The difference between the right word and the almost right word is the difference between lightning and the lightning bug.
– Mark Twain
Surely every person who makes his or her way into a managerial position in health care has adequate writing skills. Surely everyone who has graduated from college or university can write better than the average person. If you believe what William Zinsser says about writing (and you should), then you know that “Few people realize how badly they write.”1 And many healthcare managers are guilty of this.
But the fact remains: writing skills are critical to a manager’s ability to communicate on a number of very important levels. In addition, how you write says more about you than you may have intended to say. In this case, with apologies to Marshall McLuhan, the writing in the medium is the message.
As you read this, take a mental journey through your own shelf of reference books. You should own (and use) the following:
• a good dictionary
• a medical dictionary
• a copy of The Elements of Style (by William Strunk and E.B. White)
• a copy of The Elements of Grammar (by Margaret Shertzer) or a reasonable facsimile
• a good book on business writing
If you lack even one of these books, you probably haven’t given enough thought to the quality of your writing. And writing is something that a healthcare administrator does every day. What’s more, evidence supports the notion that people who write well, think well. In other words, if you can organize your thoughts and select appropriate words to succeed in getting your message across to your audience accurately, you are probably a clear thinker. In fact, some managers even use this as a kind of litmus test when hiring new employees whose job responsibilities require them to be clear thinkers.
If we consider when and where a healthcare manager’s writing skills are tested, we develop a kind of snapshot of the manager’s job. Here are just a few of the situations where your own writing skills tell important tales about you as a communicator:
• memos
• letters
• reports and proposals
• minutes
• opinion pieces
• annual report letter
• editing employees’ work
• clearing news releases
• articles for the employee or donor newsletter
• speeches and presentations
And the list goes on. Even if you have public relations personnel and administrative assistants to help you with these pieces, are you always so confident about the quality of their writing that you sign as if you had created it yourself? If you are at a lower level in the organizational hierarchy, you probably have to do your own writing, and the quality of your written communication will have a significant effect on your ability to climb to a higher level in that hierarchy.
Thus, it is clear that your own ability as a writer is a critical managerial skill. Let’s examine how we determine what good writing is and then assess your own abilities in this area: how do you stack up?
The notion of considering your own writing style may bring back memories, good or bad, from high school and university English teachers. They always seemed to be talking about style, usually related to a particular writer: Ernest Hemingway, Mark Twain, Jane Austen, or William Shakespeare. And although you may have even developed a sense of the differences in the individual writers’ styles, that seems years ago and miles away from a healthcare setting and the kind of writing that you are required to do as a manager. But is it really? That depends upon how you define style.
A dictionary is always a good place to start (especially when you are writing). Webster’s defines style as the “manner of expressing thought, in writing or speaking: distinctive or characteristic form of expression.”2 This sounds very much like what your high school teacher was trying to impart to you as you studied English literature. It also has some information for us as we develop our skills in writing on the job. Style certainly is your manner of expressing thought in writing, but we need to add to this the notion of expressing thought for a particular audience and purpose. Unlike Hemingway and Twain, or your current favourite author, written communication in health care is done not simply to express the author’s thoughts or tell a story, rather to achieve a specific purpose for a specific audience. (We will discuss this further later in the chapter.)
Another way of defining style, however, is a bit more pragmatic, and perhaps for our current purposes, even more useful. In 1919, English professor William Strunk Jr wrote and self-published The Elements of Style,3 a book that has become like a bible to many writers. Some years later one of his students, E.B. White, added his name to the author list, and we have what is now reverently referred to simply as “Strunk and White,” and often cited as the final word on style. Most of Strunk and White is devoted to considering style as “what is correct, or acceptable, in the use of English.”4 In other words, the correct use of grammar, syntax (word order), word choice, and punctuation are an important part of style. And the reality of writing in business and the professions is that correct writing says much more about you than simply whether you can make your point.
Have you ever received a letter (perhaps a cover letter for a job application) that was riddled with spelling and/or typographical errors? What was your first impression of that person? Are you even confident enough of your own grasp of style to be able to determine all the errors?
If you listen to the sound of your words – yes, read them aloud – you begin to get a sense of the style of your writing. Your style is your own unique way of expressing your thoughts. But this is not enough in work situations. Keep in mind that your own personal style isn’t necessarily good writing. You can write whatever you want in your personal journal that no one else reads (and I highly recommend doing so), but your writing on the job must meet a litmus test of a different set of criteria. Here are some of those criteria by which you may judge the quality of your writing.
1. Good writing is accurate. Nothing can harm your credibility more quickly than when a reader finds that you have not been accurate. This is even more important in health care, where inaccuracies can have deleterious effects on people’s health.
2. Good writing is truthful. Just as in everything else that you do, integrity is paramount. Truthfulness does not, however, necessarily mean telling everything. You need to be able to exercise judgment when you are disclosing sensitive information, or when you are approving the disclosure by others in your work group.
3. Good writing is utilitarian. When you are writing in business situations, it is important that what you write has a purpose. Just as you are too busy to read material that has no purpose for you, consider others – good writing is useful for you, the communicator, and for your reader. It is your challenge to ensure that what is useful for you is perceived to be useful by the receiver.
4. Good writing is clear. Vague, murky writing, choking on too many words, fails to achieve its goals. If you like to use big words in places where smaller ones will do, get over it. Be clear and concise at all times.
5. Good writing is well organized. As we discussed earlier, well-organized writing often signifies a clear thinker. Looking at this another way, clear thinking must precede any writing, and a good outline helps to organize.
6. Good writing is complete. There is no point in writing something if you are not prepared to provide all the required details to ensure an appropriate response. Make sure the reader has all the necessary information to understand your message.
7. Good writing is targeted. Every piece of writing you do must consider its audience. Knowing who will read your message is just as important as the message itself, and should guide you as you write.
One final piece of advice on good writing has stuck with me since I read it somewhere many years ago. I believe that the most important rule of good writing is never to bore your reader. Although you might consider much of what you write to be mundane, day-to-day information exchange, you know that even an e-mail that fails to grab your attention in the first line or two gets only a skim from you, while an interestingly written one compels you to read it. Which scenario do you want played out on the receiving end of the e-mails that you take your own time to compose? As business writing coach Dr Wilma Davidson says, “Business writing at its best is a form of problem solving and calls for fresh thinking, imagination, and original, clear language.”5
What was the purpose of that memo you just wrote to your managers? Why did you e-mail a response to that family who was looking for information about their mother’s hospitalization? Was there a reason for you to write that opinion piece in the local paper after their scathing series on local healthcare facilities?
There are many reasons for using written communication, and each instance has a unique purpose that you must consider before you write. The reason for the piece of writing has a huge effect on its style and on the outcome that you are likely to achieve. Both purpose and the resultant style, however, are also tied into the audience for the communication. We will discuss audience in detail shortly, but for now we will concentrate on answering the question “why” for each piece of writing.
Three key components that differentiate one style from another are its pace, the tone that is taken, and sentence construction.6
Whereas each individual writer can develop his or her own style of writing, there are essentially four styles that we tend to use in health-care situations.
1. Business style. This is probably the most commonly used style, and even it has variations. Business style is characterized by directness, relative impersonality, and speed of coming to the point. Effective business writing is fast paced, has a boardroom tone of voice, and uncomplicated sentence structure.
2. Academic style. You would have used academic style when you wrote research papers in college. In healthcare settings, you are more likely to read academic papers than to write them, but you need to be aware of this style so that you don’t mistake it for business or any other style of writing. (Indeed, if you are interested, you may find yourself collaborating on academic papers as well.) Academic writing is characterized by complete impersonality, remoteness, objectivity, detailed attribution, and a scholarly tone. Its pace is slower, and it tends to be more ponderous than business writing (although one might reasonably question why this has to be so – and the ubiquity of online academic journals does seem to be making a change in this), takes on a very impersonal, third-person style, and can contain more complicated sentence constructions. It presumes that the reader is highly educated and very interested in the subject area.
3. Feature style. Feature writing is the style that is characteristic of magazine writing (or, in the healthcare manager’s case, the employee newsletter). In a modified form, it will also be useful for the fundamentals of a presentation, and sometimes in proposals or for opinion/editorial pieces. It is characterized by a relatively rapid pace, a familiar tone, and uncomplicated sentence structure.
4. Personal style. In healthcare situations, this kind of writing is usually appropriate only for written communication with individuals with whom you are well acquainted. It can vary in its pacing, has a first-person, personable tone, and relies on simple structures. In any business situation we need to be wary of too much familiarity and use this style judiciously. Extreme caution needs to be taken when creating e-mail correspondence in particular, where this style can easily creep in. Overfamiliarity has become the hallmark of social media communication among younger peer groups, and as they make their way into the work world including into healthcare management, they need to work hard at ensuring that this style does not creep into their written business communication.
It should be clear by now that each of these styles has a particular purpose and a specific target audience. You need to think very carefully about each piece you write before you write it – even when responding to what you consider to be routine correspondence.
Written communication in the management of healthcare services and organizations has two main objectives. The first is a very simple, one-way approach: to provide information. The second is much more complicated than it appears on the surface: to induce someone to act.
1. Providing information. Arguably, providing information can be considered fundamental to any other objective one might have in communication. Indeed, it is difficult if not impossible to induce someone to take the action you desire if that person lacks clear, accurate, understandable information. This means that the better you are at providing information to a variety of different audiences, the better you will be at achieving your objectives.
2. Inducing action. The second objective for your written communication is to induce someone to take the action that you want or need that person to take. This involves perhaps even more planning and may require a number of steps.
Obviously, the first step is to provide the appropriate level of information, and at the same time to open a dialogue for two-way communication – feedback on the information received. This allows you to clarify and enhance. Then you move into finding the best way to get action.
It has often been said that there are essentially only four ways to get other people to do what we want them to do:
• payment
• patronage
• pressure
• persuasion
Your written argument could contain elements of any or all of these but essentially should be concerned with the last – persuasion – only.
First, you can, indeed, pay people to get them to do what you want them to do. In the case of management in health care, that approach usually means hiring. Enticing someone to do something by offering more money is a good approach under certain circumstances: if it is ethical, if you have no other option, and if you have the money. This is generally for only very specialized situations.
You could take the second approach and call in a favour. Patronage, in this sense, refers to convincing someone to do something for you because you have done something for them, or you might offer to do something in the future. This might work as the basis for your argument if you know your audience well and have a concrete, ethical foundation upon which to base this.
The third approach, pressure, could just as easily be termed coercion. It is highly ethically suspect as an approach because it has long-term, negative ramifications for your relationship with the person or organization on the receiving end. If your written communication seems to have an undertone of threat to the receiver, you are failing to consider the implications of your action, and you have not spent enough time considering how to develop the content of your written communication.
Although you may have been inclined to term each of the above persuasion techniques, in fact, from a communication perspective, they are not. You must consider changing how you think about persuasion. For our purposes, we can define persuasion as the use of communication strategies to change the way someone thinks about an issue – the pictures that person has in his or her head – so that he or she changes behaviour in the direction that the communicator wants. This requires you to consider the images that might be elucidated by the words that you select in your written communication.
Three ways of thinking about the persuasive words you select are using positive images, using negative images, or using logic.7 If you paint a positive picture, you are inviting the receiver to move toward that image, to be a part of it. If you paint a negative image, then you are trying to make the receiver feel uncomfortable enough about it that he or she wishes to change behaviour away from that image. Finally, you may have an unemotional issue that does not lend itself to either a particularly positive or negative image. This is when you take Aristotle’s approach and create a logical argument. It is often particularly useful to use this as a supplement to the more emotional approaches for long-term effect. Research on emotionally laden persuasion approaches has found that the results are fast, but short lived. Logic takes much longer to penetrate the mind of the receiver, but has more lasting effects.
The overriding objectives for all of your written communication should be to maintain and enhance a positive relationship with the receiver of the message.
Throughout this discussion about what to write, when, and for what reason, we have continually hearkened back to the reader, the receiver of your written communication. The notion of knowing as much as possible about your receiver holds true for any kind of communication, but can be forgotten in the daily grind of completing our written communication requirements.
You have a number of audiences with whom you will need to communicate in writing, and each of them is different. They have different backgrounds, different levels of education, different types of relationships with you and your organization, and they have differing levels of interest in the topic about which you are writing. They also have different preferences for the medium used for receiving important information. Does your board request detailed reports? Do your colleagues favour letters? Do your employees prefer e-mails? Considering each of these factors is a key element in achieving your communication goals.
We all have certain beliefs about writing and how we write. Holding on to false beliefs can impede our success. Here are some commonly held myths about writing.
1. Good managers are good writers. Although this may, indeed, be true in some cases, one does not have any true relationship to the other. Many managers are particularly poor writers. In fact, there is no reason to believe that a manager will be any better at written communication than anyone at a lower level on the organizational hierarchy. Writing is a skill that must be consciously developed over time, and the only way to become a good writer is to write.
2. If you can write for one type of audience, you can write for anyone. Wrong. If you can write well for one audience (college professors, perhaps?), bravo. But suggesting that this can be extrapolated to other audiences has no foundation. Each audience has different needs (as we have already discussed), and you will likely find that writing for some audiences is easier and more satisfying than writing for others.
3. Everyone who graduates from college or university has a good grasp of style (grammar, syntax, punctuation, and word choice). When was the last time someone discussed placement of commas, semicolons, conjunctions, and the use of the subjunctive tense with you? For most college graduates, it has not been recently, unless you studied writing specifically. When was the last time you pulled out your style reference, or even your dictionary?
4. Your reader is just as interested in your topic as you are. This is almost never true, unless you are responding to something that originated with your reader, in which case it is more likely that you are less interested. Interest level is a very personal thing and something about which you should gather information, especially when you are trying to persuade someone. For example, if you are trying to convince your board about an issue, you need to begin by determining how everyone feels about the issue before developing a persuasive approach.
No discussion of effective written communication would be complete without reference to what William Zinsser calls the “disease of American writing.”8 That, of course, is clutter, and nowhere else – with the possible exception of government documents – is cluttered writing more sprinkled with jargon and unnecessary words than in healthcare communication.
Consider the following memo from the manager of an outpatient department to her booking clerks:
In an effort to streamline the booking of appointments in the outpatient clinic, staff members are to be advised that the prioritization of patients will be completed prior to providing the patient with the appointment time. This will necessitate telephoning patients and advising them of their appointment times rather than being able to provide such appointment times during the initial telephone encounter.
What precisely does this mean? Look at all the unnecessary words. The truth is that the more unnecessary words there are, the greater the chance of misunderstanding. A less cluttered and clearer way to say this in a written memo or e-mail is the following:
When patients call to make appointments, they are to be ranked in order of priority and telephoned later with their appointment times.
There was a time when the memorandum was the backbone of business communication. Everyone now accepts that electronic transmission of what used to go into memos has made a huge difference in how we use the written word to communicate. However, many people have altered their writing for electronic transmission with little thought about good writing for this specific medium. Clearly, different formats require different rules.
Electronic mail has been a godsend to many busy executives. The quick turnaround that it requires is a huge advantage for efficiency (this in spite of the seemingly endless daily arrivals in the inbox). However, this rapidity has also caused some writing problems to sneak into such communication. Although e-mail is generally accepted to be less formal than other types of written communication, this can, and often is, taken too far. Here are some things to keep in mind.
• The subject line is extremely important. Ensure that it is clear, descriptive, and to the point.
• The body should have a salutation. Don’t simply launch in. If you know the recipient well, you might begin with a simple “hello.” Otherwise, “Dear …” is suitable.
• Don’t ramble on. Keep the message brief. Some people suggest keeping the length to the amount of text that can be read on the average screen without scrolling. Anything longer should be sent as an attachment.
• Use short paragraphs, and always proof the message before you send it! Typos are so common in e-mails, largely because many people who use e-mail are poor typists. Errors in e-mails provide the same subliminal messages as errors in other types of writing.9
Although you may not be the one actually writing the news release, as a manager you need to be aware of the rules of this special format, because there is no doubt that you will have to approve them from time to time.
• News releases should contain news and not be sent on a regular basis. They should only be released when there is a specific, actual news item to relate.
• The audience for the news release may ultimately be the general public, but its first audience is an editor or journalist. Therefore, it should be written in newspaper style.
• News releases use the “inverted pyramid” structure. The most important who, what, when, where, and why should be in the first paragraph. The rest of the details can be filled in throughout the piece.
• News releases usually require a quote attributed to someone in the organization who is a credible source of information for the topic. It may be you.
As a healthcare manager it is very likely that you will be required to produce such a piece of writing at some point in your career. In fact, you should be looking for such opportunities. Here are some suggestions about this format.
• Select the media outlet for your opinion piece carefully. Ensure that the readership of the particular newspaper – whether printed or online – is a large part of your intended target audience.
• Write professionally, but personably. Keep your points clear and simple. Avoid jargon, but if you must use it, explain it.
• Keep the piece to between 600 and 800 words.
No matter what your level on the organizational hierarchy, you should consider the internal newsletter (print or electronic) to be an important venue through which employees can get to know you, and for which you can provide important information. You should seek out opportunities to use this medium. Here are some pointers for healthcare managers and their contributions to internal newsletters.
• Ensure absolute accuracy! This is a rule for all forms, but you cannot afford even one slip-up with your internal audience. Your credibility and future relationships depend on trust.
• Use a crisp, clear, uncluttered style. Avoid the use of adjectives and adverbs, and stick to the subject and its action. People do not spend a lot of time reading organizational newsletters, so get to the point whether printed or posted on the company intranet. Keep it short and simple.
Each of these kinds of writing (as well as any others you may have to do) has specific issues that govern their successful accomplishment. In the final analysis, however, the important thing is to ensure that your writing is readable.
If no one reads what you write there is little point in writing it. As a manager you write to accomplish a variety of goals, not, like the creative writer, for the love of it. You may be able to bring a subtle artistic flair to what you write, but you must consider a number of concrete approaches that ensure your writing will be read.
The first rule of readable writing is to simplify the complex. Knowing your audience helps you to do this without insulting the intelligence of your readers. If you are trying to explain an upcoming merger to your employees, go one step at a time. Most healthcare workers will have had little business experience, and the process may seem complex and outside their realm.
Second, each individual element must be coherent. For example, as your teachers told you, the first (or topic) sentence of a paragraph indicates what that paragraph should be about. Writing that lacks this kind of coherence is difficult to follow and therefore not readable.
Third, select the correct word. Remember the Mark Twain quote at the beginning of this chapter? That says it all. C.S. Lewis added to this sentiment when he said, “Don’t use words too big for the subject. Don’t say ‘infinitely’ when you mean ‘very,’ otherwise you’ll have no word left when you want to talk about something infinite.” These days, there doesn’t seem to be any word for what we used to call “awesome” since everything from your restaurant order to the Grand Canyon is awesome evidently.
Fourth, readable writing uses as little jargon as possible. Again, jargon use is related to the audience for your piece; however, you probably should consider your audience and then use even less.
Finally, readable writing does not insult anyone. Avoid sexism, stereotyping, ageism, and all other subtleties that may have a negative effect on anyone. Reread all your writing, and purge it of these negative habits.
When you have completed a writing piece, make a point of reading it out loud. You will begin to hear the sound of your words as mentioned earlier, and you will be able to pick up problems more quickly than if you simply read it silently.
Because writing is so fundamental to communication, I want to make specific mention of writing resources. Countless books and Web sites are available to help you improve your writing. Listed at the end of the chapter are some of the more useful ones I have found, as well as several tests and crib sheets for your personal use.
Don’t use this … |
Use this … |
|---|---|
slowed down |
slowed |
in the near future |
soon |
at this point in time |
now |
at the present time |
now |
four o’clock in the afternoon |
four p.m. |
past history |
history |
very unique |
unique |
along the lines of |
like |
is in the process of planning |
is planning |
completely destroyed |
destroyed |
rose to the defence of |
defended |
be in need of |
need |
at all times |
always |
due to the fact that |
because |
give assistance to |
help |
in order to |
to |
make use of |
use |
make payment for |
pay |
on numerous occasions |
often |
The following are some words that the not-so-trusty spellchecker on your computer won’t pick up when used in error:
accept |
except |
adapt |
adopt |
affect |
effect |
appraise |
apprise |
canvas |
canvass |
complement |
compliment |
dual |
duel |
further |
farther |
grisly |
grizzly |
naval |
navel |
parameter |
perimeter |
pore |
pour |
reign |
rein/rain |
stationary |
stationery |
their |
there |
then |
than |
(If you don’t know the proper usage of each of these words, now is the time to look them up!)
Active voice is stronger and therefore almost always preferable to passive voice. Edit the following sentences to ensure that they’re in active voice.
1. Control of the furnace is provided by the thermostat.
2. Fuel cost savings were realized through the installation of thermal insulation.
3. The policy manual is frequently updated by the supervisor’s secretary.
4. Medical coverage in the emergency department will be provided by medical Emergency Specialists Inc.
Purging clutter from your writing is essential to enhancing its readability. Rewrite the following sentences.
1. It is most useful to keep in mind that the term Alzheimer’s disease refers to a whole spectrum of symptomatology.
2. It is unfortunate that I was unavailable to you when you visited our hospital facility on Monday.
3. It has come to the attention of management that there has been excessive smoking carried out by various employees close to the front doors, and thus we have come to the decision that there is to be a new policy that smoking within fifty feet of any doorway is to be stopped immediately and for the future.
Shertzer, Margaret. The Elements of Grammar. New York: Collier Books. (Any edition.)
Strunk, William, Jr, and E.B.White. The Elements of Style. (Any edition.)
Zinsser, William. On Writing Well. (Any edition.)
The Basic Elements of English (U of Calgary). http://www.ucalgary.ca/UofC/eduweb/grammar/
The Elements of Style (Strunk). http://www.bartleby.com/141/
Purdue University Online Writing Lab (OWL). http://owl.english.purdue.edu/
Theories about Persuasion. http://changingminds.org/explanations/theories/a_persuading.htm
Twitter Tips: How to Write Better Tweet (Computerworld). http://www.computerworld.com/s/article/9132410/Twitter_Tips_How_to_Write_Better_Tweets
Writing Effective E-mail. http://www.mindtools.com/CommSkll/EmailCommunication.htm
Section 1: 1. The thermostat controls the furnace. 2. The installation of thermal insulation resulted in fuel cost savings. 3. The supervisor’s secretary frequently updates the policy manual. 4. Medical Emergency Specialists Inc. will provide medical coverage in the emergency room.
Section 2: 1. Alzheimer’s disease refers to a whole spectrum of symptomatology. 2. Unfortunately I was unavailable when you visited our hospital on Monday. 3. As a result of excessive employee smoking close to the front doors, smoking will no longer be permitted within fifty feet of any doorway. (Note that the use of the passive voice works here.)