Better Communication = Better Healthcare System

By Beth Boynton

In applied or medical improv activities, we are always practicing communication skills and building positive relationships in a trusting environment.

With proper facilitation participants practice taking a little more risk, in a safe way to share ideas and build on the ideas of others. Intellectually, these growing edges seem simple. They are not.

​Both sides of the communication coin, listening and speaking up involve sharing power and that can be very challenging. Being more assertive means showing ownership , being accountable, and maybe even wrong. Listening more respectfully requires a letting go of control to make room for other people’s ideas and concerns. 

If our communication is limited then so too are our relationships. Our collaborative problem-solving will be stunted, we may hold resentments about not feeling heard, we’ll have trouble managing conflict, and ultimately will not be bringing our best selves into our team and leadership roles. Another way to explore how the roots of our communication can impact the system and is to look at three of the principles of complex adaptive i.e. human systems; adaptability, the butterfly effect, and flexibility. 

Adaptability
Adaptability refers to the ability of the participants to adapt and learn from changes in their environment. In a high-stakes, high-stress health care environment, we could not be adaptible without consistent, effective and respectful communication.

For example, inviting input on an issue and listening to it is key for engaging staff. Leaders sometimes avoid such engagement, because they assume that staff will expect them to follow all recommendations, which could lead to conflict if they don’t. Instead of validating, considering input and setting limits, they simply avoid asking. Staff who don’t feel heard may become disengaged or use resistance to solutions (consciously or subconsciously) as a passive-aggressive way of being heard. Whereas, many people will accept reasonable limits if they feel heard.

Leaders can also embrace this idea to increase staff accountability for stubborn problems like, for instance, hospital-acquired infections. By asking staff, “What do you need to comply with hand-washing protocols?” and then listening carefully to the responses, they create the conditions for learning new information that might help, and they relay the message that input is valued.

The butterfly effect
The butterfly effect refers to a small event happening in one place, like a butterfly flapping its wings contributing to a large event happening someplace far away, such as a hurricane on the opposite side of the world. The butterfly effect of disrespectful versus respectful communication can be seen in these two health care-related examples:

• A doctor yells at a nurse on Tuesday. On Saturday, she hesitates to call him to report a subtle change in a patient’s condition. Instead, she reports her concern to the oncoming nurse, who makes it a priority to check this patient, but the telemetry alarm beats him to it. The patient dies.
• Nurse A overhears Nurse B talking about her in a negative way and interrupts the conversation. “I’d appreciate it if you have concerns about my work that you discuss them with me directly.” Nurse B apologizes and later helps Nurse A get pain medication to her post-op patient quickly. The patient and his wife feel cared for. The patient experience scores improve.

Emergent behavior
Emergent behavior refers to how we behave in the moment and in relationship to others. To gossip or not, to offer or take in constructive feedback versus avoiding conflict, or to speak up or remain silent about a concern are soft skills that are intrinsic in each of these behaviors:

• The nurse assistant who went in and held a patient’s hand in the middle of the night when she sensed the patient was anxious.
• The surgeon who tells the OR team she expects each of them to watch for and report problems.
• The social worker who reminds the unit coordinator that computer system is going to be down during the evening shift.
• The nurse leader who negotiates budget allocations for delegation skill training for nursing staff and a part-time nurse assistant during the busiest times.
• The housekeeper who shares her insight with the clinical team that a post-op patient’s fear of falling was the reason she was afraid to walk with the physical therapist.

Conclusion
These communication-related skills and how they relate to outcomes in healthcare may be hard to see, but now that you know how to look for them, you’ll spot them more easily. As you do, you may see or suspect their impact in the workplace.

Did the nurse who hurt her back ask for help? Was the surgeon receptive to challenges during the wrong-site surgery? Would the resident have fallen if the nurse assistant sat with her for a few minutes and listened to her concerns?

Without getting at the roots of assertiveness and listening we will not have, cannot have the healthiest system we owe our patients and providers. 

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