, the tone in which the message is delivered can mean different things in different cultures.

Finally, silence can play an important role when communicating a message.(3) Silence is a form of communication and it may distort information transfer. Often, the behavior of silence is used by the minority in a group environment to withhold information. This is why physician leaders should seek minority opinion before acting on issues.

Improving Matters

The first step physician leaders should take when trying to improve communication is to determine their communication style.(8) There are four:

• Action-oriented. Tends not to be focused on others, and wants to appear powerful. Practical, goal-oriented, fears being taken advantage of, fears losing control and is generally impatient.

• Data-oriented. Analytical and perfectionistic. Overly self-critical of others. Task-oriented and fears criticism of his or her work.

• People-oriented. Generally excels at perceiving verbal signals. Wants to be popular, is often disorganized, and is motivated by social recognition. However, is generally very optimistic.

• Concept-oriented. Tends to have consistent performance, is team-oriented, is motivated by maintaining the status quo, fears loss of stability and is willing to give in under pressure.

Three-quarters of physician leaders reside in the first two communication styles.

Developing verbal skills should be the second step. Verbal proficiency includes face-to-face communication, via the telephone or through group presentations. Each requires different skills. Physician leaders tend to spend most of their verbal communication time with those physicians who are on either end of the communication scale — that is, either the most-enthusiastic physicians or the most-disconnected physicians. However, it is with the unspoken majority of physicians that leaders must engage.(2)

Effective oral communication depends on many factors. Some to consider include properly framing the message you want to communicate, using standard terminology (removing jargon and complex words), ensuring accuracy of the information, developing good enunciation skills, not speaking too quickly or slowly, always maintaining eye contact with your audience, allowing enough time for feedback, and avoiding telling jokes or teasing the other party.(10)

In addition to these factors, it is important to develop good body language. Alterations in your message can be inadvertently communicated to the other party by poor body language. Understanding body language will help guide your messaging and allow you to get insight into the other person’s thoughts. Remember, communication is always a two-way process.

Physician leaders also must master electronic communication. Almost 70 percent of communication in today’s organizations is via digital media,(3) with email the most extensively used method. Email is easy, cheap and ubiquitous, but it comes with many important drawbacks leaders should understand and guard against,(3) including misinterpretation of messages and privacy issues. Leaders should never use email to send negative messages. Delivering negative messages by email is poorly received by the workforce.(3) Also, when sending messages via email, limit emotional expressions, since emotional expressions can be misinterpreted.

Crucial Conversations

Physician leaders are often required, by the nature of their leadership positions, to have “crucial conversations” regarding organizational or workforce issues.(11) Crucial conversations can occur daily, but there are some factors that distinguish ordinary daily conversations from highly crucial ones — those involving elevated emotions, varying opinions and high stakes.

Mastering crucial conversations requires work and effort. The first step is to understand that effective communication requires dialogue.(11) Individuals enter into a conversation with their own opinions, feelings and experiences, which tend to shape the meaning of the message. The key to an effective dialogue, then, is to make sure that all of the involved individuals share the same meaning. By doing so, a physician leader can create a safe environment where the conversation can occur without fear of retribution.

Make the environment comfortable for the other party. Safety allows individuals to share thoughts and desires without distorting the message. Watch for individuals who become silent during a crucial conversation. Silence is almost always a sign that an individual is attempting to avoid potential issues that may arise in the conversation. Silence may take the form of masking (use of sarcasm or sugarcoating), avoiding (dodging the real issues in the conversation), or withdrawing (exiting from the conversation).(11)

In addition, watch for the individual who uses violence during the conversation to try to convince others of his/her views; this reduces the safety of the environment. Finally, always prepare yourself before you attempt a crucial conversation. A failed crucial conversation can have long-lasting negative effects.

References

1. merriam-webster.com/dictionary/communication .

2. The Advisory Board Company. Introducing the physician communication toolkit. 2013-14. advisory.com/pec/communicationtoolkit

3. Robbins SP, Judge TA. Organizational Behavior. 15th ed. 2013., Boston, MA: Pearson Education, 2013. pp. 370-401.

4. Shannon D. Effective physician-to-physician communication: An essential ingredient for care coordination. Physician Executive Journal 2012;38(1):16-21.

5. Abrams K. Joint Commission on Accreditation of Healthcare Organizations. 10-11-2011. centerfortransforminghealthcare.org/testimonials/?TestimonialId=190 .

6. O’Malley AS, Reschovsky JD. Referral and consultation communication between primary care and specialist physicians: finding common ground. Arch Intern Med. 2011; 171 (1): pp. 56-65.

7. Epstein RM. Communication between primary care physicians and consultants. Arch Fam Med. 1995; 4(5): 403-9.

8. Keogh T. Skills of effective interpersonal communications. American College of Physician Executives. Fall Institute. Tucson, Arizona, 2005.

9. Gray J. Men Are from Mar. Women Are from Venus. New York, NY: HarperCollins, 2012.

10. Linney BJ. Communication in a changed world. In Essentials of Medical Management. Ed. Curry W, Linney BJ. Tampa, FL: American College of Physician Executives, 2013, Chapter 13.

11. Patterson K, Grenny J, et al. Crucial Conversations: Tools for talking when the stakes are high. New York, NY: McGraw-Hill. 2002