Communication

Communication is a broad and multifaceted concept that can be defined in various ways depending on the context. Communication in health services is a very big issue. Numerous inquiries have found communication problems.  NHS trusts and other health service organisations are unaware of the costs of communication deficiencies. It is a very difficult thing to assess the cost to their business and the costs to patients.

The following general definition will be adopted for this article: “Communication is the process of transmitting information and common understanding from one person to another.“

This definition emphasises several important aspects of communication:

1. Transmission of information: At its most basic level, communication involves sending and receiving information. This information can take many forms, including words, numbers, symbols, gestures, and facial expressions.
2. Common understanding: Effective communication is not just about transmitting information, but also about creating a shared understanding. This means that the receiver has understood the information in the way that the sender intended.
3. Process: Communication is a process, not a one-time event. It involves a series of actions and reactions, and it can be influenced by many factors, including the context, the relationship between the communicators, and the communicators’ individual characteristics and experiences.
4. Interpersonal: This definition focuses on communication between people (interpersonal communication), but communication can also occur within a person (intrapersonal communication) or between a person and a machine (human-machine communication).

Communication can be verbal or non-verbal, it can be intentional or unintentional, and it can occur through various channels, including face-to-face conversations, phone calls, emails, and social media posts. Effective communication involves not only sending messages clearly, but also listening actively and responding appropriately.

Importance

Broad industry experience

Communication problems can lead to serious service delivery pitfalls in many industries, including healthcare, IT, hospitality, and more. Here are a few examples:

1. Healthcare: Miscommunication in healthcare can lead to serious consequences, including medical errors. For example, if a doctor’s instructions are not clearly communicated and understood by nursing staff, a patient might receive the wrong medication or dosage. Similarly, if a patient’s symptoms or medical history are not accurately communicated and understood, it could lead to incorrect diagnoses and treatment plans.
2. IT Services: In the IT industry, miscommunication can lead to project failures. For example, if the client’s needs and expectations are not clearly understood and communicated among the project team, the final product might not meet the client’s requirements. This can result in wasted time, resources, and dissatisfaction for the client.
3. Hospitality: In the hospitality industry, poor communication can lead to poor customer service. For example, if a customer’s reservation details are not accurately communicated and recorded, they might arrive to find that their room is not available or does not meet their expectations. This can lead to dissatisfaction and negative reviews.
4. Airlines: Miscommunication in airlines can lead to serious inconveniences for passengers. For example, if flight changes or cancellations are not clearly communicated to passengers, they might miss their flights or be left stranded. This can lead to dissatisfaction, complaints, and potential loss of business.
5. Manufacturing: In the manufacturing sector, communication problems can lead to production errors. For example, if changes in production processes or specifications are not clearly communicated to the production team, it could result in defective products.

These examples illustrate the importance of effective communication in service delivery. Clear, accurate, and timely communication can help to prevent errors, improve efficiency, and enhance customer satisfaction. Conversely, communication problems can lead to errors, inefficiencies, and dissatisfaction.

There have been several high-profile cases where communication failures have led to significant costs, both in terms of financial loss and human lives. Examples:

1. Challenger Space Shuttle Disaster (1986): The Challenger disaster is often cited as a tragic example of communication failure. Engineers from the contractor Morton Thiokol were aware of potential issues with the O-rings in cold weather but failed to communicate the severity of the risk adequately to NASA decision-makers. The shuttle was launched in cold weather, leading to the failure of an O-ring and the subsequent explosion of the shuttle, killing all seven astronauts on board.
2. Three Mile Island Nuclear Accident (1979): This nuclear accident was the result of both mechanical failures and human error, much of which was due to poor communication. Misinterpretation of the reactor’s status led operators to make decisions that exacerbated the problem. The accident resulted in the release of radioactive gases and almost led to a full meltdown, which could have had catastrophic consequences.
3. Deepwater Horizon Oil Spill (2010): The largest marine oil spill in history was partly due to communication failures. A critical safety test result was misinterpreted, and the warning signs of a surge in pressure were not adequately communicated or acted upon. The resulting explosion killed 11 workers and caused an environmental disaster.
4. Columbia Space Shuttle Disaster (2003): The Columbia Space Shuttle disintegrated upon re-entry into Earth’s atmosphere, killing all seven crew members. An investigation revealed that a piece of foam had struck the shuttle’s wing during launch, causing damage that led to the disaster. Some engineers had expressed concern about the foam strike, but these concerns were not adequately communicated or addressed.
5. Financial Crisis (2008): Poor communication among financial institutions, credit rating agencies, regulators, and investors contributed to the financial crisis. Risks associated with mortgage-backed securities were not adequately communicated or understood, leading to a financial meltdown and a severe global recession.

These examples underscore the importance of clear, effective communication, especially in high-stakes situations. They also highlight the need for organisations to have systems in place to ensure that critical information is accurately communicated and acted upon.

Costs of communication failures

Quantifying the exact cost of communication failures challenging to assess due to the complex and often indirect ways that these failures can impact on the financial integrity of a business. However, some studies that have attempted to estimate the cost of communication failures in specific sectors or contexts.

For example, a study published in the Journal of Healthcare Management estimated that communication inefficiencies could cost a typical 500-bed hospital in the U.S. about $4 million annually.

In the broader context, a report by Holmes (a report sponsored by Siemens Enterprise Communications) suggested that the cumulative cost of productivity losses due to communication barriers could be as high as $37 billion across the U.S. and U.K.

While these figures provide some insight into the potential costs of communication failures, they likely represent just the tip of the iceberg. Communication failures can also lead to missed business opportunities, damaged relationships, lower employee morale and engagement, and in some cases, catastrophic accidents or disasters, the costs of which can be difficult to quantify but are undoubtedly significant.

These costs can be reduced through investments in communication training, systems, and infrastructure. Effective communication is not just about avoiding costs—it is also about creating value. Good communication can enhance productivity, innovation, customer satisfaction, and employee engagement, all of which can contribute positively to economic viability.

Importance for health services

Lessons from inquiries

Numerous inquiries into healthcare services in the UK have identified communication problems as significant contributors to failures in patient care. Here are a few examples:

1. The Francis Report (2013): This report was the result of an inquiry into the failings of care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The report highlighted a culture of fear and secrecy, with staff often feeling unable to raise concerns. Poor communication between healthcare professionals and patients and their families was also a significant issue, with patients often left uninformed about their care.
2. The Bristol Royal Infirmary Inquiry (2001): This inquiry looked into the management of children’s heart surgery at Bristol Royal Infirmary between 1984 and 1995, where a higher than average number of children died following surgery. The inquiry found that there was a lack of open and honest communication, both within the surgical team and with patients and their families.
3. The Morecambe Bay Investigation (2015): This investigation was launched following concerns about the safety of maternity services at Furness General Hospital. The report found that poor communication between staff, and between staff and patients, contributed to unsafe care. In particular, there was a failure to listen to and act upon the concerns of patients and their families.

These and other inquiries have led to a greater emphasis on the importance of good communication in healthcare. This includes not only communication between healthcare professionals and patients, but also communication within and between healthcare teams. Improving communication in healthcare is seen as a key strategy for improving patient safety and quality of care.

E-communication

Text-based

Text-based communication methods like email, text messaging, or instant messaging are convenient and efficient for transmitting information but they do have some potential pitfalls.

1. Lack of non-verbal cues: Text-based communication lacks the non-verbal cues that come with face-to-face communication, such as tone of voice, facial expressions, and body language. It is often difficult to extract intended real-world contexts in words on a page. This can lead to misunderstandings of clinical information, as cues that would have been obvious in face-to-face communications are absent.
2. Misinterpretation: Without these non-verbal cues, it is easy for the recipient to misinterpret the sender’s tone or intent. For example, a message meant to be sarcastic or humorous might be taken seriously, or a straightforward message might be perceived as harsh or rude.
3. Delayed response: Unlike face-to-face or phone conversations, responses in text-based communication are not always immediate. This can slow down decision-making processes or cause anxiety in situations where a timely response is needed.
4. Impersonal: Text-based communication can sometimes feel impersonal, which can hinder the development of strong relationships or rapport.
5. Information overload: With the ease of sending emails and messages, it is possible for individuals to become overwhelmed with the volume of communication, leading to important messages being missed or overlooked.

To overcome these pitfalls, consider the following strategies:

1. Use clear and concise language: To avoid misunderstandings, use clear, straightforward language and avoid jargon or overly complex sentences. Be explicit about your intentions and expectations.
2. Use emoticons or emojis sparingly: These can help to convey tone and emotion in a text-based message, but they should be used sparingly and appropriately, especially in a professional setting.
3. Establish response time expectations: To avoid anxiety over delayed responses, teams can establish norms or expectations about response times.
4. Combine communication methods: Use text-based communication for simple, straightforward messages, and switch to phone calls, video calls, or face-to-face meetings for more complex or sensitive discussions. This can also help to build relationships and rapport.
5. Use subject lines effectively: In emails, use clear, specific subject lines to help the recipient understand the importance and content of the message.
6. Regularly review communication practices: Teams should regularly review their communication practices to identify any issues or areas for improvement. This could involve seeking feedback from team members or using communication tools that provide analytics.

Video-conferencing

Video conferencing has become an increasingly popular tool for communication, especially in the context of remote work and telemedicine. It offers several advantages but also comes with potential disadvantages.

Merits of Video Conferencing:

1. Reduced travel time and costs: Video conferencing allows people to meet and collaborate from different locations, reducing the need for travel.
2. Increased accessibility: People who are unable to travel due to health, location, or other constraints can participate in meetings or consultations via video conferencing.
3. Visual communication: Unlike phone calls or text-based communication, video conferencing allows for visual cues such as facial expressions and body language, which can enhance understanding and rapport.
4. Screen sharing and collaboration: Many video conferencing tools allow for screen sharing, which can facilitate collaboration and learning.
5. Record keeping: Video conferences can be recorded and reviewed later, which can be useful for training, documentation, or review purposes.

Demerits of Video Conferencing:

1. Technical issues: Video conferencing relies on technology and a stable internet connection. Technical issues or connectivity problems can disrupt meetings.
2. Privacy and security concerns: Confidential or sensitive discussions require secure, encrypted video conferencing platforms to protect information.
3. Lack of personal interaction: While video conferencing allows for visual communication, it may not fully replicate the experience of in-person interaction. This can sometimes make it harder to build relationships or rapport.
4. Fatigue: “Zoom fatigue” or “video conferencing fatigue” has emerged as a common issue, with people feeling drained or burnt out from excessive video calls.
5. Access and inclusivity: Not everyone has access to the necessary technology or a stable internet connection for video conferencing. This can create barriers to participation for some workers or even patients.

Competence over-estimation

People often overestimate their communication skills. This is a common cognitive bias known as “illusory superiority” or the “above-average effect,” where individuals overestimate their own abilities in relation to others.  This is how it may happen:

1. Lack of feedback: People often do not receive direct feedback about their communication skills, especially in informal settings. Without feedback, it is easy to assume that one’s skills are adequate or even superior.
2. Subjectivity: Communication effectiveness can be somewhat subjective. What one person considers clear and effective, another might see as vague or confusing. This subjectivity can lead people to overestimate their skills.
3. Self-focus: When communicating, people are often focused on their own perspective and intentions. They may not fully consider how their message is being received by others, leading them to overestimate their effectiveness.
4. Lack of awareness: Some people may not be aware of the full range of skills that effective communication requires, such as active listening, empathy, non-verbal communication, and the ability to adapt one’s communication style to different audiences or contexts.
5. Confirmation bias: People tend to seek out and remember information that confirms their existing beliefs. If they believe they are good communicators, they may focus on instances where their communication was successful and overlook or forget instances where it was not.

To improve communication skills and overcome these biases, individuals can seek out feedback, engage in self-reflection, and invest in communication training. It can also be helpful to learn about the common barriers to effective communication and strategies for overcoming them.

Assessing communication

Assessing the quality of communication within an organisation can indeed be challenging due to its complex and multifaceted nature. However, there are several strategies that managers can use:

1. Feedback surveys: Managers can conduct surveys to gather feedback from employees, customers, or other stakeholders about the quality of communication. These surveys can ask about clarity, timeliness, appropriateness, and other aspects of communication.
2. Observation: Managers can observe communication in meetings, presentations, or day-to-day interactions. They can look for effective communication behaviours, such as active listening, clear and concise messaging, and respectful dialogue.
3. Performance reviews: Communication skills can be included as a key component of performance reviews. Managers can assess an employee’s ability to communicate effectively with colleagues, customers, or other stakeholders.
4. 360-Degree feedback: This involves gathering feedback about an individual’s communication skills from a variety of sources, including peers, subordinates, supervisors, and customers. This can provide a more comprehensive view of an individual’s communication skills.
5. Communication audits: This involves a systematic evaluation of an organisation’s communication practices. It can include reviewing written communication for clarity and effectiveness, assessing the functionality of communication channels, and surveying employees about their communication experiences and needs.
6. Key Performance Indicators (KPIs): Managers can establish KPIs related to communication, such as response times to customer inquiries, resolution rates for customer complaints, or employee engagement scores.
7. Training and development assessments: After providing communication training, managers can assess its effectiveness through tests, role-play scenarios, or other assessments.

Remember, the goal of assessing communication is not just to identify problems, but also to recognise strengths and opportunities for improvement. Feedback should be provided in a constructive and supportive manner, and employees should be given the resources and support they need to improve their communication skills.

Tale away summary

1. Effective communication in health services: Key features include clarity, active listening, empathy, respect, patient-centred communication, non-verbal communication, cultural competence, timeliness, use of technology, feedback, and team communication.
2. Pitfalls of text-based communication: These include lack of non-verbal cues, misinterpretation, delayed response, impersonal nature, and information overload. Overcoming these requires clear language, appropriate use of emoticons, setting response time expectations, combining communication methods, effective use of subject lines, and regular review of communication practices.
3. Costly communication failures: Examples include the Challenger and Columbia Space Shuttle disasters, the Three Mile Island nuclear accident, the Deepwater Horizon oil spill, and the 2008 financial crisis. These highlight the importance of clear, effective communication, especially in high-stakes situations.
4. Cost of communication failures: While it is challenging to quantify the exact cost of communication failures as a fraction of an organisation’s turnover, studies suggest that communication failures can lead to significant financial losses and inefficiencies.
5. Overestimation of communication skills: Many people overestimate their communication skills due to lack of feedback, subjectivity, self-focus, lack of awareness, and confirmation bias. Improving communication skills requires seeking feedback, self-reflection, and communication training.
6. Definition of communication: Communication is the process of transmitting information and common understanding from one person to another. It involves transmission of information, common understanding, process, and interpersonal interaction.
7. Standards for better communication in health services: These include using plain language, active listening, showing empathy and respect, patient-centred communication, use of visual aids, repeating and summarizing information, cultural competence, use of technology, team communication, and continuous learning and improvement.
8. Pitfalls of electronic communication: These include privacy and security concerns, misinterpretation, technical difficulties, impersonal nature, information overload, and lack of immediate response. Overcoming these requires using secure communication channels, clear and concise messages, providing training, and combining electronic communication with other forms of communication.
9. Merits and demerits of video conferencing: Merits include reduced travel time and costs, increased accessibility, visual communication, screen sharing and collaboration, and record keeping. Demerits include technical issues, privacy and security concerns, lack of personal interaction, fatigue, and access and inclusivity issues.
10. Assessing communication quality: Managers can assess the quality of communication through feedback surveys, observation, performance reviews, 360-degree feedback, communication audits, key performance indicators (KPIs), and training and development assessments.