What Do Radiology Incident Reports Reveal About In-Hospital Communication
Title
Critically discuss how leaders can communicate effectively to develop staff and transform an organization, with particular emphasis on health care organization. Illustrate your argument with critical discussion of examples from clinical experience and the literature on leadership and communication.
Introduction
According to Westwood (2001), effective communication was defined as a two-way process that leaders transfer the right message to the team members who receive the correct message and understand it simultaneously. Blake (2013) purposed that nurses always find job satisfaction if there is a good quality of communication in their workplaces. Therefore effective communication becomes an important element to retain manpower and avoid turnover of nurses. Oppositely, when communication breakdowns such as bias and misunderstanding …show more content…
occurs between team members, it will lead to a decline in job satisfaction of workers and even a irretrievable result such as medical incident (Dimigen et al., 2012). Burnard (1997) stressed that the nurse leaders must promote a harmony workplace environment through effective communication. On the other hands, clinical leaders can use communication as a motivation tool to increase morale of the team and prevent any medical error (Wolk, 1999).
In this paper, the writer will explore different aspects of communication through clinical experience and find out how effective communication helps nurse leaders to obtain common understanding in team, prevent conflict and motivate all team members to achieve final goals of the organization.
Background
In Hong Kong, community nurses visit elderly who are living in private old age homes everyday. Most of these elderly suffered from several chronic diseases and need intensive nursing care. As old age home staffs who are neither registered nor enrolled nurses always provide daily activities such as feeding and bathing to these frail elderly, there is a closely co-operational relationship between community nurses and old age home staffs. The job responsibilities of community nurses include educating and empowering the old age home staff in order to provide proper nursing care skills to the elderly and to maintain patient’s health. One day, an incident occurred in one of the old age homes of my working cluster. An old lady who newly started tube feeding suffered from aspiration pneumonia. Milk directly fed into the patient’s lung instead of her stomach since the old age home staff didn’t check the placement of feeding tube before feeding the patient. The old age home staff involved in the incident stated that she was a new staff and she’d never taught by a community nurse about the procedure of tube feeding whereas an experienced community nurse emphasized that she had taught the involved staff once. As a supervisor of the nursing team, the writer tried to investigate the incident and found out that communication breakdown between different parties was the “prime criminal” and the main factor of the incident. On the other hands, managing communication breakdown and promoting effective communication became the urgent and challenging issues faced by nurse leaders.
Literature review
As already mentioned, communication is defined as sharing a mutual meaning between a group, an organization or even a community (Barrett, 2011). Daniels and Spiker (1991) believed that communication is not just simply sharing meaning but people can also obtain new ideas through the information sharing of communication process. The method of information and meaning transmission includes formal and informal communication (Daniels & Spiker, 1991). Besides, Longest and Young (2006) suggested that verbal and non-verbal communication is another form of meaning sharing.
Formal and informal communication
Daniels & Spiker (1991) cited the differences between formal and informal communication. Formal communication is likely connects with relations of power and authority. In a formal communication, information flows “upward” from a high- ranking staff such as department head to manager to junior staffs regarding guidelines and directions of the department. Feedback then flows “downward” from the junior staffs to department head through oral or written report. As formal communication always linked with a chain of command, staffs always need to maintain a level of respect and clearness when adopting formal communication at workplace (Daniels & Spiker, 1991).
Different from formal communication, Daniels & Spiker (1991) suggested that an informal communication is not related to any ranking and organizational culture. It just uses to satisfy the emotional needs of an individual. This kind of communication keeps off all constraints from the formal communication. It makes people to feel calm and relaxing as information shared by oral words directly and spread quickly throughout the group without any restriction of departmental rules and guidelines (Daniels & Spiker, 1991)
Verbal and non-verbal communication
When the first human beings knew how to use symbols to communicate, verbal language started to present. Language is human’s most important tool of verbal communication (Longest and Young, 2006). People have an inborn capacity for language. They can use oral language or written words as a channel for self- reflection, interaction and communications. Furthermore, signs and symbols made up of laughing and cries are also the examples of verbal communication (Longest and Young, 2006). However, all human languages are legally controlled by many rules under a complex system such as rules of pronunciation and verbal symbols (Rosengren, 2000). Since these rules are always extremely different between different countries of the world, a communication breakdown can easily occurred when the rules are unknown to someone (Rosengren, 2000).
According to Longest and Young (2006), non-verbal communication is also an important element of human communication. There are various types of non-verbal communication such as human’s gesture, emotions and feelings. Others forms of non-verbal communication include pictures and music, as well as more representing arts such as drawing and drama. Moreover, logic, mathematics and statistics are three powerful non-verbal communicative instruments for people to develop their strength from facts (Longest and Young, 2006).
Barriers to communication
The barriers of effective communication can be occurred at any stage of communication process. They may change the real meaning of message created by the sender and cause confusion and misunderstanding to the receiver (Fink-Samnick, 2002). Better understanding of these barriers can improve the quality of communication and help both sender and receiver to transmit a clear and accurate message. The examples of barriers to effective communication include the use of jargon, emotional barriers, lack of attention, differences in perception and culture, physical disabilities and language differences (Fink-Samnick, 2002). Overcoming these communication barriers at workplace becomes an important issue of leadership. It help leader to eradicate difficulties, gets all staffs closer and lessened the risk of incident (Scott-Cawiezell et al., 2007). We will take a closer look at these barriers in the following section of discussion.
Impact of ineffective communication
Quality of clinical communication is measured by five factors that include timeliness, accuracy, openness, satisfaction and understanding (Devers et al., 1991). Timeliness refers to the degree which information is spreading to public instantly. Accuracy means the degree to which all the medical and nursing staffs think that the information being transferred is correct and reliable. Openness refers to the extent that whether team members can communicate openly. Satisfaction involves the extent to which team members are satisfied in the communication process. Understanding refers to the degree that everyone obtains the information without doubting and misunderstanding (Devers et al., 1991).
When one of these five factors is being ignored, ineffective communication will easily occur in clinical areas. Ineffective communication always brings serious result among staffs and patient (Dimigen et al., 2012). Lindbloom et al. (2002 ) found that incorrect and inappropriate communication delayed timely treatment of acutely and critical patients. Ineffective communication also caused various kinds of medication error (Scott-Cawiezell et al., 2007) and medical incident (Forbes-Thomspon & Gessert, 2005) in a certain extent. Thus, health care providers must recognize how effective communication helps them to connect with others, to improve relationships with colleagues and to increase productivity at work.
Relationship between leadership and communication
Wolk (1999) proposed that effective communication is the best tool for a leader to achieve the organizational goals and improve relationships between leaders and staffs. She found that high degree of openness and satisfaction of communication could reduce staff turnover. One the other hand, leaders can develop and enhance role of the nursing staff through supportive communication (Apker, 2001). As relationship plays an important role in dynamic communication system, leaders should promote positive relationship among staffs in order to obtain trust from the staffs and to empower them in an effective manner (Apker, 2001). Without effective communication in relationships result in misunderstanding, frustration and creating more differences between people Wolk (1999).
Discussion
Communication between nursing staffs and carers can affect quality patient care and clinical outcomes. The following discussion is going to analyse the different aspects of communication breakdown happened at my workplace and how it led to the serious incident as mentioned before. As a team leader, the writer will further explore on how a leader can overcome the problem of communication breakdown through effective communication.
Cultural and Language Barriers
Effectiveness of communication is often determined by cultures (DerGurahia, 2008). Different kinds of culture presented in the workplace will lead to communication barriers. Refer to the case study, since the old age home staff and the community nurse having different cultures on status, religion, family role etc that finally lead to communication breakdown at their workplace. Besides, the old age home staff is a new immigrant from Mainland China who uses “Mandarin” as her native language but the community nurse doesn’t familiarize about it, it caused problem of language barriers at workplace.
Channel Barriers
The writer investigated the incident and found that channel barriers presented between both parties. The community nurse taught the procedure of tube feeding to one of the old age home staffs and then ask the “educated staff” to teach the procedure to the “involved staff” of the incident. In this communication process, the “educated staff” might filter the information that obtained from the community nurse and the final message might be misrepresented. The channel barrier is common and always present at workplace, which lead to misunderstanding between team members (Boockvar, Burack & Shah, 2010).
Perceptional and Personality Barriers
People always perceive an issue according their own mindset. When two people holding different viewpoints can result in communication breakdown and even conflicts (Boockvar, Burack & Shah, 2010). In the case mentioned before, the nurse thought that tubing feeding was a “ patient care procedure” in her concept whereas the old age home staff inferred tubing feeding as a “daily job routine” only. The different viewpoints caused perceptional barrier and led patient suffered from incident at last. Besides, the different personality of two people also created communication barrier. As the old age home staff was always too shy of asking anyone about her doubts on patient care, the community nurse would never know the weakness of the old age home staff and wouldn’t help her to solve the problem automatically.
In order to maintain quality of care and protect patient’s safety, nurse leaders must ensure all nursing staffs have good communication skills and break down all the barriers mentioned before. Although nurses’ competence of performing effective communication is a challenging issue, the writer thinks that leaders can ensure the standard quality through the following communication skills.
Using effective communication technique
As a team leader, the writer tried to promote some techniques for effective communication to both the community nurse and the old age home staff. I think that all these techniques can act as the icebreakers to solve the problem of communication barriers in workplace. Listening is one of the important techniques. It helps one to focus and digest the conversation and then giving self-feedback accurately (Wolk, 1999). Through listening, the audience will have a sense of respect that can improve the communication between both parties (Wolk, 1999). Besides, avoiding arguments and taking criticism are other essential technique (Wolk, 1999). Arguing always wastes time and lead to an unhealthy conversation whereas criticism positively can provide a constructive way of problem solving.
Apart from the techniques mentioned above, the writer believes that understanding the audience’s perception and giving proper feedback can’t be ignored in effective communication. Understanding and feedback always provide leaders a clear picture of one’s weakness or strength and allow leaders to find a suitable way to solve the problem of communication barriers.
Role modeling and leadership style
Role modeling of leaders can support staffs and spurring good communication behaviors in team (Davis and Rosenblatt, 2009). The writer agrees that good communication skills of leaders provide a calm working atmospheres that improve nurses’ morale and job satisfaction. Moreover, leaders need to apply approachable leadership when communicate with the team members. They should be open, flexible and always involving staffs in decision-making (Thyer, 2002). On the other hands, respecting staffs and listening to staffs are good communication behaviors (McMurray and Williams, 2004). It helps leaders to obtain suggestions and feedbacks from the staffs and find out their problem on daily work.
Conflict Management
Since different people will have different viewpoints and ideas, conflict is natural and always occurs in a group (Brinkett, 2010). All kinds of conflict are created by personal interest and difference in goal and values that will lead to the outcomes of poor clinical care, low morale of team and even regrettable error. Therefore, conflict management skill is essential in leadership. In my point of view, one of the crucial points of conflict management is providing working environment that nurses can speak out boldly when problem arise. Besides, conflict resolution is another skill of conflict management (Milstead, 1996). Conflict resolution provides a platform of discussion that just focusing on the problem. Leaders should aware gender or cultural differences during conflict resolution. All follow up actions should also be agreed by everyone participated in discussion process (Milstead, 1996).
Emotional intelligence
Emotional intelligence means identification of own and others’ feelings. A leader who always understands staff’s feeling can get benefits on his or her leadership. There are three emotional intelligence skills for leaders to adopt. They include social skills, motivation and self-awareness. Social skills refer to the ability to use communication skills to persuade staffs and create change in team (Pahl, 2008). Motivation is leaders’ enthusiastic on work and the ability to promote optimism in workplace (Pahl, 2008). Besides, Rosenblatt and Davis, 2009 suggested the nurse leaders should realize how their communication skill could affect others. On the other hands, they need to evaluate their relationship and interaction with their colleagues regularly. Through the self-awareness process, the leaders can improve their communication skill and to discover more effective ways they can communicate with their staffs.
Mentoring
The writer thinks that mentoring is an essential part of implementation of effective communication. To prevent recurrent of the incident, the writer invited the community nurse as the “mentor” whereas the old age home staff as the “protégé”. Through mentoring program and establish successful mentoring relationships, mentor can create a positive climate of open communication and offer constructive criticism to the protégé in a supportive way. On the other hands, the protégé can communicate openly with the mentor in order to get impartial feedback from mentor. Furthermore, a successful mentoring relationship requires a commitment from both parties. To achieve the goal, both mentor and the protégé should respect each other, communicate regularly and set up a development plan together.
Shared governance
Thyer (2002) highlighted the importance of shared governance in leadership. Inviting staff in the process of decision-making can improve communication and help leaders to empower their staffs more easily (Thyer, 2002). To achieve shared governance, the writer thinks that leaders should provide an open communication system within the team, making policies and guidelines that convince staffs to communicate willingly. Chapman and Robert-Malt (2008) suggested that the nurse leaders should set up committees of communication that encouraging staffs to voice out their thought openly. For me, these committees are valuable that enhance the communication between staffs and leaders.
Recommendation
Although leaders can use effective communication to transform the team and improve the quality of care, reverse outcomes and resistances may occur if changes were not managed properly (Domm, Eisler & Smadu, 2007). Change management should be enhanced to avoid such outcomes and resistances. According to Lewin (1951), the initial phase of change should prepare staff to accept the process of change and set up a new way to improve status quo. During practical process, management team should support the change such as propagating the importance of effective management at workplace. Meanwhile, leaders should being open-minded to team members’ concerns and explain the need of change clearly within the team.
Effective communication always becomes more significant in the second phase of change. In this phase, team members start to resolve their doubts and follow the new way and direction of their leaders (McCalman & Paton, 2008). Leaders should give clear explanations to their staffs on how effective communication will bring positive affect to them.
The third phase of change happens when all staffs accepted the new ways such as new protocol on communication channel (McCalman & Paton, 2008). In this phase, leader should develop the changes into the culture. Besides, feedback system can’t be ignored to support the change.
Conclusion
In conclusion, leaders’ strategies of effective communication and the provision of an understanding of team dynamics enhanced good working relationship. The good relationships help leaders to build a successful team and develop a positive atmosphere at workplace in a certain extent. However, leaders must develop interpersonal relationship and elevate staff’s efforts at communication in order to keep on team-building. With effective communication, team members become more willing in voicing out their feelings on every issue, finding out and solving problems together, resolving conflicts and preventing undesirable incident at last.
Furthermore, effective communication plays an important role in enhancing team’s spirit and staffs’ job satisfactions, which help leaders to retain manpower in workforce and maintain economic stability of hospital. Last but not least, the writer expects the management group and the staff development expert can lend a hand and support the leaders to develop strategies of effective communication in order to build more successful and cohesive teams in future.
References
Apker, J. (2001). Role development in the managed care era: A case of hospital-based nursing. Journal of Applied Communication Research, 29, 117-136.
Barrett, D.J. (2001). Leadership Communication (3rd ed.). America , New York: The McGraw-Hill Companies, Inc.
Blake, N. (2013). Healthy Work Environments and Staff Nurse Retention: The Relationship Between Communication, Collaboration and Leadership in the Pediatric Intensive Care Unit. Nursing Administration Quarterly. 37(4), 356-370.
Boockvar, K. L., Burack, O., & Shah, F. (2010). Perceived Barriers to Communication Between Hospital and Nursing Home at Time of Patient Transfer. Journal of the Amercia Medical Directors Association, 11(4), 239-245.
Brinkett, R. (2010). A litersture review of comflict communication causes, costs, benefits and interventions in nursing. Journal of Nursing Management, 18, 145-146.
Burnard, P. (1997). Skills for Health Professionals (2nd ed.). Cheltenhan, United Kingdom: Stanly Thornes (Publishers) Ltd.
Chapman, Y., & Robert-Malt, S. (2008). Finding the right direction: the importance of open communication in a governance model of nurse management. Contemporary Nurse, 29, 60-66.
Daniel, T.D. & Spiker,B.K. (1991). Perspective on Organizational Communication (2nd ed.). Dubuque, India : Wm.C. Brown Publishers.
Davis, M.S, & Rosenblatt, C.L. (2009). Effective communication techniques for managers. Journal of Nursing Management, 40(6), 52-54.
DerGurahia, J. (2008). Breaking barriers. Modern Healthcare, 38(27), 28-30.
Devers, K.J., Gillies, R.R., Rousseau, D.M., Shortell, S.M., & Simons, T.L.
(1991). Organizational assessment in intensive care units (ICUs): construct development, reliability, and validity of the ICU nurse-physician questionnaire. Medical Care, 29(8), 709-726.
Dimigen, M., Hordem, A., Strwart, M.J.,& Westwood, J. I. (2012). What do radiology incident reports reveal about in-hospital communication processes and the use of health information technology? Studies in Health Technology and Informatics, 178, 213-218.
Domm, E., Eisler, k., & Smadu, M. (2007), Developing high-quality health-care workplaces: facilitators and barriers. The Canadian Nurse, 103(9), 11-12.
Fink-Samnick, E. (2004), Was that Fee or Free? Managing Communication Barriers. Retrieved from http://ezproxy2.corp.ha.org.hk:2056/science/article/pii/S106192590400181X.
Forbes-Thompson, S. & Gessert, C.E. (2005). End of life in nursing homes: connections between structure, process, and outcomes. Journal of Palliative Medicine, 8(3), 545-555.
Lewin, K. (1951). Field theory in social science; selected theoretical papers. D. Cartwright (ed.). New York: Harper and
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Lindbloom, E., Longo, D.R., Mehr, D., Salerno, L.D., & Young, J. (2002). Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study. Journal of Amercia Medical Diectors Association, 3(6), 360-365.
Longest , B.B. & Young, G.J. (2006). Coordination and Communication. In S.M . Shortell & A.D. Kaluzny(Ed.) (5th ed), Health care management: Organization design and behavior (pp. 237-275). Albany, NY: Delmar.
McCalman, J., & Paton, R. (2008). Change Management: A Guide to Effective Implementation. London, UK: Sage.
Milstead, J.A. (1996). Basic tools for the orthopaedic staff nurse- part II : conflict management and negotiation. Orthopedic Nurse, 15(2), 39-45.
Pahl, N. (2008). The Role of Emotional Intelligence in Leadership. Scholarly Research Paper. Retrieved from http://books.google.com.hk/books?id=coapjezZmb4C&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false.
Rosengren, K.E. (2000). Communication: an introduction. London, UK: SAGE Publications Ltd.
Scott-Cawiezell, J., Vogelsmeier, A., & Zellmer, D. (2007). Barriers to safe medication administration in the nursing home-exploring staff perceptions and concerns about the medication use process. Journal of Gerontological Nursing Assication, 33(4), 5-12.
Thyer, G.L. (2002). Dare to be different: transformational leadership may hold the key to reducing the nursing shortage. Journal of Nursing Management, 11, 73-79.
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Wolk, D. (1991). Leadership Through Communication. Clinical Newsletter, 21, 18.
Critically discuss how leaders can communicate effectively to develop staff and transform an organization, with particular emphasis on health care organization. Illustrate your argument with critical discussion of examples from clinical experience and the literature on leadership and communication.
Introduction
According to Westwood (2001), effective communication was defined as a two-way process that leaders transfer the right message to the team members who receive the correct message and understand it simultaneously. Blake (2013) purposed that nurses always find job satisfaction if there is a good quality of communication in their workplaces. Therefore effective communication becomes an important element to retain manpower and avoid turnover of nurses. Oppositely, when communication breakdowns such as bias and misunderstanding …show more content…
occurs between team members, it will lead to a decline in job satisfaction of workers and even a irretrievable result such as medical incident (Dimigen et al., 2012). Burnard (1997) stressed that the nurse leaders must promote a harmony workplace environment through effective communication. On the other hands, clinical leaders can use communication as a motivation tool to increase morale of the team and prevent any medical error (Wolk, 1999).
In this paper, the writer will explore different aspects of communication through clinical experience and find out how effective communication helps nurse leaders to obtain common understanding in team, prevent conflict and motivate all team members to achieve final goals of the organization.
Background
In Hong Kong, community nurses visit elderly who are living in private old age homes everyday. Most of these elderly suffered from several chronic diseases and need intensive nursing care. As old age home staffs who are neither registered nor enrolled nurses always provide daily activities such as feeding and bathing to these frail elderly, there is a closely co-operational relationship between community nurses and old age home staffs. The job responsibilities of community nurses include educating and empowering the old age home staff in order to provide proper nursing care skills to the elderly and to maintain patient’s health. One day, an incident occurred in one of the old age homes of my working cluster. An old lady who newly started tube feeding suffered from aspiration pneumonia. Milk directly fed into the patient’s lung instead of her stomach since the old age home staff didn’t check the placement of feeding tube before feeding the patient. The old age home staff involved in the incident stated that she was a new staff and she’d never taught by a community nurse about the procedure of tube feeding whereas an experienced community nurse emphasized that she had taught the involved staff once. As a supervisor of the nursing team, the writer tried to investigate the incident and found out that communication breakdown between different parties was the “prime criminal” and the main factor of the incident. On the other hands, managing communication breakdown and promoting effective communication became the urgent and challenging issues faced by nurse leaders.
Literature review
As already mentioned, communication is defined as sharing a mutual meaning between a group, an organization or even a community (Barrett, 2011). Daniels and Spiker (1991) believed that communication is not just simply sharing meaning but people can also obtain new ideas through the information sharing of communication process. The method of information and meaning transmission includes formal and informal communication (Daniels & Spiker, 1991). Besides, Longest and Young (2006) suggested that verbal and non-verbal communication is another form of meaning sharing.
Formal and informal communication
Daniels & Spiker (1991) cited the differences between formal and informal communication. Formal communication is likely connects with relations of power and authority. In a formal communication, information flows “upward” from a high- ranking staff such as department head to manager to junior staffs regarding guidelines and directions of the department. Feedback then flows “downward” from the junior staffs to department head through oral or written report. As formal communication always linked with a chain of command, staffs always need to maintain a level of respect and clearness when adopting formal communication at workplace (Daniels & Spiker, 1991).
Different from formal communication, Daniels & Spiker (1991) suggested that an informal communication is not related to any ranking and organizational culture. It just uses to satisfy the emotional needs of an individual. This kind of communication keeps off all constraints from the formal communication. It makes people to feel calm and relaxing as information shared by oral words directly and spread quickly throughout the group without any restriction of departmental rules and guidelines (Daniels & Spiker, 1991)
Verbal and non-verbal communication
When the first human beings knew how to use symbols to communicate, verbal language started to present. Language is human’s most important tool of verbal communication (Longest and Young, 2006). People have an inborn capacity for language. They can use oral language or written words as a channel for self- reflection, interaction and communications. Furthermore, signs and symbols made up of laughing and cries are also the examples of verbal communication (Longest and Young, 2006). However, all human languages are legally controlled by many rules under a complex system such as rules of pronunciation and verbal symbols (Rosengren, 2000). Since these rules are always extremely different between different countries of the world, a communication breakdown can easily occurred when the rules are unknown to someone (Rosengren, 2000).
According to Longest and Young (2006), non-verbal communication is also an important element of human communication. There are various types of non-verbal communication such as human’s gesture, emotions and feelings. Others forms of non-verbal communication include pictures and music, as well as more representing arts such as drawing and drama. Moreover, logic, mathematics and statistics are three powerful non-verbal communicative instruments for people to develop their strength from facts (Longest and Young, 2006).
Barriers to communication
The barriers of effective communication can be occurred at any stage of communication process. They may change the real meaning of message created by the sender and cause confusion and misunderstanding to the receiver (Fink-Samnick, 2002). Better understanding of these barriers can improve the quality of communication and help both sender and receiver to transmit a clear and accurate message. The examples of barriers to effective communication include the use of jargon, emotional barriers, lack of attention, differences in perception and culture, physical disabilities and language differences (Fink-Samnick, 2002). Overcoming these communication barriers at workplace becomes an important issue of leadership. It help leader to eradicate difficulties, gets all staffs closer and lessened the risk of incident (Scott-Cawiezell et al., 2007). We will take a closer look at these barriers in the following section of discussion.
Impact of ineffective communication
Quality of clinical communication is measured by five factors that include timeliness, accuracy, openness, satisfaction and understanding (Devers et al., 1991). Timeliness refers to the degree which information is spreading to public instantly. Accuracy means the degree to which all the medical and nursing staffs think that the information being transferred is correct and reliable. Openness refers to the extent that whether team members can communicate openly. Satisfaction involves the extent to which team members are satisfied in the communication process. Understanding refers to the degree that everyone obtains the information without doubting and misunderstanding (Devers et al., 1991).
When one of these five factors is being ignored, ineffective communication will easily occur in clinical areas. Ineffective communication always brings serious result among staffs and patient (Dimigen et al., 2012). Lindbloom et al. (2002 ) found that incorrect and inappropriate communication delayed timely treatment of acutely and critical patients. Ineffective communication also caused various kinds of medication error (Scott-Cawiezell et al., 2007) and medical incident (Forbes-Thomspon & Gessert, 2005) in a certain extent. Thus, health care providers must recognize how effective communication helps them to connect with others, to improve relationships with colleagues and to increase productivity at work.
Relationship between leadership and communication
Wolk (1999) proposed that effective communication is the best tool for a leader to achieve the organizational goals and improve relationships between leaders and staffs. She found that high degree of openness and satisfaction of communication could reduce staff turnover. One the other hand, leaders can develop and enhance role of the nursing staff through supportive communication (Apker, 2001). As relationship plays an important role in dynamic communication system, leaders should promote positive relationship among staffs in order to obtain trust from the staffs and to empower them in an effective manner (Apker, 2001). Without effective communication in relationships result in misunderstanding, frustration and creating more differences between people Wolk (1999).
Discussion
Communication between nursing staffs and carers can affect quality patient care and clinical outcomes. The following discussion is going to analyse the different aspects of communication breakdown happened at my workplace and how it led to the serious incident as mentioned before. As a team leader, the writer will further explore on how a leader can overcome the problem of communication breakdown through effective communication.
Cultural and Language Barriers
Effectiveness of communication is often determined by cultures (DerGurahia, 2008). Different kinds of culture presented in the workplace will lead to communication barriers. Refer to the case study, since the old age home staff and the community nurse having different cultures on status, religion, family role etc that finally lead to communication breakdown at their workplace. Besides, the old age home staff is a new immigrant from Mainland China who uses “Mandarin” as her native language but the community nurse doesn’t familiarize about it, it caused problem of language barriers at workplace.
Channel Barriers
The writer investigated the incident and found that channel barriers presented between both parties. The community nurse taught the procedure of tube feeding to one of the old age home staffs and then ask the “educated staff” to teach the procedure to the “involved staff” of the incident. In this communication process, the “educated staff” might filter the information that obtained from the community nurse and the final message might be misrepresented. The channel barrier is common and always present at workplace, which lead to misunderstanding between team members (Boockvar, Burack & Shah, 2010).
Perceptional and Personality Barriers
People always perceive an issue according their own mindset. When two people holding different viewpoints can result in communication breakdown and even conflicts (Boockvar, Burack & Shah, 2010). In the case mentioned before, the nurse thought that tubing feeding was a “ patient care procedure” in her concept whereas the old age home staff inferred tubing feeding as a “daily job routine” only. The different viewpoints caused perceptional barrier and led patient suffered from incident at last. Besides, the different personality of two people also created communication barrier. As the old age home staff was always too shy of asking anyone about her doubts on patient care, the community nurse would never know the weakness of the old age home staff and wouldn’t help her to solve the problem automatically.
In order to maintain quality of care and protect patient’s safety, nurse leaders must ensure all nursing staffs have good communication skills and break down all the barriers mentioned before. Although nurses’ competence of performing effective communication is a challenging issue, the writer thinks that leaders can ensure the standard quality through the following communication skills.
Using effective communication technique
As a team leader, the writer tried to promote some techniques for effective communication to both the community nurse and the old age home staff. I think that all these techniques can act as the icebreakers to solve the problem of communication barriers in workplace. Listening is one of the important techniques. It helps one to focus and digest the conversation and then giving self-feedback accurately (Wolk, 1999). Through listening, the audience will have a sense of respect that can improve the communication between both parties (Wolk, 1999). Besides, avoiding arguments and taking criticism are other essential technique (Wolk, 1999). Arguing always wastes time and lead to an unhealthy conversation whereas criticism positively can provide a constructive way of problem solving.
Apart from the techniques mentioned above, the writer believes that understanding the audience’s perception and giving proper feedback can’t be ignored in effective communication. Understanding and feedback always provide leaders a clear picture of one’s weakness or strength and allow leaders to find a suitable way to solve the problem of communication barriers.
Role modeling and leadership style
Role modeling of leaders can support staffs and spurring good communication behaviors in team (Davis and Rosenblatt, 2009). The writer agrees that good communication skills of leaders provide a calm working atmospheres that improve nurses’ morale and job satisfaction. Moreover, leaders need to apply approachable leadership when communicate with the team members. They should be open, flexible and always involving staffs in decision-making (Thyer, 2002). On the other hands, respecting staffs and listening to staffs are good communication behaviors (McMurray and Williams, 2004). It helps leaders to obtain suggestions and feedbacks from the staffs and find out their problem on daily work.
Conflict Management
Since different people will have different viewpoints and ideas, conflict is natural and always occurs in a group (Brinkett, 2010). All kinds of conflict are created by personal interest and difference in goal and values that will lead to the outcomes of poor clinical care, low morale of team and even regrettable error. Therefore, conflict management skill is essential in leadership. In my point of view, one of the crucial points of conflict management is providing working environment that nurses can speak out boldly when problem arise. Besides, conflict resolution is another skill of conflict management (Milstead, 1996). Conflict resolution provides a platform of discussion that just focusing on the problem. Leaders should aware gender or cultural differences during conflict resolution. All follow up actions should also be agreed by everyone participated in discussion process (Milstead, 1996).
Emotional intelligence
Emotional intelligence means identification of own and others’ feelings. A leader who always understands staff’s feeling can get benefits on his or her leadership. There are three emotional intelligence skills for leaders to adopt. They include social skills, motivation and self-awareness. Social skills refer to the ability to use communication skills to persuade staffs and create change in team (Pahl, 2008). Motivation is leaders’ enthusiastic on work and the ability to promote optimism in workplace (Pahl, 2008). Besides, Rosenblatt and Davis, 2009 suggested the nurse leaders should realize how their communication skill could affect others. On the other hands, they need to evaluate their relationship and interaction with their colleagues regularly. Through the self-awareness process, the leaders can improve their communication skill and to discover more effective ways they can communicate with their staffs.
Mentoring
The writer thinks that mentoring is an essential part of implementation of effective communication. To prevent recurrent of the incident, the writer invited the community nurse as the “mentor” whereas the old age home staff as the “protégé”. Through mentoring program and establish successful mentoring relationships, mentor can create a positive climate of open communication and offer constructive criticism to the protégé in a supportive way. On the other hands, the protégé can communicate openly with the mentor in order to get impartial feedback from mentor. Furthermore, a successful mentoring relationship requires a commitment from both parties. To achieve the goal, both mentor and the protégé should respect each other, communicate regularly and set up a development plan together.
Shared governance
Thyer (2002) highlighted the importance of shared governance in leadership. Inviting staff in the process of decision-making can improve communication and help leaders to empower their staffs more easily (Thyer, 2002). To achieve shared governance, the writer thinks that leaders should provide an open communication system within the team, making policies and guidelines that convince staffs to communicate willingly. Chapman and Robert-Malt (2008) suggested that the nurse leaders should set up committees of communication that encouraging staffs to voice out their thought openly. For me, these committees are valuable that enhance the communication between staffs and leaders.
Recommendation
Although leaders can use effective communication to transform the team and improve the quality of care, reverse outcomes and resistances may occur if changes were not managed properly (Domm, Eisler & Smadu, 2007). Change management should be enhanced to avoid such outcomes and resistances. According to Lewin (1951), the initial phase of change should prepare staff to accept the process of change and set up a new way to improve status quo. During practical process, management team should support the change such as propagating the importance of effective management at workplace. Meanwhile, leaders should being open-minded to team members’ concerns and explain the need of change clearly within the team.
Effective communication always becomes more significant in the second phase of change. In this phase, team members start to resolve their doubts and follow the new way and direction of their leaders (McCalman & Paton, 2008). Leaders should give clear explanations to their staffs on how effective communication will bring positive affect to them.
The third phase of change happens when all staffs accepted the new ways such as new protocol on communication channel (McCalman & Paton, 2008). In this phase, leader should develop the changes into the culture. Besides, feedback system can’t be ignored to support the change.
Conclusion
In conclusion, leaders’ strategies of effective communication and the provision of an understanding of team dynamics enhanced good working relationship. The good relationships help leaders to build a successful team and develop a positive atmosphere at workplace in a certain extent. However, leaders must develop interpersonal relationship and elevate staff’s efforts at communication in order to keep on team-building. With effective communication, team members become more willing in voicing out their feelings on every issue, finding out and solving problems together, resolving conflicts and preventing undesirable incident at last.
Furthermore, effective communication plays an important role in enhancing team’s spirit and staffs’ job satisfactions, which help leaders to retain manpower in workforce and maintain economic stability of hospital. Last but not least, the writer expects the management group and the staff development expert can lend a hand and support the leaders to develop strategies of effective communication in order to build more successful and cohesive teams in future.
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