Closing the Communication Gap: How Perception Affects Dynamic

Posted on March 6, 2013 by VITAL WorkLife

Communication emerged as a particularly challenging issue in our 2012 Organizational Culture Survey. While physicians and administrators ranked attributes related to communication as very important, 3 of the communication-related attributes were among the top 5:

  • Respectful communication (8.6 average score)
  • Transparent communication (8.4)
  • Open dialog across roles (8.3)

Yet, these attributes also showed some of the widest gaps between importance to physicians’ overall satisfaction and their satisfaction with their organizations’ focus on these attributes, ranging from 1.7 to 2.7 points on a 10-point Likert scale.

The First Barrier: Perception

When healthcare leaders assemble medical staff to discuss a change initiative, who is in their audience:

A bunch of greedy, narcissistic babies who live in the past, approach change with knee jerk negativism who perform cutting-edge medical procedures but can’t master EMR?
Highly dedicated medical practitioners whose time is a precious resource but whose perspectives and buy in we need in order to succeed?

When physicians look forward, who do they see:

A gang of clueless pencil pushers who care more about their next bonus and making sure the right codes are entered into electronic medical records than they do about the life-saving miracles doctors perform each and every day?
Business professionals who view their role in keeping the doors open (and having sufficient funds to provide the highly skilled, highly paid physicians they employ with the extremely expensive technology they need) every bit as vital to saving lives?

Conversations That End Before They Start

Administrators who view physicians as troublesome probably aren’t really meeting “to discuss” anything. They’re typically going to want to give physicians a “heads up” about an impending change rather than truly invite feedback. They’re going to try to foresee every possible objection and come to the meeting “armed” with responses.

Physicians who distrust the motives of administrators are going to distrust their work product even more. They may not even bother to make suggestions “knowing” that their ideas will fall on deaf ears—even if they never voice them. They take some enjoyment in watching the initiative fail, just as they knew it would before it even started.

”The temptation for administrators is to think they’re saving time by gathering all the information and making a decision,” says Liz Ferron, senior consultant for VITAL WorkLife. “The reality is that lack of engagement is the reason that more than 70% of change initiatives fail.”

Gathering Input and Accepting Feedback

Whether administration begins a dialogue with physicians before drafting a proposal or brings a proposal forward for feedback, leadership’s willingness to listen to physician input non-defensively is critical.

“Billing efficiency can’t be the only standard for evaluating EMR software,” says Ferron. “Nobody wins when a doctor can’t find a pull-down menu that accurately describes a needed treatment or medication. This should be common sense, but all too often it’s adversarial.”

Addressing Communication Barriers: How VITAL WorkLife Can Help

VITAL WorkLife was recently called in to work with a clinic whose administrators said had developed “a culture of negativity.” Providers were frustrated with administration. Nurses were frustrated with providers. All staff reported feeling stressed and burned out. Communication within professions was reported to be fine, but between disciplines not so much. Leadership felt frustrated because their own attempts to build relationships and consensus had not been effective.

“We brought together small groups with representatives from leadership, physicians and nursing to better understand the underlying issues and develop an action plan,” says Ferron.

A surprising result of the intervention was that most participants reported an almost immediate improvement in their understanding and appreciation of the other disciplines represented in their group—simply by attending the first meeting.

“They saw that they had far more in common when it came to their values and vision than they had differences,” notes Ferron. “They all shared a desire for their clinic to thrive, be productive and to provide exceptional patient care.”

Participants also realized that each discipline had been forming a sort of “we-them” viewpoint that made them avoid either interacting or cooperating with the other disciplines. “They realized their attitudes were not only ineffective, they were also misinformed,” Ferron notes.

In addition to identifying similarities, they also acknowledged areas of clear difference, (i.e., salaried vs. non-salaried) and talked openly about how to deal with conflicts rising out of these differences in a productive fashion. Ferron observes, “I think people are much better able to deal with actual differences, once they eliminate mistaken suspicions of negative intent.”

We Can Help

If there are unaddressed communication issues at work in your organization, VITAL WorkLife can provide consulting and training in organizational, group and individual levels. Contact us for more information!

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