To the man who has only a hammer in his tool kit, every problem looks like a nail.
– Abraham Maslow
Let’s begin by looking in on a day in the hypothetical life of one healthcare manager.
By the time Michael Smith had a moment to even look at his watch it was 9:20 a.m. Already this morning he had met with his senior managers about a pending labour dispute with their technical staff, and he had sifted through sixty-four e-mail messages. He had answered the most urgent of them; taken a quick look at two departmental budgets; fielded a call from an irate board member whose daughter had not gotten the job she wanted on his staff; and now his secretary had just buzzed him to say that Carla MacDonald, his PR director, was waiting anxiously to see him. And he hadn’t even had his coffee yet. Such is the life of a hospital CEO, he thought wryly.
Michael had been the CEO of St Swithin’s Health Sciences Center for almost five years, and he actually liked his job despite the fact that there were days like these when there seemed to be one problem after another; he knew that Carla needed to discuss one of the most pressing with him. St Swithin’s was caught between one of their most prestigious research scientists and a pharmaceutical company. The researcher had discovered that a drug she was testing on a group of patients did what the manufacturer said it would, but she had also found that it had significant, deleterious – indeed life-threatening – side effects. As a result, she had discontinued using it and then gone public with her findings so that other researchers using the drug experimentally could protect their patients, too, in spite of an apparent gag order by the drug company. The drug company was preparing to sue the doctor and St Swithin’s for breaching a confidentiality clause in the research grant contract. To make matters worse, the researcher and many of the other doctors at St Swithin’s were now accusing the hospital of not standing behind its researchers and the ethical protection of patients. They were accusing hospital administration of bowing to the pressures of big business.
“Michael,” Carla began, taking a seat in front of his desk and opening a large file folder full of papers. “We need to plan a media conference.”
“Why can’t we just send out releases? You know how much I hate facing the press.”
Carla was adamant that they couldn’t deal with all the hospital’s relationship issues by sending out media releases and newsletters. Michael could write a dynamite memo or letter or e-mail message, and that was how he preferred to communicate. In fact, he was one of the few people he knew who had welcomed electronic communication with open arms – no longer would he be required to have small talk with anyone. To him it was a miracle. Carla, however, did not share his view.
On his desk she placed five pages of media printouts from the Internet. There were bona fide news stories, blog posts, Facebook updates, and a plethora of tweets. He had already seen the news stories. He sighed and knew that he was going to have to listen to her.
Put yourself in Michael Smith’s chair for a moment, and consider how you would feel about his issues.
Abraham Maslow was the psychology luminary who pioneered the idea that people who are hungry, cold, or in physical pain are not likely to be interested in reaching for self-actualization. His work in understanding human behaviour also indicated that people need a wide variety of skills to deal with the equally wide variety of challenges that come their way through life. Managers in healthcare facilities and organizations face ever more diverse issues on a daily basis, and their skill sets need to be eclectic as well.
Communication issues and the relationship problems and opportunities that arise from these issues require managers with a high level of knowledge about modern communication, an attitude that allows them to apply that knowledge in a strategic way, and highly developed personal skills that can be applied in diverse situations. The bottom line is that you need a variety of tools in your management tool kit, and communication skills are an important key to the successful application of most other tools and techniques of management.
In 1955, the Harvard Business Review published a now-classic article (which they republished in 1974) that posed and answered the following question: What observable skills does an effective executive demonstrate? The author divided the skills into technical, human, and conceptual, and indicated that the executive must be “skillful in communicating to others, in their own contexts, what he [sic] means by his [sic] behavior.”1
Recent literature continues to support this view, yet managers of all stripes still seem to be unprepared in the area of personal communication skills. Conrad and Newberry (2012) concluded that “… the literature supports the lack of preparedness of new graduates with respect to business communication skills despite a consensus among practitioners and academia of those skills sets’ importance …”2 Their study suggests that there continues to be an argument between those who hold that face-to-face skills are paramount, whereas others consider that in these days of growing electronic communication, skills in written communication are the top priority. Regardless of the order of priority, if we examine a healthcare manager’s various functions and roles, we can develop a clear picture of where communication skills are key.
Regardless of when you first study management and at what level – undergraduate or graduate – the term management as a construct is a bit like the word personality. Psychologists have difficulty defining it; there seem to be as many definitions as there are psychologists studying it. The same is true of the term management. Most definitions, however, have some distinct commonalities.
First, management is a process of getting things done efficiently and effectively. It is not something that exists only at one point in time, but is continuous and dynamic, and in the process of “getting things done,” specific outcomes can be measured.
Second, management accomplishes its goals through people as well as through the strategic use of other organizational resources, including time and money. What’s crucial here is that people are the key to a manager’s ability to get things done.
Finally, most authors of basic texts in management agree that managers use four fundamental activities to accomplish their goals: planning, organizing, leading, and controlling.3
Let’s take a closer look at where communication plays a role in these aspects of management.
If part of what a manager does is accomplish goals with and through people, little doubt exists that a manager must be a master communicator, first on an interpersonal level. Most people think they know what it means to have good interpersonal skills. They believe that an individual who appears to get along well with co-workers possesses these good skills. This is, however, an oversimplification when we’re talking about a healthcare manager’s skill set. A manager with good interpersonal skills is able to assess the situation in which the person-to-person interaction is taking place, understand the communication skill level of the other person, communicate his or her message clearly, listen well, and respond appropriately.
It is also true that managers play a variety of interpersonal roles, which might be traditionally described as the figurehead role, the leadership role, and the liaison role.4
• As a figurehead, the healthcare manager might speak at a meeting or conference of healthcare administration students, or hand out diplomas at the graduation ceremonies of the medical technology course hosted by his or her hospital.
• In a leadership role, the manager is the one with the vision for the future of the organization, but also the responsibility to communicate that vision to the employees to ensure their buy-in and support for its accomplishment. This role requires high-level interpersonal communication skills, as well as proficiency in the use of mediated communication (which will be discussed later).
• The liaison role is played almost daily by managers at all levels within healthcare organizations. Henry Mintzberg, author of the now-classic text The Nature of Managerial Work, sees this liaison role as one of gathering information from sources external to the manager’s own work unit.5 When the vice president of administrative services has a meeting with the transplant coordinators to gather information about how they are setting up flights to receive outside organ procurement teams, he or she is functioning in an internal liaison role. When the director of the transplant program meets with other such directors from other hospitals, this is an external liaison role. When the CEO meets with government representatives to discuss Medicare, this is also an external liaison.
Central to the success of each of these encounters is the individual manager’s communication skills at the interpersonal level. Interpersonal skills are important, but they aren’t the only kind of communication skills that are crucial to the healthcare manager’s success.
It might be a good time to consider the current issue of proximity when we examine interpersonal skills. Is it necessary to be in the same room with someone to use your interpersonal skills?
Not necessarily. Today’s technological work environment often requires us to use mediated communication rather than direct, person-to-person communication. First, consider the telephone. You are not actually in the same room with the person with whom you are talking, and thus the communication values of such things as nonverbal cues are not available to you in interpreting what is being said or in conveying your own message. Your ability to communicate with that person on an interpersonal level, however, is still very important – it is just a bit different than if you were in the same room.
What about voice mail? E-mail? Although good interpersonal skills might improve your ability to use these to their best advantage, they do require somewhat different proficiencies. And although making a presentation at a large staff meeting might seem like an interpersonal approach, in fact it, too, requires a different set of skills again.
Here are some examples of where interpersonal skills are important in healthcare management:
• daily interaction with close staff
• interaction with medical staff
• interaction with individual board members
• negotiating with labour organizations
• interviewing staff and others (in the same room or over the Internet via webcam)
• disciplining staff
• being interviewed by media
• talking to patients and their families
• telephone calls
• internal or external meetings
Healthcare managers also require a high level of achievement in the area of written communication. If we examine the managerial activities already mentioned (planning, organizing, leading, and controlling) it becomes clear that many of these require written communication for their successful accomplishment.
William Zinsser is arguably one of America’s finest writing teachers. In his now-classic book On Writing Well (originally published in 1976) he lays it on the line by telling the reader this: “Few people realize how badly they write.”6 You may have graduated with a master’s degree in health or business administration and written dozens of papers, perhaps even a thesis. You have written more exams than you care to remember and taken hundreds of pages of notes, but can you truly say that all of this makes you a good writer? If you didn’t study applied communications at the college or university level, then it is likely that no one ever really taught you to write or evaluated your writing as a key part of the process. Writing, however, is fundamental to almost every other type of communication that is important in health care (or any other industry for that matter). Indeed, the roles and activities of managers, by their very nature, require excellence in written communication.
Here are some examples of where written communication skills are important in healthcare management:
• everyday e-mail
• letters to both internal and external individuals and groups
• correspondence with government
• speeches and presentations to employees, community groups, or government
• preparation for media interviews
• editing the written work of lower-level staff
• your submission to the newsletter or annual report
• reports and proposals
• your submission to the hospital blog
• writing proposals
Many basic textbooks on communicating within organizations seem to give short shrift to important aspects of written communication. Perhaps this is the reason why so many managers enter their positions believing that writing is something that they have already learned by osmosis. Whereas writing requires a good grasp of the fundamentals of our language (spelling, punctuation, grammar, and syntax), it demands even more. Healthcare managers must be able to mould their writing to achieve specific and often diverse results, and must be able to target their writing to a variety of audiences including medical and nonmedical staff, patients and their families, community groups, government, and the media. Writing academic papers in college is not necessarily good preparation for these challenges.
The final skill set that is an important key to success in healthcare communication is presentation skills. This does not refer to chairing meetings, rather to situations where you find yourself having to make an appearance before a group and must be prepared to say something that is meaningful and targeted to that specific audience. Sometimes the group is interested in what you have to say – and sometimes it emphatically is not. Regardless of the reception, you have to be prepared and effective in front of your audience.
An oft-cited statistic claims that when people are polled about what they are most afraid of, public speaking ranks ahead of snakes, spiders, and even death. Whether or not this is actually true, it is likely that at least some healthcare managers are uncomfortable making presentations, and may even try to avoid every such situation. Arguably, it is impossible to be a truly effective healthcare manager without highly developed presentation skills. Perhaps one of the most compelling reasons that some individuals fear public speaking is that their skill set is not at the level it should be.
Here are some examples of where presentation skills are important in healthcare management:
• facing the media at a press conference
• presenting the annual report to the board
• speaking to community groups
• acting as master of ceremonies at social functions
• conducting workshops for peers at conferences
• pitching to government or private groups for project support
Clearly communication skills are an important key to success as a healthcare manager. Now is a good time to figure out what we really mean by the term communication.
Just as the term management was difficult to define precisely, so too is the term communication. In fact, the author of one classic book on communication theory lists 126 such attempts!7 Some of the definitions refer specifically to verbal communication, while others are broader. Some focus on the goals of communication while others focus on the medium. Although all of this is useful for a prolonged discussion of the semantics of the issue, we need a clear definition of healthcare communication upon which we can all agree. For the purposes of this book, we will define it as follows:
Healthcare communication is a two-way process of informing, persuading, and sharing ideas while utilizing the most appropriate medium for the situation and for the participants.
It is crucially important to recognize that although the purpose of much of your communication activity on a daily basis might appear to be one-way (e-mail, letters, and meetings), the reality is that there needs to be an opportunity for a two-way process within every communication encounter. The reason for this is that communication is the foundation upon which relationships are built (more about this in the next section). Even a small e-mail message designed to provide the receivers with specific information needs to be open to feedback.
The simplest model of communication in health care is illustrated in Figure 1.1.
Figure 1.1 The Simplest Model of Communication
In one scenario, the healthcare manager is the sender of the message, the receiver picks up that message, and a feedback loop allows the manager to know of the receiver’s response. Did the receiver actually receive the message? Did the receiver understand the message? Does the receiver have anything to add to the message? Does the receiver agree/disagree with the message? The answers to all of these questions are useful information for the manager. The manager who ignores this aspect of the communication process does so at his or her peril! More recently, with the advent of social media, the receiver providing feedback is just as likely to be a member of one of the organization’s external publics. The loop, however, is the same in both cases.
This simple model, however, tells only part of the story. Twenty-first-century communication is focused not only on that feedback loop and responding to it, but on engagement. A simple dialogue is no longer enough. There is much more of an emphasis on finding ways to facilitate behaviours that are supportive of an organization’s objectives and that involve active participation of the target publics. Only when the communication targets become an active participant are they truly engaged with the organization – a situation that supports strong relationships. The social media tools of the digital age have made this engagement both important and unavoidable.
Finally in terms of communication models, it’s important to note that although two-way communication and engagement seem desirable, they may not be appropriate in all situations. Making that decision is part of the strategic planning process, and integration of communication planning in the development of operational strategy is the whole point of expanding the view of what communication can and cannot accomplish for you and your organization.
If we look more critically at the simple communication model above, we find that it doesn’t really provide any indication of why we might communicate. Initially, we might consider that communication is required to inform and to persuade. If we examine this more closely, it is clear that communication theorists aren’t too far off base when they tell us that we communicate to fulfil a human need. (Indeed, a number of telecommunication companies have based their advertising campaigns on this concept.) Whereas all of this is useful when we are talking about communication within our own personal worlds, are the same reasons sufficient to support the need to be a highly skilled communicator in your job in health care? Not really.
In the context of your job as a healthcare manager, one of the most important reasons to consider the quality of your communication is because the relationships that you have with other individuals – and that your organization has with other groups and organizations – often originate directly from the quality of the communication that has flowed between you and these others.
If we go back to the scenario played out at the beginning of this chapter, we find our hypothetical healthcare manager Michael Smith in a situation that has implications for his own and his hospital’s relationships with a variety of individuals and groups. If Michael is a master communicator and has placed a high value on his communication over the past four years, it will be much easier for him to deal with the current situation.
• If Michael has cultivated a good interpersonal relationship with the medical director, that individual will feel comfortable going directly to Michael to discuss the current situation with the researcher. It is then less likely that the medical staff members who are concerned about the hospital’s commitment to, and support of, their research will discuss the situation with the media before administration knows about it.
• If Michael has been strategic about his communication efforts with the medical staff as a group, the positive relationship would make it less likely for them to jump to conclusions about how senior administration is handling this situation.
• If Michael has always been strategic about his communication with his hospital board, and he has maintained a policy of keeping them informed, there is less likelihood that any board members will feel that they have to enter into the fray without first allowing senior administration to have their say.
• If Michael has been an effective, credible spokesperson when members of the media have asked to interview him from time to time over the years, they are more likely to provide his hospital’s senior administration with a fair hearing and airing in the media.
• If Michael has been a solid member of the community, supporting community issues and events, providing his leadership and expertise when necessary – developed a good relationship – they will cut him a bit of slack before forming their own opinions of the hospital’s behaviour.
These are just a few of the crucial long-term relationships that can have either a positive or negative effect on both the day-to-day activities of a healthcare organization and on crisis situations. While it may seem at first glance that it is the organization’s relationship, rather than the manager’s, with these groups that is most crucial, the CEO’s own personal communication skills and knowledge will play a key part. At lower levels in the organizational hierarchy, the situation for managers is similar. In this particular situation, the director of pharmaceutical services may find him or herself on the firing line. This individual’s strategic communication skills will also play a role in the direction of the outcome, positive or negative.
Before we go any further, we need to understand another term and another role within your organization. That is the public relations (PR) function in health care, and how your own mastery of strategic communication plays a role in that managerial area.
Public relations uses communications tools and techniques to help organizations develop and maintain relationships.8 What this means to you is that your public relations department should be expected to have expertise in all areas of strategic communication for the purposes of assisting your organization to achieve the goodwill of important publics both internally and externally. Recent analyses of the aftermath of crises has taught us that it is important to establish what might be referred to as a “reservoir of good will” in advance of the requirement for it.9
In addition, you should be able to rely on them for expert advice in the development of your own skills, whether you are the CEO or a manager at a lower level. If, however, you are a manager in a small organization that does not have a PR staff, then you probably have an even more crucially important role in strategic communications. (We will go into more detail about this in chapter 9.)
The bottom line is that in your role as a manager in a healthcare facility or other health-related organization, every communication encounter that you personally have with any person or group inside or outside your working environment will have an effect on both yours and the organization’s relationship with a variety of constituencies. And the goodwill of these groups could be key to the accomplishment of your mission.
Healthcare managers communicate with a wide variety of people and groups on a daily basis. Some of these encounters are planned, while others simply spring up during the course of the day’s work. If you were to make a list of the number of communication encounters you have in the run of a working day, how many could you come up with?
Here are the important groups with whom you communicate. Most of the people and groups on your own list should fit into one of the following general classifications:
• employees
• medical staff
• board members
• financial donors/potential financial donors
• patients and their families
• future patients and their families
• community members
• financial institutions
• government
• the media
• community health-related organizations
• regulatory bodies
• professional organizations
• suppliers
• union leadership
You probably noted already that these broad groupings could be broken down even more finely, but for now this general list allows us to consider the implications of the encounters.
Each of these groups has a different reason for wanting to communicate with you, and you have a different objective for every communication encounter you initiate. We do, however, need to note right from the start of any discussion of targeted, goal-driven communication, that the advent of social media has forever changed the public communication landscape. All of our stakeholders now have access to forms of mass media and audiences that were unheard of in years gone by. Indeed, gone are the days of controlling the message to the extent we might like. That said, honing your own skills can put you in a much stronger position when you are the receiver of the communication.
The question is this: are you ready to communicate effectively with each of these groups to achieve important strategic objectives for yourself and your organization? By the end of the next few chapters, you should be ready to answer that question more accurately.
Clampitt, Phillip. Communicating for Managerial Effectiveness. Thousand Oaks, CA: Sage, 2010.
Hynes, Gerald. Managerial Communication: Strategies and Applications. New York: McGraw-Hill/Irwin, 2010.
Parsons, Patricia J. A Manager’s Guide to P.R. Projects: A Practical Approach. Mahwah, NJ: Lawrence Erlbaum, 2003.
Management Skills List. http://www.buzzle.com/articles/management-skillslist.html
Management Styles. http://www.rpi.edu/dept/advising/free_enterprise/business_structures/management_styles.htm
Management versus Leadership. http://managementhelp.org/ldrship/ldrship.htm#anchor2078406