COMMUNICATION IN HEALTHCARE - TrainingABC

LEADER’S GUIDE TO THE CRM VIDEO

COMMUNICATION IN HEALTHCAREThe Power of Words

18 minutes, color

Videoscript by Kirby Timmons, Bob Torrance and Melanie Mihal Leader’s Guide prepared by Sonia Fader

CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

SYNOPSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

PROGRAM CHECK LIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

TRAINING OBJECTIVES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

DISCUSSION STARTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

SUGGESTED TRAINING DESIGNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

TRAINING DESIGN 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

TRAINING DESIGN 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

EXERCISES AND WORKSHEETS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

RECOMMENDED RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

COMPANION VIDEOS FROM CRM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

CLOSED CAPTIONED BY THE NATIONAL CAPTIONING INSTITUTE. USED WITH PERMISSION.COPYRIGHT © 2000, CRM LEARNING, L.P.

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COMMUNICATION IN HEALTHCARE Leader’s Guide

INTRODUCTION

Words. They are at the same time our connection with, and expression of, theworld around us. And nowhere is the choice of the words we use morecritical than in the delivery of healthcare, where a misunderstood word canundermine treatment, create unnecessary stress, and even put a patient’s lifeat risk.

Today’s Healthcare Industry is in a state of flux as it redefines itself again andagain. This puts new pressures on professions and patients alike, and makesc l e a r, concise communication more important than ever. But in anenvironment where constantly evolving and improving technology continuesto increase the speed and efficiency with which healthcare professionals areable to organize, access, and transfer information, the clarity of our messagecan easily fall victim to the quickened pace. Only by paying careful attentionto the words we use, by choosing words that are clear and concise, and byunderstanding the principles of good communication, can we be assured thatthe message we intend is the message that is received.

COMMUNICATION IN HEALTHCARE: the Power of Words is designedto help healthcare professionals meet the pervasive need they have tocommunicate effectively. The video provides a stimulating exploration of theimportance of language in the day-to-day life of a healthcare professional.This Leader’s Guide provides trainers and leaders with useful strategies tohelp healthcare professionals make sure that their communication is clear anddirect. It provides active listening techniques to ensure that the informationbeing received is undistorted and clearly understood. Suggested trainingdesigns and discussion starters can help you adapt the information providedto the specific needs of your group.

We hope that you will find COMMUNICATION IN HEALTHCARE:The Power of Words and this Leader’s Guide a powerful, invaluable tool formeeting the communication challenges your organization and groups face intoday’s competitive, ever changing Healthcare Industry.

Kirby Timmons for CRM Learning

SYNOPSIS

As the video opens, a series of phrases and words familiar to healthcareprofessionals appear in succession, white letters on a black screen; words andphrases that evoke a sense of the crucial role communication plays in theprofession. The viewer is asked three questions: “What do words mean?”“What do you mean when you say them.” “Is it the same?” The universalityof the challenge to communicate effectively is underlined by a final question:“Have you ever been misunderstood?” which is answered “yes” in a vastarray of languages. These four questions set the tone for four stories.

Our first story begins as a woman receives a call from the hospital. Herhusband is ready to be discharged, and a nurse provides vague directions onhow to get there. The woman’s hurried efforts to leave for the hospital aretemporarily thwarted by her young daughter’s insistent request for a cookie,reminding us how we learn at an early age the potential that words have tohelp us get what we want or need.

In the hospital, as the nurse straightens the covers on the woman’s sleepinghusband, she discovers a note on a prescription form which reads, “Patientrequires large dose of Essamine,” triggering a mystery. Neither the nurse, northe attending physician have ever heard of a drug called Essamine.Recognizing the handwriting as belonging to a doctor known for writinghumorous prescriptions to help the morale of her patients, the attendingphysician suggests they ignore the note, but the nurse decides to call thedoctor to make sure.

In the hospital’s billing office, a heated argument is taking place betweenBruce, an accounting clerk and his supervisor, Stephanie. Bruce insists thatStephanie told him to use an infectious disease billing code when thecomputer rejected his efforts to put in the proper billing code for a live birth.She denies ever making such a suggestion. The incident illustrates that whiletechnology has improved our ability to organize, retrieve and transferinformation, it has also increased the need for concise and clearcommunication.

Using the interaction that takes place between a pilot and an air trafficcontroller as a model for successful communication, the video next introducesus to the five essential elements found in any communication: The Sender,who launches the thought. Language, that for successful communication

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Leader’s Guide COMMUNICATION IN HEALTHCARE

must be made up of words that are clear and specific. The Environment inwhich the communication takes place, which needs to be organized and freeof distraction. The Receiver, responsible for interpreting the message.

Feedback, which needs to be thorough and precise to guarantee that theSender and Receiver understand each other.

Returning to Bruce and Stephanie, we see how their failure to communicatehas left them both feeling frustrated and angry. A flashback helps usunderstand how this failure occurred. Returning to the present, we learn theconsequences of their mis-communication.

Arriving at the hospital with her little girl, armed with only vagueinstructions, the patient’s wife tries unsuccessfully to find her husband’sroom. Her confusion is compounded when an orderly she asks for helpprovides her with more vague directions, running off before she can clarifythem.

Elsewhere in the hospital, a patient accidentally spills some water. An orderlyanswers her ring for help, but calls housekeeping to clean up the spill, sayingthat it is a big spill, and big spills are their job. The narrator points out thateven when team members agree on clear definitions, they need to be aware ofhow their patients will perceive a situation.

Briefly returning to the woman looking for her husband’s room, we find hercompletely lost. An attempt to get clear directions from a candy-striper onlyadds to her confusion.

At a nurse’s station another act of mis-communication unfolds when two busynurses are interrupted by a visitor seeking help to find a friend who has beenbrought into the hospital with heart problems. “Cardiology, twelfth floor,”one of the nurses mutters. The visitor doesn’t understand. In an example ofhow distractions can undermine the effectiveness of language, the nurserepeats the number “twelve,” and the man goes off in search of room twelve.When he reaches room twelve, where some of the staff have gone on theirbreak to watch the basketball playoffs, the door is closed. The visitormisinterprets the commotion inside created by the basketball enthusiasts, andconcludes that his friend has succumbed to a failed emergency procedure,demonstrating the inherent imprecision of language, and how the meaning ofwords change depending on the context in which we hear them.

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Returning to the room where the spill has taken place, we find a woman fromhousekeeping and the orderly arguing over the size of the spill and whoseresponsibility it is to clean it up. The patient, having had enough, spills theentire pitcher on the floor, and asks them if now they can decide.

An expectant mother being wheeled past the nursing station is involved in aconversation with an orderly about names for her unborn baby. Overhearinga discussion about the mysterious prescription for “Essamine,” she fixes onthe word, seeing it as a beautiful name for her baby. This sends the nurselooking in a new direction for the answer to her puzzle.

We return briefly to the pilot and air traffic controller to demonstrate how,during the landing process, they both use continuous and precise feedback toensure that they understand each other. The concept is then demonstrated ina hospital setting when a doctor, seeing the confusion of the lost mother andchild, finally provides them with clear, concise directions, which the womanrepeats (Feedback) for the doctor ’s confirmation.

Finally, the nurse pursuing the Essamine puzzle finds her answer in thepatient’s history. Essamine is the name of the patient’s five year old daughter.And little Essamine’s mother, equipped at last with clear instructions, findsher husband’s room.

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SYNOPSIS(continued)

BACKGROUND

“Words, like glasses, obscure everything which they do not make clear.”Joseph Joubert

THE POWER OF WORDS

As our world grows more complex, it becomes increasingly important that weunderstand the power of words and learn how to use them effectively. Wordscan help or hinder our relationships with one another. Writer Ingrid Bengissees words as a form of action, capable of influencing change. Words talk tothe mind, which produces images, thoughts and emotions; thus generatingactions. Words allow us to crystallize our thoughts and make themrecoverable, both to ourselves, and to others. But used carelessly, words canalso obscure our thoughts. As Herbert Spencer reminds us in his book,“Principles of Ethics,” “...misused words generate misleading thoughts.”

When you follow a profession that impacts the lives of human beings, thereis no room for obscured or misleading thoughts. This makes the use of clearand concise language not an option, but a necessity for healthcareprofessionals.

As the video, COMMUNICATION IN HEALTHCARE: The Power ofWords explains, a successful communication has five basic elements, eachcrucial to keeping the meaning of the message intact. Those five elementsare: The Sender, Language, Environment, The Receiver, and

Feedback.

The Sender

“The most basic of all human needs is the need to understand and beunderstood.” Ralph Nichols

According to the book “Communicating Comfortably,” we spend about sevenout of every ten waking hours communicating, either in the role of Sender orReceiver. Communication specialists Allen and Lientz, tell us that it is theresponsibility of the Sender to transfer the meaning of the message intact bylaunching the idea in an open, honest and clear manner, so that it doesn’t haveto be decoded by the Receiver. The Sender must also be prepared to react ifthe Receiver misunderstands or seems confused. This sounds simple enough,but many people find this kind of open and direct verbal or writtencommunication uncomfortable or difficult.

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One reason for this is the conflict many of us feel between our desire to beconnected, and our desire to maintain our individuality. This conflict,according to Dr. Deborah Tannen, is part of being human. In her book, “That’sNot What I Mean,” Tannen writes that the double bind created by this conflictprevents perfect communication. What we do, Tannen says, is makeadjustments from one side to the other with what she calls the “politenessphenomena.” How this phenomena is played out depends on what oneconsiders polite behavior, based on one’s background and culture.

Character is another factor that determines whether or not our meaningarrives intact. As Aristotle pointed out, a person’s character cannot beseparated from what he does or says, and therefore has a profound impact onthe effectiveness of his message. To ensure that we are perceived as authentic,Lilyan Wilder suggests in “Talk your Way to Success” that we need to projectour real selves from the inside out. “Three dimensionality, being in touchwith real feelings, at one with our bodies, reacting honestly and humanly tothe world.” These, according to Wilder, are the qualities that make forsuccessful communication.

Meta Messages, or the non-verbal aspects of communication, such as bodylanguage, gestures, eye contact, dress, intonation and facial expression alsoimpact on the Sender’s ability to transfer a message intact. Like character,they affect the Receiver’s perception of the credibility of both the Sender andthe message.

How a message is received is also affected by the Sender’s attitude. If theSender projects a negative attitude, toward either the message or the Receiver,this perceived attitude will distract from the message, and probably triggerresistance to it. When this occurs, there is little chance that the message theSender intended will arrive intact. On the other hand, a positive, enthusiasticattitude on the part of the Sender usually reduces both the possibility fordistortion and resistance to the message.

BACKGROUND(continued)

Language

“No man means all he says, and yet very few say all they mean, for wordsare slippery and thought is viscous.” Henry B. Adams

For successful communication, we need to choose words that are precise andappropriate. Because words are perceived differently by different people andin different situations, we need to be aware of not just the dictionary meaningof our words, but the connotation those words will have for the Receiver. Thismeans that the more we know and understand our Receiver, the better chancewe will have that our intended message will be delivered intact.

In searching for the appropriate words, the Sender should be aware that theReceiver may already have thoughts on the subject. These implied thoughtswill affect how they receive the message. For effective communication to takeplace, these thoughts must be consistent with the Sender’s intent. Or, as Dr.Myles Martel writes in “The Persuasive Edge,” “My word choice must bothaccurately capture my thoughts and accurately stimulate yours.”

Communications specialist B.J. Hateley reminds us That Senders will have abetter chance of getting their message across without triggering defensivenessin the Receiver if they talk or write from their own perspective. Using “I”statements instead of “you” statements when expressing an opinion helpsprevent conflict. Loaded words should be avoided. In “Smart Moves,” SamDeep and Lyle Sussman call these “Red Flag Words;” words that offendpeople or provoke strong emotional responses, such as referring to a womanas a “girl.” Deep and Lyle also suggest caution when using idioms (whichmay confuse outsiders), euphemisms (which weaken language), and jargon(which can alienate Receivers). Other words that could interfere with apositive reception for our message are “should” and absolutes such as“always” and “never” which can make even a friendly, well intended messagesound dictatorial or arrogant.

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Environment

“To do two things at once is to do neither.” –Pubilius Syrys

Ideally, all important communication should be launched in an organizedenvironment, free from distractions. For pilots and air traffic controllers (theexample shown in the video) this does not present a problem.Communicating with each other is a primary part of their jobs, so theirenvironments have been designed to expedite clear communication.Hospitals and health care facilities, however, are designed to facilitate thecare of patients, not promote ongoing communication. Finding an area freeof distractions in one of these facilities, an area conducive to creating clearcommunication, may be no easy task. While it is true that few healthcareprofessionals enjoy the luxury of being able to control their environment, weall have the ability to create a distraction-free psychological environment bydirecting our focus completely on the work at hand until it is completed. Thisfocus, if maintained, will increase the chances for the sender’s message toarrive undistorted and intact.

The Receiver

“It is the province of knowledge to speak, and it is the privilege of wisdomto listen.” –Oliver Wendell Holmes

A written communication is usually read thoroughly, and reread, if themeaning is not clear at first. A verbal communication seldom receive suchattention. This is unfortunate, since seventy-five per cent of allcommunication is verbal. In fact, ineffective listening is the greatest barrierto successful communication.

There is a good reason we often find it difficult to maintain our concentrationwhen someone is talking to us. Our brain is capable of thinking at five wordsa second, but most speakers speak at half that pace. So if the brain is onlyspending about one half of its processing capabilities to record and interpretwhat is being said, what is the rest of it doing? Sometimes we begin planningour rebuttal or our next question, or think about something we need to do.Sometimes our brain just takes a mental vacation, and we daydream.

One of the reasons most people are poor listeners is that they have neverlearned how to listen. On the average, our formal training includes eight totwelve years of writing, six to eight years of reading, one to three years ofspeaking, and no formal training in listening. This is why the average persononly remember a small percent of what they hear.

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BACKGROUND(continued)

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To improve our listening habits we first must want to listen, because learningto listen is hard work. It means learning not to let our minds wander; stayingin the moment. Maintaining eye contact with the Sender can help theReceiver stay focused on the message. Asking questions for clarification atthe appropriate time is helpful, but interrupting the Sender could interferewith his or her ability to deliver a clear message. Probably the greatest toolboth the Sender and the Receiver have for staying focused is the use ofFeedback.

Feedback

Successful communication requires that the message being sent be perceivedin the same way by both the Sender and the Receiver. As illustrated by thepilot and the air traffic controller in the video, the best way to ensure this isfor both parties to provide feedback, verifying and clarifying what has beensaid. This could involve the Sender asking the Receiver if the message isclear. The Receiver could repeat what the Sender said, rephrasing the thoughtin his own words to ensure that he has understood it correctly. Or the Receivercould ask for clarification of something the Sender said. The essential pointto remember is that during F e e d b a c k the S e n d e r and the R e c e i v e rcommunicate to each other their clear understanding of the message.

Summary

The ability to communicate clearly is always desirable, but for healthcareprofessionals it is critical. The five basic elements of eff e c t i v ecommunication discussed here and presented in the video,COMMUNICATION IN HEALTH CARE: The Power of Words, provideshealthcare professionals with a tool to help them develop this important skill.The five elements necessary for clear communication are:

• The Sender who launches a thought into the world.• Language the words must be clear and specific.• Environment that needs to be as organized and as free of distractions as

possible.• The Receiver responsible for interpreting the message.• Feedback to guarantee the Sender and the Receiver understand each

other completely.

PROGRAM CHECK LIST

Before Meeting With Your Group to View the Video:

• Preview the video, COMMUNICATION IN HEALTH CARE: ThePower of Words and make reminder notes on aspects of the video youmight want to emphasize with your group, in keeping with your goals forthe training session.

• Prepare an introduction for the video that will focus participants on theaspects of the training video that best address your training goals.

• Review the suggested Training Designs . Select the design mostcompatible with your training goals, or combine sections from both thatyou feel are appropriate.

• Check out room and technical equipment to make sure everything youwill need is in working order.

• Select and photocopy worksheets in this Leader’s Guide that you plan touse.

• If possible, obtain a list of the participants so you can familiarize yourselfwith their names.

• Prepare an opening statement to introduce yourself and the purpose of thework session.

• Check to make sure you have all the materials you need: video and videoplayer, workbook, flip board and tablet, markers, timepiece, handouts,pencils for all participants (if you choose to use the “Getting the Picture”exercise), etc.

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TRAINING OBJECTIVES

After viewing H E A LTHCARE COMMUNICATION: The Power o fWords, and completing the appropriate exercises in the suggested TrainingDesigns in the Leader’s Guide, viewers will:

• Understand the power of words and particularly the impact the proper orcareless use of words can have on their ability to function effectively intheir job as a healthcare professional.

• Recognize the Five Stages of Clear Communication: A responsibleSender. Clear Language A conducive Environment. An activeReceiver Precise, frequent Feedback.

• Be aware of their individual responsibility for clear, understandablecommunication whether they are the Sender or the Receiver.

• Be able to put the strategies and ideas presented in the video andworkbook into action to improve their communication skills.

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DISCUSSION STARTERS

• What is your definition of good communication?

• What do you think is essential for good communication to take place?

• Think of situations in your work where mis-communication has created aproblem. What was the cause of the miscommunication?

• What do you find most difficult about trying to communicate informationto a colleague or patient?

• When asked to provide directions, how do you determine how much andwhat kind of details to provide the individual asking? When asking fordirections, what kind of and how much details do you expect?

• You have probably all heard the expression “the power of words.” Whydo you think some words seem to have power? Can you give someexamples?

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SUGGESTED TRAINING DESIGNS

While they differ slightly in focus, either of the following two suggestedTraining Designs will reinforce the effectiveness of your use of the videoCOMMUNICATION IN HEALTHCARE: The Power of Words.”

Training Design 1 addresses the overall challenge of helping today’shealthcare professionals strengthen their ability to communicate effectivelywith colleagues and patients or clients. Equal weight is given to all fiveelements of clear communication: T h e S e n d e r, L a n g u a g e,

Environment, The Receiver, and Feedback. This design concentrateson the symbiotic relationship between these five elements, and stresses thecritical importance of each one.

Training Design 2 also covers and stresses the need for all of the fiveelements necessary for clear communication. However, this training designplaces a special focus on the most pervasive cause of failed communication—i n e ffectual listening. While listening is most often perceived as theresponsibility of the Receiver, Senders also need well developed listeningskills, or the fifth element of clear communication, Feedback, will not workproperly. Training Design 2 includes exercises that can help you alertparticipants to weaknesses in their listening skills, and provides techniquesand suggestions for helping them to improve these skills.

HOW TO USE THESE DESIGNS

We have presented you with two separate approaches for your trainingsession. One of these designs may be a perfect fit for your group. However, ithas been our experience that different groups have different strengths andneeds.

You may find elements in both which address areas which will help you meetyour specific training goals. We suggest you select whatever elements youfind of value and customize a program that best meets your needs.

TRAINING DESIGN 1

PRE-VIEWING DISCUSSIONIntroduce yourself to the workshop. Underline the specific importance ofclear communication in a profession like healthcare, wheremiscommunication can put patients at risk. Explain that in today’sworkshop, you will be looking at how to improve their communicationskills, state it now. (2 minute)

Begin the session with a brief discussion about communication. Use thediscussion starters on page 12. Optional: Write some of their answers onyour flip chart pad to refer to after the group views the video. This willhelp you gauge changes in attitude or understanding. Do not comment orcorrect any misconceptions at this point. (6 minutes)

INTRODUCE VIDEO Briefly remind participants of the reason you areshowing the video, and alert them to anything you may want them to lookfor while watching it. (2 minutes)

SHOW VIDEO (18 minutes)

AFTER VIEWING THE VIDEO, ask participants to name the fiveelements necessary for clear communication. Write their answers on aclean sheet on the clip board, leaving space under each element forfurther information. Once the list is completed, have the group explainwhat must happen in each of these five stages to ensure that thecommunication is clear. (For example: The Sender launches the thought.The Language must be clear and specific, etc.) Record their answers. Ifappropriate, refer back to any comments you recorded during the pre-viewing segment that might be relevant to this discussion. (15 minutes).

HAVE PARTICIPANTS GO THROUGH EXERCISE A(page 17) (28 minutes)

HAVE PARTICIPANTS GO THROUGH EXERCISE B(page 22) (19 minutes)

END SESSION. Answer any final questions and summarize theinformation presented in the workshop. (5 minutes)

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Materials Needed:

Flip chart, markingpens, video, videoplayer, photocopies ofworksheets I & II andpencils.

1 1/2 - 2 hours

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TRAINING DESIGN 2

PRE-VIEWING DISCUSSIONIntroduce yourself to the workshop. Establish why the group is there. Ifthere is a specific goal you wish to accomplish beyond helping yourgroup acquire a better understanding of how to improve theircommunication skills, state it now. (1 minute)

HAVE PARTICIPANTS GO THROUGH EXERCISE C. (page 26)(8 minutes)

INTRODUCE THE VIDEO, C O M M U N I C ATION IN HEALT HCARE: The Power of Words. Explain that the video is about the fivecrucial elements necessary for clear communication. Instruct participantsto look for these five elements as they watch the video. (2 minutes)

SHOW VIDEO (18 minutes )

DISCUSS THE VIDEO. Ask your group to name the five essentialelements of clear communication explained in the video and write theiranswers on the flip board, leaving space under each element foradditional information. When the list is complete, discuss each elementseparately. Have participants explain what must happen in each of theseelements for clear communication to take place. (For example, theprocess begins when the Sender launches a thought in the form of amessage. The Language must be clear and specific.) Write their answersunder the appropriate headings. (15 minutes)

DISCUSS THE ROLE OF LISTENING IN THE OVERALL PROCESS.Ask participants to guess what the number one cause ofmiscommunication is. Provide them with a hint: the sequence in thehospital billing department.) Once the group identifies “ineffectuallistening” as the answer, explain that listening is not intuitive, but alearned skill, and why it is such a difficult skill to learn. Point out thatwhile it is obvious that listening is the job of the Receiver, the Sender alsohas to know how to listen, or the fifth element necessary for clearcommunication, Feedback, cannot take place. (4 minutes)

H AVE PA RT I C I PANTS COMPLETE EXERCISE D.(page 27) (15 minutes)

1 1/2 - 2 hours

Materials Needed:

Flip chart, markingpens, video, videop l a y e r, photocopiesof worksheets III &I V, The Frog Story(Exercise C), andpencils.

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INTRODUCE EXERCISE E “GETTING T H EPICTURE.” (page 30) (40 minutes)

Ask if there are any more questions. Leave your group with this finalthought about listening: For most of us, being listened to spells thedifference between feeling accepted and feeling isolated We all want ouropinions and point of view heard. But most people will not really listento our point of view until they are convinced that we have heard andappreciate theirs. So if we want our thoughts and ideas to be listened to,we need to practice good listening. (5 minutes)

TRAINING DESIGN 2(continued)

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Pass out pencils and Worksheet I (pages 18-20). Explain that the groupis now going to analyze some of the breakdowns in communicationpresented in the video. Briefly go over Worksheet I, answering anyquestions participants may have.

Have group complete Worksheet I.

Discuss Worksheet I. See Key to Worksheet I on page 21. During thecourse of the discussion, on a clean sheet on the flip board, record theanswers to the four questions. Ask the group to suggest how each of thecommunication failures could have been prevented.

EXERCISE A (Worksheet I) (28 minutes)

Katie M Simpson

When communication fails, it is rarely the fault of one person or a single element of thecommunication process. The following exercise provides an opportunity to analyze thecommunication failures illustrated in the video, to better understand where and how thecommunication process broke down. In each case, indicate which elements in the communicationprocess you believed failed, and the reason the failure occurred.

THE LOST WOMAN AND CHILD. What elements of the communication process failedto cause the woman to have so much difficulty finding her husband’s new room?

SENDER __________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

ENVIRONMENT____________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

LANGUAGE _______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

RECEIVER ________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

FEEDBACK _______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

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WORKSHEET I (Exercise A)

Katie M Simpson

ARGUING CO-WORKERS. How and why did the frustration and anger producing mis-communication occur?

SENDER _________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

ENVIRONMENT____________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

LANGUAGE_______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

RECEIVER ________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

FEEDBACK _______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

HEART PATIENT’S VISITOR. What elements in the communication process failed andcaused him to go to the wrong room and mistakenly believe his friend had died?

SENDER__________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

ENVIRONMENT ___________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

LANGUAGE ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

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Katie M Simpson

page 20


RECEIVER _______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

FEEDBACK ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

WATER SPILLING PATIENT. What kind of failure in communication frustrated thiswoman to such a level that she spilled the pitcher of water on the floor.

SENDER _________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

ENVIRONMENT ___________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

LANGUAGE ______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

RECEIVER _______________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

WORKSHEET I (continued)

Katie M Simpson

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FEEDBACK

THE LOST WOMAN AND CHILD . The issue here is vague instructions. During the originalcommunication, the nurse (SENDER) provided the woman (RECEIVER) with vague instructions(LANGUAGE: “Just turn left when you get off the elevator and you can’t miss it.”). TheENVIRONMENT could also have been a contributing factor. The nurse sounded hurried. Therewere probably distractions in the area when she made the call. The mother also had distractions,which may have prevented her from asking for a clarification of the directions (FEEDBACK).

ARGUING CO-WORKERS. ENVIRONMENT and LANGUAGE played a major role in thecreation of this communication failure. The SENDER, distracted as she responded to the receiver’squestion about the code, really didn’t hear or understood the question. And her LANGUAGE inresponding to the question was sufficiently VAGUE so that Bruce easily misunderstood it. But heis not without culpability in the problem. Distracted by his problem instead of her answer, hewasn’t really listening for her answer. The major problem here is that although they both thoughtthey were talking about the same thing, they weren’t, and because the element of FEEDBACK wasmissing from the communication, neither verified nor questioned the other to make sure they weretalking about the same thing.

HEART PATIENT’S VISITOR. This is a casebook example of how distractions in theENVIRONMENT in which the communication takes place can distort the communication. Thenurse (SENDER), distracted by the activity on the computer, never even really looks at the visitor,so has no sense of whether he understands her or not. The visitor (RECEIVER) must also acceptsome responsibility for the communication failure because he never questions or asks forclarification of her instructions (FEEDBACK.) You might also want to explore the visitorsmisunderstanding of what was going on in room 12 to remind your group that the meaning ofwords can change when the context in which they are used changes.

WATER SPILLING PATIENT. All the patient (SENDER) wants is for someone to clean up herspill, but she is having trouble getting her message through to the orderly (RECEIVER), notbecause she isn’t clear about what she wants, but because she has bumped into his assumptionabout what his job is in relationship to the size of the spill. The problem here is with theRECEIVER. This failure to obtain action when she communicates her need to the orderlyunderstandably frustrates the patient. The second issue here is a breakdown in communicationbetween the orderly, who in this case is the SENDER and the housekeeper (RECEIVER) becauseof their different perception of the meaning of the phrase “large spill.” This segment provides anopportunity to remind your group that communication between staff members seldom happens ina vacuum. Patients are impacted.

KEY TO WORKSHEET I (Exercise A)

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Hand out Worksheet II. “Your Communication I.Q.” Explain to yourgroup that now that they have seen and discussed the video, this brieftrue-false test will help them assess their understanding of the elementsnecessary for clear communication.

Have group complete Worksheet II.

Review Worksheet II. Have participants grade their own papers as youreview the answers to the quiz. (See Key to Quiz answers on page 25 ofthis guide.) Discuss the answers and any questions participants mayhave.

EXERCISE B (Worksheet II) (19 minutes)

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YOUR COMMUNICATION I.Q.

The more we understand the process of communication, the better the odds that our efforts tocommunicate will succeed. The following exercise is designed to help you determine yourcommunication I.Q. Give yourself ten points for every correct answer.

In any written or verbal communication, our understanding of our receiver, and choosing ourwords accordingly, can greatly improve our chances for being understood.

True q False

An environment with distractions actually helps communication because it forces the senderand the receiver to concentrate.

q True q False

One of the reasons people mis-communicate is because we tend to think slower than we talk.

q True q False

An explosion in the use of computers and other new technology in the healthcare industryhas greatly reduced our chances for mis-communication.

q True q False

Because language is inherently imprecise, we cannot assume that the words we use in acommunication will hold the same meaning for the receiver as they do for us.

q True q False

In any verbal communication, the role of the receiver is simply to focus on hearing what thesender is saying.

q True q False

The Sender bears total responsibility for the success or failure of a communication.

q True q False

WORKSHEET II (Exercise B)

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When engaging in feedback, the receiver should never paraphrase the sender’s words, butrepeat them exactly as they have been said.

q True q False

Listening is not intuitive, but a learned skill. Mastering this skill requires effort andconcentration.

q True q False

For successful communication, you must succeed in at least four of the five steps outlined inthe video.

q True q False

WORKSHEET II (continued)

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YOUR COMMUNICATION I.Q.

Some answers are obvious. Some require thought. For example statement 6 is only partially true.Receiver is also responsible for understanding, and feedback.

TFFFT

FFFTF

KEY TO WORKSHEET II (Exercise B)

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READ “THE FROG STORY.”

THE FROG STORY

A group of frogs were traveling through the woods, and two of them fellinto a deep pit. All the other frogs gathered around the pit. When theysaw how deep the pit was, they told the two frogs that they were as goodas dead. The two frogs ignored the comments and tried to jump up outof the pit with all of their might. The other frogs kept telling them tostop, that they were as good as dead. Finally, one of the frogs took heedto what the other frogs were saying and gave up He fell down and died.The other frog continued to jump as hard as he could. Once again, thecrowd of frogs yelled at him to stop the pain and just die. But he justjumped harder until, finally, he jumped out of the pit. When theyreached him, the other frogs said, “Did you not hear us?” He smiled andshrugged, not understanding. You see, he was deaf. The entire time hethought they were encouraging him.

DISCUSS THE STORY. When you have finished the story, ask themembers of your group to identify the communication messages in thestory. If you have chosen to use The Frog Story, guide the discussionso that they recognize that the story is really about:

a The power of words.Because the frogs gathered around the pit kept telling the two frogswho had fallen in that it was hopeless and they were as good asdead, one of the frogs gave up and died.

b Mis-communicationThe more the frogs on the edge of the pit yelled at the remainingfrog that it was hopeless, the harder he tried to jump out— because,being deaf, he didn’t understand what they were saying and mistookall their shouting for encouragement.

Point out that because our words have power, it is important that welearn to use them thoughtfully. And because every time wecommunicate, there is a possibility that our receiver may not hear ormay misunderstand our intended message, we need to learn to use wordsthat are specific and clear. Then explain that while our choice of wordsor language is a major consideration in our quest for clearcommunication, it is not the whole story.

EXERCISE C (8 minutes)

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Distribute pencils and WORKSHEET III. Explain that Worksheet IIIis designed to help the members of the group evaluate their own listeningskills. The purpose of the exercise is to help them become aware of theirstrengths and weaknesses as listeners, the first step in improving listeningskills.

Have participants complete Worksheet III.

GENERALDISCUSSION ON WORKSHEET III. When the group hascompleted the exercise, discuss the experience in general terms. How didthey feel about the exercise? What did they learn about effectivelistening? To complete the exercise, review with your group the fourimportant stages of effective listening:

• First the listener must actually hear the message. Environment playsan important role in this stage. Distractions such as noise, or anythingthat takes the receiver’s attention away from the message (includingthe receiver’s own thoughts) can prevent the Receiver from hearingthe message. If you can repeat the message, you probably have heardit.

• Next the listener must be able to interpret what he or she has heard.This requires an understanding of the sender’s language and context.Differences in experience, knowledge, culture, background, evenattitudes, between the Sender and the Receiver can cause theReceiver to misinterpret the sender’s message.

• The next crucial stage of effective listening is evaluation. TheReceiver must decide what to do about the information they havereceived.

• And finally, the Receiver must respond, verbally or visually, to let theSender know they understand the message.

Answer any questions about the four stages of effective listening.

EXERCISE D (Worksheet III) (15 minutes)

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LISTENING SKILLS - SELF EVALUATION

“We were given two ears but only one mouth. This is because God knew that listening wastwice as hard as talking.”

The following four minute exercise is designed to help you evaluate your ability as a listener. Noone will see your answers but you, so be honest with yourself. The first step to building effectivelistening skills is to be aware of where your weaknesses are, so you know what to work on.Check the square that best describes your answer, Always, Most of the time Sometimes

Occasionally, Never.

As a listener . . .

I look directly at people when they are speaking, and maintaincomfortable eye contact.

I can place myself in the speaker’s position and understand his orher feelings.

I understand what people mean, not simply hear what they say.

I am aware of a speaker’s inflections and body language andusually understand what they are telling me about the speaker’sfeelings.

I try to listen with an open mind, free of biases.

I don’t interrupt, correct, or complete sentences when others arespeaking

I respond to the speaker non-verbally by nodding or with facialexpressions that demonstrate I am listening.

I control any habits or mannerisms that might distract the speakeror others listening.

I listen and show respect to the speaker even when I’m not

WORKSHEET III (Exercise D)

ALWAYS NEVER

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

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interested in the subject.

I continue to listen and show respect to a speaker even when I feelI may know more about the subject.

I concentrate on the speaker’s ideas and concepts, rather than tryto memorize specific facts and figures.

I ask questions or rephrase the speaker’s comments, to ensure thatI understand what has been said.

I listen to the speaker with disciplined concentration, not lettingmy thoughts wander.

I think about the subject under discussion before responding.

I wait for the speaker to complete the presentation before formingmy opinion on what has been said.

I judge what has been said based on its merits, rather than on howI may feel about the speaker.

I am able to ignore the thoughts and comments of others, andform my own opinions about what the speaker is saying.

I ask relevant questions for clarification on points that aretechnical or that I do not understand.

I take notes when notes are appropriate

I am able to re-sort the order and importance of information whena speaker’s presentation is not correctly or effectively in

ALWAYS NEVER

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

q q q q q

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sequence. Provide each participant with a pencil and two sheets of paper. Ask for avolunteer to act as the Communicator for the exercise.

Give the Communicator a copy of Worksheet IV - PatternA (on page 31) in your Leader’s Guide(do not give outPattern B). Have the Communicator sit with his or herback to the group and describe the pattern of rectangles tothe participants as precisely and in as few words aspossible. Without talking to each other or asking questions,have all of the participants attempt to draw the pattern fromthe Communicator’s description.

At the end of ten minutes stop the exercise. Ask the participants how theyfeel about this example of one-way communication? Did they find theexercise difficult? Frustrating? Without comparing their results with theoriginal, ask for another volunteer to act as Communicator.

Give the new Communicator a copy of Worksheet IV -Pattern B (on page 32) in your Leader’s Guide. This timehave the Communicator face the group, and allowparticipants to ask question as the Communicator describesthe series of rectangles for them to draw.

At the end of the ten minutes have participants compare and discuss thedifference in the results between the first effort without feedback and thesecond effort with feedback. Which produced more accurate results?Which was easier; which more stressful?

EXERCISE E (Worksheet IV) (40 minutes)

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PATTERN A

WORKSHEET IV

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WORKSHEET IV

PATTERN B

Katie M Simpson

RECOMMENDED RESOURCES

Communicating With Today’s Patient. Essentials To Save Time, Decrease Risk and Increase PatientCompliance by Desmond, Joanne & Lanny R. Copeland. (Jossey-Bass Inc.) 2000

Speech in Personal and Public Affairs by Baker, Virgil L. and Ralph T. Eubanks (New York: DavidMcKay Company)

Communicating Comfortably by Buller, Linda K. and Lilles McPherson Shilling Amherst, (MA:Human Resource Development Press 1990)

Smart Moves Reading, Deep, Sam and Lyle Sussman,. (MA: Addison-Wesley Publishing Co. 1990)

Say It Right by Glass, Lillian (New York: G.P. Putnam’s Sons, 1991)

You Just Don’t Understand by Tannen, Deborah (New York: Simon and Schuster, Inc. 1990)

From Management to Leadership: Interpersonal skills for success in Healthcare by Manion, Jo (SanFrancisco: Jossey-Bass 2000)

Effective Listening Skills by Kratz, Dennis M. (McGraw Hill Companies 1994)

Interpersonal Relationships: Professional Communication Skills for Nurses 3rd edition. by Arnold,Elizabeth and Kathleen Underman-Boggs, (W.B. Sanders Company 1999)

Effective Interaction With Patients by Faulkner, Ann (Edinburgh: Churchill Livingstone, Secondedition, 1998)

The Art of Talking So People Will Listen: Getting Through To Family, Friends and Business Associatesby Swets, Paul W. (Simon & Schuster Trade Paperbacks)

Improving Communication Skills for Better Care by Fuzy, Jetta. RN, MS (Albuquerque NM:Hartman Publishing, Inc.)

The Lost Art of Listening: How learning to Listen Can Improve Your Relationships by Nichols,Michael P. (Guilford Publications 1996)

Communication: The Key to Therapeutic Relationship by Schuster, Pamela McHugh (Davis FA 1999)

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COMMUNICATION IN HEALTHCARE - TrainingABC