Advantage of teamwork

Advantage of teamwork

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What are the advantages of teamwork in today’s health care organizations? What factors make teamwork difficult to achieve?
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du Pré: Communicating du Pré: Communicating 10. Leadership and © The McGraw-Hill
about Health: Current Health Organizations Teamwork Companies, 2004
Issues and Perspectives,
Leadership and Teamwork
Sam Hill was on duty at the Center for Advanced Medicine in Chicago
one night when he saw an older woman leave the building. It was raining and
dark outside, and no taxis were waiting at the curb. Hill, encouraged by the
organization’s mission of providing top-quality service, dashed out in the rain
himself. While the woman stood under shelter, he ran down the street to find
a taxi. “I practically had to stand in the middle of the road,” he recalls. But the
woman’s gratitude made the trip worthwhile. Waving off her offer of a tip, he
recalls, “I was just so glad I could help.”
his story, told by Judy Schueler (2000) in an article about customer service
in health care, illustrates how a well-defined mission can influence the way
people communicate and behave in health care organizations.
Health care organizations are changing the way they do business. Changes
in care delivery systems are accompanied by intense competition for clients
and qualified employees. The principle change agent is communication.
Effective communication can improve satisfaction, earn clients’ and employees’
loyalty, save money, and stimulate change and innovation—goals
health care organizations cannot afford to ignore. Health care leadership consultant,
Quint Studer, articulated the need for a revised vision in an article
published by the American Hospital Association in 2002. In the article Studer
described a 1998 survey in which health care executives listed their strategies
for organizational change. The executives listed technology, provider networks,
and new services. “What didn’t make the list?” Studer asked. “Not patient
or employee satisfaction, nor leadership development. As a result, these
goals did not receive attention or resources” (Studer, 2002, paragraph 1). He
says this is a mistake.
Studer advocates creating “cultures of excellence” in which employee and
client satisfaction are paramount and, although goals are clearly defined,
leadership is dispersed throughout the organization. His ideas are catching
on. Studer works with organizations around the country and has been named
one of the Top 100 Most Powerful People by Modern Healthcare magazine
(Romano, 2002). In Box 10.1, Studer shares additional insights about health
care leadership.
As Quint Studer and others have recognized, health care is in a state of
transition. In some ways this adds to the stress of communicating in health
organizations, making it especially important to keep employees and clients
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Chapter 10. Leadership and Teamwork 271
informed and involved. At the same time, transition provides exciting opportunities
to help reshape the system. Communication skills are put to the test
as people from many disciplines come together to share ideas and establish
new policies.
This chapter describes the conditions that make it necessary for health
care organizations to break free of the slow-moving bureaucratic model in
favor of more innovative leadership and teamwork. You will read about current
issues, evolving ideas about leadership and teamwork, and ways communication
specialists can help health organizations manage the challenges
ahead. The chapter showcases the challenges, but also the opportunities, for
communicating effectively in health care organizations. Throughout the
chapter experts share their tips for working in teams, training new leaders,
collaborating on creative solutions, developing a shared vision, evaluating
existing rules, and managing crises.
Health care has changed dramatically in the last few decades, primarily because
of efforts to control costs. As you may recall from Chapter 2, in the 1970s
insurance and governmental agencies began to limit the amounts they would
pay for medical services. Health organizations were subsequently faced with a
drastic loss of income unless they cut their own costs. Organizations unable to
adapt quickly or efficiently enough closed their doors. Some 949 U.S. hospitals
closed between 1980 and 1993 (American Hospital Association, 1994). Hospitals
in minority neighborhoods were especially hard hit. Between 1990 and
1997, 70% of hospitals in predominantly African-American or Hispanic
neighborhoods closed (Robert Wood Johnson Foundation, 2001).
Remaining organizations have reacted to funding limitations by consolidating,
becoming more competitive and consumer oriented, and investing in
employee retention. In each case, communication has become a valuable
means of establishing and pursuing important goals.
Health organizations that once operated independently are now likely to be
part of multicorporation enterprises. By the 1990s, more than half the hospitals
in the United States had been bought by large corporations (Shortell,
Gillies, & Devers, 1995). Many others merged with competitors or formed alliances
with other health organizations. Integrated health systems are formed
when local care providers collaborate to offer a spectrum of health services
(Jennings & O’Leary, 1995). An integrated health system may include hospitals,
outpatient surgery centers, doctors’ offices, fitness centers, nursing homes,
rehabilitation centers, hospices, and more (Slusarz, 1996). The idea is that, by
sharing resources, these organizations can reduce their operating costs. As a
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Leaders Communicate With Purpose
As futurists continue to forecast a “perfect storm” brewing in health care
(i.e., all industry challenges are converging toward an unprecedented crisis),
I believe the reality is quite different. There has never been a more rewarding
or exciting time to be a leader in this noble profession. In health
care, we have great purpose, do worthwhile work, and have the opportunity
to make a difference. This passion is at the heart of all we do in
health care. When leaders find ways to engage it and harness it in their
organizations, the opportunity to shape great change is limitless.
I meet many highly effective leaders daily in my work with hospitals
and health systems across the country. And I find that it is truly the good
organizations that want to become great. Their leaders are committed to
creating and sustaining a corporate culture that thrives on communication
at all levels, so physicians and employees can live the organization’s
mission and vision daily in ways that meet and exceed patient expectations.
In fact, I find that the strength of a hospital’s culture correlates
directly with the amount of compassion and caring that employees
show for each other and patients.
Where does culture reside in an organization? Is it in the bricks and
mortar? Or the technology we are so proud of? I believe the heart and
soul of an organization lies in its people . . . from the receptionist who
reaches out for the hand of a walk-in suicidal patient to the physician who
goes in search of throat lozenges for a sick child at an all-night pharmacy.
Creating this kind of ownership requires goals that are aligned at every
level (from housekeeper to CEO), accountability that is “hardwired” into
Quint Studer shares his ideas about innovative leadership with
audiences around the country.
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Issues and Perspectives,
Chapter 10. Leadership and Teamwork 273
the infrastructure of the organization, and tools that open channels of
communication. The hospitals and systems I work with achieve this by
setting goals and measuring progress in Five PillarsTM: service, people,
quality, finance, and growth. Leaders at these organizations align goals
and performance objectives that cascade throughout the organization so
there is a cohesive plan with benchmarks and tools to get there. Each
employee knows the hospital’s goals, where it is headed, how it is doing,
and how well they as individuals are contributing.
These leaders also build service and operational excellence through
the use of Nine PrinciplesTM: They commit to excellence; measure the important
things; build a culture around service; create and develop leaders;
focus on employee satisfaction; build individual accountability; align
goals and values; communicate at all levels; and recognize and reward
Communicating with purpose (Principle #8) means using prescriptive
tools and practices that convey a constant and consistent message to all
employees about an organization’s mission, vision, and values. Posting
communication boards throughout the hospital, for instance, promotes
a “no secrets” culture by graphing each department’s progress toward
organizational goals in service, quality, finance, people, and growth
(i.e., the Five PillarsTM).
I also recommend the use of key words at key times. There are many examples
of how specific words, when used with patients, can proactively set
patient expectations, demonstrate caring, and increase patient satisfaction.
Perhaps the most compelling are the words, “Is there anything else
I can do for you? I have time.” Even busy nurses find that by anticipating
patient needs, these words magically and dramatically reduce call lights.
Then nurses find they actually do have more time to care for patients.
I also believe effective unit rounding is a key communication tool. It is the
single most important thing a hospital can do to dramatically increase
patient satisfaction and drive employee satisfaction. When nurse leaders
round on their staff by talking to each person, for instance, their goal is
to empower staff to help patients. They should ask five key questions:
(1) a relationship-building question (e.g., How was your family vacation?),
(2) Which systems are working well? (3) Who among the staff
can I recognize?, (4) Who among the physicians can I recognize?, and
(5) What can be improved? Then they must follow through by delivering
needed improvements.
In my experience, employee thank-you notes, especially when sent to an
employees’ home, are another great way to communicate. Thank-you
notes build the emotional bank account with employees by recognizing
the good things leaders have seen and heard during rounding. Leaders
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Leaders Communicate With Purpose, continued
can “manage up” their staff in this way, by sharing noteworthy accomplishments
with their supervisors who can thank the employee. This is
also a surprisingly powerful way to reduce employee turnover, one of the
biggest challenges in health care today.
I also recommend that staff conduct discharge phone calls to patients 24
to 48 hours after they have left the hospital. This allows them to reconnect
back to their sense of purpose (delivering quality care) and to the
patient by demonstrating empathy, hearing the patient’s perception of
care, and improving clinical outcomes.
As one hospital CEO I know says, “We are in the life enhancement
business.” Just as students ask teachers to help cultivate their potential,
patients come to our hospitals for help during pivotal events in their
lives . . . whether a loved one has just been diagnosed with terminal cancer
or a child is born. It is my greatest hope that the next generation of
leaders in health care will reach out with sensitivity, skill, and compassion
during such moments. Never underestimate the difference one individual
can make.
—Quint Studer, Studer Group
About Quint Studer
Quint Studer, named one of the top 100 most powerful people by Modern
Healthcare in 2002, began his career in a hospital staff position in 1984
result, they can offer health care at discount prices, either to members of their
own health care plans or to managed care organizations that pay the system to
provide care for their enrollees.
By joining forces health organizations may be more marketable and cost-
efficient. But takeovers, mergers, and alliances present communication challenges.
For one thing, long-standing competitors may find themselves working together.
This challenges organizational members to form new relationships and find ways
to integrate their ideas (Slusarz, 1996). Furthermore, as organizations become
more complex, it is difficult to manage them by the old rules. Centralized decision
making is inadequate to guide the efforts of highly diverse enterprises.
With health care dollars limited, health organizations have become more competitive.
With capitated fees and limited reimbursements, organizations must
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and later became chief operating officer of Holy Cross Hospital in
Chicago and president of Baptist Hospital, Inc., in Pensacola, Florida,
before forming Studer Group in January 2000. Today, Studer Group
coaches more than 250 hospitals and health systems nationwide to service
and operational excellence. To learn more about these principles and
practices in action at hospitals nationwide, visit
Other Articles by Quint
Read excerpts of some of these articles online at
Full reprints are available at no charge by e-mailing allyson.holliday@
Studer, Q. (2003, November). Communicating quality. COR Healthcare
Market Strategist, published by COR Health.
Studer, Q. (2003, Summer). How healthcare wins with consumers who
want more. Frontiers of Health Services Management 19(4), 3–16,
published by the American College of Healthcare Executives.
Studer, Q. (2002, September). Back to the basics: Making service excellence
a priority. Trustee Magazine 55(8), 7–10, published by the
American Hospital Association.
Studer, Q. (2003, May/June). Sustaining the gains: Creating organizational
alignment through accountability. Press-Ganey Satisfaction Monitor,
published by Press-Ganey. Available online at
anticipate as accurately as possible what health services their subscribers are
likely to need (Azevedo, 1996). This requires that they collect and track information
about community health and that they promote community health as
much as possible. As you will see later in the chapter, communication specialists
can help with this.
To be competitive, health systems must also keep the public up to date
about the services they offer. Competition has led to a new emphasis on marketing
and advertising. The AMA, which banned physician advertising in 1914,
lifted the ban in 1975 under pressure from the U.S. Supreme Court, which felt
that the ban restricted public information and physicians’ livelihood (Kotler &
Clarke, 1987). Although doctors have been somewhat reluctant to advertise aggressively
themselves, many insurance companies and managed care organizations
are avid advertisers, as are pharmaceutical companies, which spend more
than $2 billion a year to advertise prescription drugs (Kane, 2003). (You will
read more about this in Chapter 11.)
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Should Health Organizations Advertise?
In 1914 the American Medical Association forbade physicians to advertise
their services, asserting that commercialism had no place in medicine.
The association felt it was unethical to promote medical services for
the purpose of making money (Walt, 1997). That ban was lifted in 1975,
and although doctors have not become conspicuous advertisers, many
types of health care organizations do advertise.
Some people object to advertising medical services and products.
Robert Boyd (1997), for one, argues that “media hype” has no place in
health. He warns that it is confusing enough to keep up with medical research
without being bombarded by sales pitches promoting various
health products and services.
A related worry is that advertisers will exaggerate the benefits, but
minimize the ill effects, of what they are selling. For example, prescription
drug advertisements may lead people to expect miracle cures or may underrate
the side effects of the products (Chaker, 1998). Patients may be
disappointed when their doctors do not prescribe products they have
seen advertised or may disregard warnings in light of the rosy pictures
painted by advertisements. The argument is that patients do not have the
expertise to know when advertisers are making exaggerated and inaccurate
claims about health benefits. Moreover, seriously ill patients and
their loved ones may be particularly vulnerable to advertisers’ claims because
they so badly want to believe a cure is possible (Irvine, 1991).
Others fear that health advertisements will alarm people and make
them needlessly preoccupied with health issues. Alison Bass (1990) describes
a hospital advertisement that shows a woman examining her
breasts for lumps. The headline reads: “This woman just missed the cancer
that will kill her” (p. 1). Bass concludes: “People who provide health
care have begun playing on the very fears and anxieties they are supposed
to alleviate” (p. 1).
There is also concern that advertising will damage the professional
image of caregivers. Critics cringe at sales ploys that make health professionals
seem silly or greedy. For example, some clinics now offer money-
back guarantees if patients are not satisfied with the care they receive.
Although competition is fierce, “selling” medical services remains a controversial
subject. For a discussion of the ethical issues involved, see Box 10.2.
Patients have choices in the health care marketplace. Choice is underlined not
only by advertising and marketing efforts, but also by an unprecedented
amount of health information available in the news media and on the Internet.
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Health ethicist John La Puma (1998) wonders if free toasters will be the
next marketing strategy.
People who support health advertising have a simple but compelling
case as well. They feel that advertising is a useful way to let the public
know what health products and services are available (Bass, 1990).
Without advertisements, they argue, people may not be aware that certain
treatments exist. Proponents of health advertising maintain that
consumers are wise enough to be skeptical about advertisers’ claims and
avoid being taken in by misleading promises.
What Do You Think?
Should doctors be allowed to advertise their services? Why or why
2. Should other providers (hospitals, drug companies, rehabilitation
centers, managed care organizations, etc.) be allowed to advertise?
Why or why not?
3. If advertising is allowed, should there be any restrictions on what
the ads may (or must) contain?
Suggested Sources
Bass, A. (1990, November 25). Health care marketing seeks gain from
pain. Boston Globe, National/Foreign section, p. 1.
Boyd, R. S. (1997, June 21). Medical aids, media reports “a flood of
confusing advice”: Marketing hype, thirst for the news among causes
of bewilderment. Houston Chronicle, p. 7.
Chaker, A. M. (1998, October 4). Anti-acne birth control pills cause conflicting
viewpoints. Wall Street Journal, Business section, p. 2.
Irvine, D. H. (1991, March). The advertising of doctors’ services. Journal
of Medical Ethics, 17, 35–40.
Walt, D. (1997, March 17). Standing up for ethics. American Medical
News, 40, 12–15.
In this context, patients are well-informed consumers motivated and capable
enough to choose between different health services vying for their business.
As a result of these factors, health organizations must strive for consumer
satisfaction. Putting the consumer first may require that managers relax protocol
so that employees can accommodate consumers’ needs. For instance,
many medical centers have eliminated the paperwork that used to make hospital
admissions a lengthy and frustrating process. Instead, they now obtain information
over the phone in advance so people feel less hassled when they
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More About Adapting to Changes in Health Care
Coddington, D. C., Moore, K. D., & Fischer, E. A. (2001). Strategies
for the new health care marketplace: Managing the convergence of consumerism
and technology. San Francisco: Jossey-Bass.
Geisler, E., Krabbendam, K., & Schuring, R. (2003). Technology, health
care, and management in the hospital of the future. Westport, CT: Praeger.
Leebov, W., & Scott, G. (2002). The indispensable health care manager:
Success strategies for a changing environment. San Francisco: Jossey-Bass.
arrive for treatment. Others have authorized employees to reimburse patients
for lost items or award gift certificates and coupons when they see fit.
Staffing Shortages
In the midst of other challenges, health care organizations are also struggling
to attract and keep qualified personnel. As you read in Chapter 9, experts estimate
that by 2010, U.S. health care organizations will be short-staffed by
220,000 registered nurses (U.S. Department of Health, 2002). Already, the
shortage has topped 100,000. Consequently many health care organizations
are doing whatever they can to attract and keep qualified personnel. This includes
listening more closely to employees’ needs, responding to their ideas,
and involving them in collaborative efforts to create satisfying environments.
(For additional resources about strategic changes in health care organizations,
see Box 10.3.)
Health care is reacting to a new set of challenges: to conserve resources, to develop
a clearer understanding of community health needs, and to attract and
satisfy clients and employees. The next section examines some of the changes
taking place in the health industry in response to these challenges. The most
notable change is a shift from bureaucratic management to an emphasis on
human resources.
Like most businesses that developed during the Industrial Revolution, U.S.
health organizations (especially large ones) adopted a bureaucratic model.
A bureaucracy is a highly structured organization with a clear chain of
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command, centralized power, specialized tasks, and established rules for operation
(Weber, 1946).
Over the years, the bureaucratic model has strengthened health care organizations
in some ways and weakened them in others. The principle weakness—
top-down leadership that is often insulated and slow moving—has become a
liability few organizations can afford. A case in point is the U.S. Veterans Administration
(VA). Although the VA is the second largest bureaucracy in the
American government, its health system has launched an extensive effort to
become less bureaucratic. Describing the VA’s planned transformation, Vestal,
Fralicz, and Spreier (1997) explain:
The rigid, functionally focused, command-and-control culture that has
long been a hallmark of VA must be replaced by one that values speed, flex
ibility, and the processes for delivering high-quality, cost-effective patient
care. (p. 339)
An effort is underway to restructure the VA health system so employees are
empowered to respond to consumers’ needs, not simply to the dictates of the
bureaucracy. Employees will be encouraged to think of ways to please customers,
solve problems, work together in teams, and come up with innovative
methods to improve care and conserve resources.
As in the VA, members of many health care organizations are considering
new options. A few of those options are presented here. As you will see, future
trends are still more easily defined by questions than answers, which means
leaders and teams have a particularly challenging and exciting task ahead of
Hierarchies or Partnerships?
In a classic bureaucracy a strict hierarchy establishes who the bosses are. The
organizational chart is vertical, meaning there are many layers of management,
and managers at each level supervise a relatively small number of people
(Hamilton & Parker, 1997). The old saying, “It’s lonely at the top,” is true in a
vertical organization. Few people make it that far. Although top-level managers
make most of the decisions, employees are encouraged to communicate
mostly with those directly above and below them, meaning that top-level administrators
typically have little contact with the majority of organizational
Advantages There are some advantages to a vertical hierarchy. Centralized
authority provides stability and a common sense of purpose. This is important
in health care organizations, which may have dozens of departments and different
types of employees. Particularly with mergers and consolidations, it may
be difficult to achieve a shared vision without strong leadership at the core.
Moreover, a strict hierarchy reduces ambiguity. It is clear who has decision-
making power. This is useful when making quick or important decisions.
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In emergencies, for example, paramedics know exactly which procedures they
are authorized to begin and which procedures require the approval of a supervisor
or physician. This clarity can save time and prevent mistakes that inexperienced
personnel might make. Likewise, appointed decision makers can help
organizations reach decisions about marketing, new service lines, staffing, and
other issues that cross departmental lines. Without clear management levels, divisions
may be at odds with each other, unclear what agenda should prevail.
Disadvantages Centralized authority also has drawbacks. Nurse executive
Ann L. Hendrich proposes that vertical health care organizations should consider
a change of format. As she puts it: “Vertically structured organizations
are often bureaucratic, expensive, and difficult to operate in a cost-driven,
competitive environment. In the new market there will be two kinds of organizations—
quick and dead” (quoted by Porter-O’Grady, Bradley, Crow, &
Hendrich, 1997, paragraph 10).
As Hendrich points out, centralized decision making does not enable bureaucracies
to change quickly or to accommodate unusual circumstances. Because
people who carry out policies do not often have direct contact with
decision makers, opportunities for change may be lost or delayed. This means
organizations may perpetuate inefficient and costly procedures and miss opportunities
to respond to emerging market needs.
Restricted communication limits organizational effectiveness, but it also
frustrates employees. Human resource theorists have long observed that employees
are more satisfied when they have a voice in the workplace (Blake &
Mouton, 1964; Likert, 1961; McGregor, 1960). However, hierarchies inhibit an
open and trusting exchange of information. Employees may be reluctant to
discuss sensitive issues with people in positions of higher power, particularly
since there is typically little opportunity to get to know (and trust) top-level
leaders. Information may be filtered and distorted as it moves upward through
the chain of command (Lee, 1993). For example, employees in the billing department
may be reluctant to admit that the new computerized billing system
they requested is not working well. Ironically, because power is centralized, the
people at the top (who make the decisions) may be poorly informed or misinformed
about day-to-day issues and client responses.
In short, innovation and problem solving are compromised when people
are poorly informed or afraid to be honest. Considering that (under the right
conditions) employees want to share ideas and have valuable suggestions to
make, reserving power for top-level officials seems to present more problems
than it solves.
Opportunities for Change Faced with the need to adapt more quickly than a
bureaucratic framework allows, some health care organizations have eliminated
one or more layers of middle management. The rationale is that, with
fewer status differences and hierarchical levels, communication will flow more
freely and organizational members will be better informed and more actively
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Chapter 10. Leadership and Teamwork 281
involved. (No doubt, another consideration is that it is less costly to employ
fewer managers.)
In a decentralized, horizontal structure, organizational members have
more peers and fewer managers. For example, perhaps you are a market research
coordinator who used to report to the marketing supervisor, who reported
to the director of marketing and public relations (PR), who reported to
the vice president of strategic planning, who reported to the CEO, who reported
to the board of directors. (Confusing, isn’t it?) However, it has recently
been declared that the marketing and PR departments will report directly to
the vice president. This can be an exciting opportunity to present your ideas
directly to top-level management, and perhaps you will now be more involved
in making decisions that affect everyday operations.
Participative decision making (PDM) means people are involved in making
the decisions they will be expected to carry out (Goldhaber, 1993). As previously
mentioned, employees are usually more satisfied with their jobs, and
more committed to staying with the organization, when they have input
(Bucknall & Thomas, 1996; Ellis & Miller, 1993; McNeese-Smith, 1996; Miller
et al., 1990; Nakata & Saylor, 1994).
However, simply removing a layer of management does not guarantee
more or better communication. With PDM, the greatest influence lies with
people who are able to express themselves clearly and win support for their
ideas. While it is true that you (at least theoretically) have more access to top-
level administrators and more voice in decision making, so do a lot of other
people. You may find yourself either fighting for the spotlight or wondering
how you should perform when you are suddenly in the spotlight. I remember
being promoted to PR supervisor one week and being asked to make a presentation
before the board of directors the next week. Although I was trained to
give presentations, it was a tense week for me. I did not know how board meetings
were conducted or what was expected of me. The pressure is especially
great for people thrust into leadership roles without much communication
Nevertheless, organizations often expect people to assume leadership roles
with little or no preparation. At a recent workshop I attended, Bob Murphy,
vice president and chief operating officer of Baptist Hospital in Pensacola,
Florida, quipped: “There’s an old saying, ‘What’s the difference between a
nurse on Friday and a nurse leader on Monday?’ . . . A weekend to think about
it!” The same is often true of personnel in other areas as well.
Murphy compares leadership to bull-riding in that, even if you know
what you want to accomplish, it still takes a good deal of skill to be successful
at it. “Bull-riding is a simple concept,” Murphy exclaims, “‘Hang on!’ But
that’s hard to do isn’t it?” The following section presents suggestions for cultivating
Communication Skill Builders: Training New Leaders The Leadership Institute
at Baptist Hospital in Pensacola has become so popular that people travel
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from around the country to take part in workshops and benchmarking sessions.
Here are some of the leadership lessons the Baptist staff shares with
Provide leadership training. Involve midlevel and upper-level managers
in day-long leadership training programs at least four times a year, and
invite people throughout the organization to take part in series of
briefer workshops. Also help people develop leadership experience by
involving them in self-governance.
Keep no secrets. If people are to be accountable as leaders, they must
know where they stand and how the organization is performing. Make
current financial records and satisfaction survey reports available to all
employees so they can chart their successes and receive immediate market
feedback on what works well and what does not.
Make organizational leaders accessible. Avoid placing administrative officers
in a far-off or segregated area. Encourage leaders to interact freely
throughout the organization and share conversations, praise, and ideas.
Reward people for sharing ideas. Develop a program that invites employees’
suggestions and rewards them for submitting workable ideas that
improve services, save money, and increase employee morale.
Respond to ideas. Even when the ideas cannot be implemented, people
want to know they have been heard. “We made a lot of mistakes when
we began,” Murphy confides. “We encouraged ideas, but 99 percent of
the time, we didn’t do anything with them.” Now committees are in
place to review ideas and respond quickly.
Celebrate successes. Post thank-you letters and praise the people involved.
Hold celebrations when the organization reaches key goals. Develop
recognition programs to honor people who exceed expectations.
Authority Rule or Multilevel Input?
In bureaucratic language, rational-legal authority is based on “rationality, expertise,
norms, and rules” (Miller, 1999, p. 13). In health care this translates to a
reverence for those people who are most educated, have the most up-to-date
knowledge, and hold the most impressive titles and credentials (Cadogan,
Franzi, Osterweil, & Hill, 1999). Health care employees typically advertise their
credentials right up front. Their name badges list their job titles, and very often
their degrees and accreditations as well. For example, the initials CRNA behind
a person’s name stand for Certified Registered Nurse Anesthetist. Patients may
not fully grasp the difference in credentials, but professionals probably do.
Advantages Most people would agree that health care is not a job for amateurs.
The emphasis on education and experience is justified by the immense
knowledge and responsibilities associated with providing top-quality care.
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Attention to norms and rules helps assure that treatment is given in time-
honored and consistent ways by people who are well qualified to provide it.
Disadvantages Status differences can cause rifts and intolerance. People
without impressive titles (including patients) may be excluded from discussions
even though they may have valuable information and ideas to share.
Health care is often characterized by what Kreps (1990) calls professional
prejudice. Some professions are considered more prestigious than others
based on their training, their authority, or their place in the organization. For
example, critical care nurses may be given higher status than maternal-child or
psychiatric nurses (Smith, Droppleman, & Thomas, 1996). Nonclinical personnel
may be given less credence than doctors and nurses. These prejudices
can silence people with good ideas to share. They also can provoke animosity
between co-workers and lead to turf battles in which one department or profession
asserts that it is more important than another, thus more deserving of
new equipment, pay raises, additional staff, or the like (Albrecht, 1982). Unfortunately,
recent efforts to cut expenses and limit resources have aggravated
this long-standing competitiveness in many institutions (Forte, 1997).
Opportunities for Change From a communication standpoint, there is value
in education and seniority, but overlooking low-ranking employees is a mistake.
Often, front-line employees are more familiar than anyone about clients’
wishes and the organization’s daily routines. Steve Miller, a worldwide manager
at Shell Oil Company, emphasizes the need to treat members throughout
the organization as intelligent change agents:
In the past, the leader was the guy with the answers. Today if you’re going to
have a successful company, you have to recognize that no leader can possibly
have all the answers. The leader may have a vision. But the actual solutions
about how best to meet the challenges of the moment have to be made by
the people closest to the action. (quoted by Pascale, 1999, p. 210)
Communication skills are essential to leaders in today’s health care industry.
Margaret Jobes and Amy Steinbinder (1996) advise that “leaders in new staff
roles will no longer achieve power through position and title, but rather
through the development of interpersonal skills” (paragraph 23).
We established earlier that participative decision making requires new skills
and expectations, up-to-date knowledge, responsiveness, and recognition. It is
also important that organizational leaders establish trusting relationships and
provide employees the latitude to experiment with new ideas and programs. In
other words, although it may look different, leadership is still important in horizontal
organizations. As James Pepicello and Emmett Murphy (1996) put it,
empowering organizational members “does not relieve leadership of its responsibility
to lead” (paragraph 17). Leaders in horizontal organizations are
charged with communicating the organization’s overall goals, enabling organizational
members to participate fully, and rewarding them for contributions.
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Otherwise, employees may feel adrift and overwhelmed, particularly if they are
accustomed to the close supervision provided within a vertical hierarchy
(Porter-O’Grady, Bradley, Crow, & Hendrich, 1997). Research shows that employees
are typically dissatisfied and unmotivated if they are unsure what is expected
of them, if they lack the skills to perform new duties, or if they are
discouraged by managers who do not seem to support organizational changes
(Northouse & Northouse, 1985).
Communication Skill Builders: Managing by Collaboration In the article, “The
View from the Middle,” two midlevel managers in health care organizations
suggest the following communication strategies for leaders in participative environments
(Bachenheimer & DeKoven, 2003):
Be a leader and a team member. As an organizational leader, you are responsible
for providing direction, but you are also a team member who
listens to and works alongside others.
Choose your words—and your medium—carefully. Do not use e-mail to
communicate praise, advice, criticism, or critical information. Discuss
sensitive and important information face to face or over the telephone.
Make the most of meetings. Plan meetings carefully, invite everyone to
participate, listen actively, and follow up afterwards.
Invite ideas and follow up on them. Bachenheimer and DeKoven urge
leaders to follow up on everything—every promise, every conversation.
Invite solutions. Create an environment in which people are encouraged
to present solutions, not just describe problems.
Think and act positively. Acknowledge challenges but present your organization
in a positive light.
Praise people for their efforts. Recognize those who try hard even if things
do not go exactly as planned.
Specialized Jobs or Mission-Centered Expectations?
A division of labor means that workers have specific tasks to perform. No one
person takes a project from beginning to end. This is the idea behind assembly
lines. The assumption is that workers operate at maximum efficiency performing
simple, repetitive tasks.
Of course, health organizations did not take medicine to the extreme of assembly
line production. But they did adopt a division of labor. Whereas rural
physicians traditionally performed the gamut of activities—from delivering babies,
to keeping medical records, to performing surgeries, to collecting fees—
health organizations during the Industrial Revolution began to separate these
tasks (Reiser, 1978). Nurses were assigned specific duties such as giving injections,
taking health history information, and so on. Bookkeeping and scheduling
were taken over by staff members trained to perform those tasks. Physicians
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also began to specialize. Although almost all doctors in the 1800s were general
practitioners, 1 in 4 doctors specialized in a particular type of medicine by
1929, and 3 out of 4 doctors were specialists by 1969 (Reiser, 1978).
Advantages As medical knowledge and the business of providing health care
became more complex, specialization helped people develop expertise in different
areas. The division of labor also helped maintain the image of caregivers
as public servants rather than businesspeople. As health organizations evolved,
doctors usually did not discuss fees with patients. Specially trained staff members
took charge of financial details, leaving caregivers to (presumably) ignore
monetary concerns in single-minded pursuit of better health for their patients.
Disadvantages A division of labor enabled health care professionals to become
highly focused experts, but to a large extent, it also created boundaries
between them. Members of one department or specialization were unlikely to
communication or collaborate with professionals in another (Raffell & Raffell,
1989), and caregivers were largely excluded from health care management.
Gradually, hospitals and clinics ceased to be run by doctors and were instead
managed by people with backgrounds in business, management, and finance.
This trend was supported by the complexity of new tax laws and business regulations,
which made managing health care organizations more complicated.
Although business expertise was welcome, many caregivers began to feel disconnected
from policy decisions.
Another disadvantage is that people with specialized job duties are not
likely to go beyond them. For example, any number of employees may walk
past a spill in the hallway because it is not their job to clean it up.
Opportunities for Change Members of some organizations are realizing that
top-quality care transcends the efforts of any one person or department. It is as
important to work together as to work hard. For example, during a rather
lengthy wait to see the doctor recently, a nurse assistant hurrying in and out
noticed me. She stopped to apologize for the delay and explain that an emergency
had disrupted the schedule. This simple gesture dispelled my irritation.
I am sure it was not part of her job description to do this, but by making the
extra effort, she improved my estimation of the entire experience. These sort of
gestures are most likely in organizations in which leaders establish over achieving
goals and reward employees for taking the initiative to satisfy clients’ needs.
Communication Skill Builders: Promoting a Shared Vision Studer (2003a)
compares an effective health care leader to the conductor of an orchestra
whose job is to achieve the following:
Establish goals for the performance.
Keep everyone on the same page.
Define the contribution of each individual.
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In other words, a good organizational leader recognizes that harmony results
from clear expectations and the coordinated performance of individuals. Although
each person will make unique contributions, they must be in sync to
be successful. We might add that good leaders also enable people to improvise
when doing so will improve the group’s performance.
At Missouri Baptist Medical Center, employees are encouraged to “make
their patients’ day” even when that requires going beyond their job descriptions.
Therefore, when nurse assistant Leo Carter was caring for an elderly patient
who was agitated and near death, Carter sought a means of soothing the
man without restraining him. A fellow nurse remembered that the patient had
been a symphony conductor. Leo ran to his car to get a clarinet, which he
played quietly in the man’s room. Stephen Lundin and colleagues (2002) describe
what happened:
As the soft, mellow notes drifted through the room, something happened.
The old man stopped thrashing. He closed his eyes and smiled. Lying on his
back, he raised his arms and began to wave them back and forth. Perhaps,
deep in his mind, he was standing in a great concert hall once again, wearing
coat and tails, with a baton in his strong hands, leading his orchestra. After a
few minutes the old man’s arms dropped slowly to his sides and he slept
quietly through the night. (p. 93)
In short, when people are united by a strong mission but encouraged to go beyond
traditional boundaries, unforeseeable circumstances become opportunities
to make a difference.
Strictly by the Rules . . . or Not?
Ask people to define bureaucracy and they are apt to mention red tape. Bureaucracies
are known for their paperwork. Nearly any task requires that a
form be filled out, signed, and submitted to the appropriate people. Ask why
and an employee is likely to pull out more paper in the form of written rules
and procedures.
Advantages In some ways, paperwork and guidelines are well suited to
health care. For one, careful records allow health care organizations (and
oversight boards) to review care procedures and evaluate their efficacy and
cost effectiveness. Additionally, written records keep teams members informed
about patient care. Standardized forms help assure that information
is recorded in a form others can quickly read and understand. This is crucial
for managing medical emergencies and around-the-clock shift changes.
Third, established policies reduce ambiguity and may give people a sense of
security and predictability (Vestal et al., 1997). For example, clear rules for
employee evaluation and advancement discourage favoritism and provide
performance guidelines (Eisenberg & Goodall, 1997). Finally, people are less
likely to overlook important information (or skip crucial steps) if they are
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following established procedures. Missing even a small detail can have tragic
consequences when people’s lives are at stake.
Disadvantages Adherence to written guidelines presents some disadvantages,
however. People may be frustrated by what they see as needless amounts of
paperwork. Nurses today say they spend almost as much time filling out paperwork
as caring for patients. Established policies can also jeopardize customer
service. Because few people have the authority to override policies when
an unforeseen problem arises, the best an employee can do is request that a
policy be reconsidered (which may take weeks or months) or refer the situation
to someone higher on the ladder hoping it will eventually reach someone
with authority to grant an exception (Hamilton & Parker, 1997). In the meantime,
clients are likely to feel mistreated, share their grievances with others,
and look for another organization more responsive to their needs. The emphasis
on following written policies, asking specific questions, and filling out
forms can also discourage open communication. Patients’ input may be
largely limited to the information requested on forms, where there is often
little room to add comments not specifically requested (Thompson, 1996;
Wyatt, 1995). Furthermore, professionals may rely on written communication
more than face-to-face discussions. Although notes and charts are informative,
they are a meager substitute for interactive discussions when it
comes to making collaborative judgments.
Communication Skill Builders: Evaluating the Rules On reflection, good rules
help organizations run smoothly and effectively. Paperwork, if used effectively,
can improve communication. However, bad rules and needless red tape frustrate
employees and clients. To separate the good from the bad, Irwin Press,
one of the country’s best known patient satisfaction experts, recommends that
health care leaders take the following steps:
Ask employees to identify “really stupid rules.” “This is fun and focuses analytical
attention on the often arbitrary nature of regulations” (Press,
2002, p. 42). By identifying what does not make sense, organizations can
get rid of rules that impede performance.
Next, examine rules that make sense but do not work well. For example,
Press (2002) asks, is it necessary that nurses deliver meal trays? Could
other staff members perform this task and free nurses to respond more
quickly to patients’ requests?
Remember that patients don’t much care about the paperwork. “No matter
how firmly we argue that paperwork is a necessary part of care, patients
don’t see it this way. Paperwork is not the hands-on care that
patients want or that they base their evaluations on” (Press, 2002, p. 39).
If the rules and paperwork are important, allow time and space to complete
them. Press (2002) urges leaders to analyze employees’ job duties to
make sure they are compatible. For example, it is unrealistic to expect an
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employee to answer the phone, file reports, and simultaneously respond
to others’ needs. Frustration—and poor service—are likely to result. Instead,
provide adequate time and space to complete necessary procedures
and paperwork. If the regulations are important, make fulfilling
them part of the job.
As hospitals and clinics began to spring up during the Industrial Revolution,
many of them adopted a bureaucratic framework. Bureaucracy presents advantages
and disadvantages relevant to health care. The advantages may include
a sense of stability within the organization, clear expectations about
performance, high standards embodied in well-established procedures, and respect
for authority and experience. The disadvantages may include a communication
gap between workers and decision makers, resistance to change,
prejudice against people who do not occupy high-status positions in the organization,
turf battles between different divisions, and separation from the organization’s
external environment. Because employees are typically divided
into specialized work units, it may be difficult for them to understand other
people’s contributions or imagine new ways to do things.
Most of the issues surrounding bureaucratic management and change involve
communication. Reshaping the health care system requires new skills and
awareness. Skills such as leadership training, collaborative leadership, development
of a shared vision, and self-evaluation become especially important.
The next section focuses on teamwork, an important part of the trend toward
participative- and self-management and a long-standing component of
health care organizations.
Simply defined, a team is “a set of individuals who work together to achieve
common objectives” (Unsworth, 1996, p. 483). Teamwork is nothing new to
health care. Doctors, nurses, technicians, clerks, and others have long relied on
each other to reach common objectives. But the rules and reasons for teamwork
are changing.
To apply the terminology of management guru Peter Drucker, health care
teams used to function like baseball teams, but now they must act like doubles
tennis partners. Drucker (1993) writes that (managerially speaking) a doubles
tennis game is different than a baseball game. In baseball each player is assigned
a position with a specific set of tasks to perform. The pitcher pitches,
the catcher catches, the batter bats, and so on. The game is specialized and precise.
Doubles tennis is different—faster, less precise. Players have basic positions
but must always be poised to help each other, and there is scarcely time
to stand still.
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To flourish health care teams must function like tennis partners, argues
Mary Fanning (1997). They must be ready for the unexpected and be prepared
to help each other. Caregivers used to play their positions with little overlap
(like baseball players). A patient might see a physical therapist, a nurse, a doctor,
and a laboratory technician—but one at a time, never all together (Zimmermann,
1994). Technically, the caregivers were working toward the same
goal, but they contributed in specialized ways, independently. The problem is
that team members who do not communicate with each other are likely to
drop the ball. Lack of communication can lead to duplicated efforts, costly
(and sometimes life-threatening) delays, frustration, and wasted time. Teamwork
can minimize the waste and frustration. However, like leadership, teamwork
is not always easy to accomplish.
One advantage of teamwork is that members are able to apply multiple perspectives
to a problem, enhancing innovation and creativity. Some health care
organizations are making the most of this with interdisciplinary teams made
up of doctors, nurses, marketing specialists, financial experts, and others.
These teams are uniquely qualified to design innovative programs that cut
costs without sacrificing the quality of care (Farley & Stoner, 1989; Pepicello &
Murphy, 1996). (See Box 10.4 for more about encouraging innovation in
health care organizations.)
Interdisciplinary teamwork blurs the line between departments and presents
new opportunities for diverse employees to take part in decision making
(Green, 1994). One result is that doctors and nurses are again playing a major
role in health care management (Pepicello & Murphy, 1996).
Another advantage is that teamwork reduces costly oversights that may
occur when people are devoted to highly specialized tasks. Health care organizations
can no longer afford (if ever they could) the oversights that result
when team members do not communicate with each other. Ask any hospital
employee about patients who have gotten “lost in the system.” Usually, the
story is that the patient is scheduled for a series of treatments or tests, but
somewhere along the way everyone assumes the patient is with someone
else—until they realize the poor soul has spent hours lying on gurney in the
hallway. (I am told of a case, years ago, when a patient went up and down in
the staff elevator for hours, with everyone assuming an escort was waiting at
the next stop.) Bureaucracies are especially vulnerable to these kinds of oversights
because many tasks do not fall squarely within the boundaries of any
job description. Workers who concentrate on specialized tasks may not take
the initiative to go beyond their borders (they may not even realize they
should). Teamwork encourages people to look at the larger picture and pitch
in, even with tasks that are not specifically assigned to them (Sullivan & Wolfe,
1996). For example, nurses who notice that lab results have not arrived on
time may take the initiative to find out if tests were run and why results are
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A Model for Innovative Leadership
When writers for the Harvard Business Review interviewed 100 innovative
business leaders they identified some common characteristics among
them (Davenport, Prusak, & Wilson, 2003). For one, innovators are idea
scouts, always looking for new ideas within the organization and outside it.
They talk to people and really listen. They are also tailors who modify new
ideas to suit the organization’s needs, all the while inviting frequent and
candid input from others. As the process continues, the best innovators
are promoters who sell their ideas to people throughout the organization,
communicating effectively and enthusiastically with top and middle management
as well as front-line employees and clients. Finally, innovators are
experimenters. They pilot and test new ideas on a small scale to prepare
them for wider adoption. Importantly, innovators are not do-it-all-myself
types. When an innovation has been tested and refined, they “get out of
the way and let others execute” (Davenport, Prusak, & Wilson, 2003,
p. 58). The implications for communication are clear: observe, listen,
invite feedback, sell your ideas, experiment, and enable others.
What Do You Think?
1. In what ways are you an idea scout? Think of the best idea scout
you know. How does he or she do it?
2. What steps might you follow to tailor ideas to a particular organization
or group of people?
3. What skills are needed to promote new ideas?
4. Have you ever been part of (or coordinated) a pilot study or experimental
program? Did you feel it was worthwhile? What did you
learn during the process?
5. Why are skillful innovators not “do-it-myself” types when it comes
to implementing widespread changes?
Suggested Sources
Davenport, T. H., Prusak, L. & Wilson, H. J. (2003). Who’s bringing you
hot ideas and how are you responding? Harvard Business Review, 81(2),
58–64, 124.
Preker, A. S., & Harding, A. (Eds.). (2003). Innovations in health service
delivery: The corporatization of public hospitals. Washington, DC:
World Bank.
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delayed. This extra effort can save time and money in the long run (Sullivan &
Wolfe, 1996).
Third, teamwork is well suited to biopsychosocial care. Some organizations
are concluding that the best way to keep patients healthy is to pay attention
to their broad range of concerns. As physician Alan R. Zwerner advises:
The dog ate a 100-year-old patient’s glasses, and she’s not eligible for a
covered pair for another year? Give her a pair. Free. It could prevent a fall
that would break her hip. There is a reward for quality care, patient satis
faction, and doing the right thing at the right time. (quoted by Azevedo,
1996, paragraph 22)
Teams can help provide care that simultaneously addresses a variety of issues
such as patients’ personal resources, nutrition, exercise, psychological wellbeing,
and more. The object is not to replace physicians with teams, but to help
physicians provide broader care than they can provide alone. Frasier and colleagues
assert that interdisciplinary care teams can provide more complex
biopsychosocial care than could any one caregiver (Frasier, Savard-Fenton, &
Kotthopp, 1983).
Finally, team members may benefit from their involvement with co-workers.
Teamwork allows professionals to share the immense responsibilities of health
care, provide mutual support, and learn from each other (Abramson & Mizrahi,
1996). For example, an ethics committee can help guide caregivers and family
members and relieve some of the pressure that an individual making a difficult
decision alone might face (Harding, 1994). This support may be especially important
as health care employees deal with the stress and uncertainty of providing
care while adjusting to industry changes.
Difficulties and Drawbacks
None of this means teamwork is easy. Although teamwork presents many advantages,
it has potential disadvantages as well. For one thing, teamwork
takes time. If a quick decision is needed, an individual may be better qualified
to make it. Some nurses in Julie Apker’s (2001) study appreciated opportunities
to be part of shared governance teams. Others said that there was
not enough time for it. Said one nurse: “I don’t feel it’s fair to give someone
a project if they don’t have time” (quoted by Apker, 2001, p. 125). Furthermore,
especially if they are rushed or intimidated, team members may resort
to groupthink, that is, going along with ideas they would not normally support
(Janis, 1972).
Teamwork can be particularly difficult in health care organizations. Professionals
from different disciplines often have very different ideas about
health, which creates the potential for competition and conflict (Abramson &
Mizrahi, 1996). A study of 320 doctors and nurses revealed that 73% of the
physicians felt they collaborated well with nurses, but only 33% of the nurses
agreed (Thomas, Sexton, & Helmreich, 2003). The discrepancy may lie in their
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different expectations. Whereas physicians were mostly satisfied with the communication,
nurses reported feeling left out and intimated about expressing
themselves freely with doctors. Busy schedules make it hard to schedule meetings,
especially if the organization is not supportive in allowing time for teamwork.
There is also a question of leadership. Doctors are accustomed to calling
the shots, but dominating group interactions may defeat the purpose of teamwork
(Frasier et al., 1983; Sharf, 1984).
Communication Skill Builders: Working on Teams
Considering the advantages and difficulties of effective teamwork, experts present
the following suggestions to help team members communicate effectively.
During meetings, minimize distractions and sit so all members can easily
see each other (Sharf, 1984).
Establish ground rules for attendance, discussions, and decision making
(Farley & Stoner, 1989).
Before trying to solve a problem, make sure group members agree on
the nature, importance, and cause of the problem.
Make an effort to understand each group member’s background and expertise.
Often, one group of professionals is not clear on what another
group is trained to do. For example, doctors surveyed were not able to
accurately describe the duties of social workers (Abramson & Mizrahi,
Be aware that conflict is a natural part of group work. Group members
who remain committed to the task often work through the conflict to
achieve a mutual sense of accomplishment (Northouse & Northouse,
Encourage all group members to contribute ideas (Sharf, 1984).
Be willing to compromise (Sharf, 1984).
Summarize group discussions out loud to clarify the group’s viewpoints
and perspectives (Sharf, 1984).
Interdisciplinary teams may help organizations bridge communication gaps
between people in different departments and professions. Teamwork may reduce
the oversights that occur when workers focus on only one aspect of a
job. Interdisciplinary teams may also be well qualified to provide biopsychosocial
care and to develop services that combine cost-efficiency and quality
care. Team members may find comfort and support in working together.
However, they will be challenged to overcome time constraints, professional
differences, and the tendency to simply go along with what other members
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Communication is a valuable tool for handling the tremendous challenges and
rewards associated with health care organizations today. Communication specialists
can help organizations meet the following goals:
To keep morale up in this time of change and uncertainty.
To encourage employees to participate in decision making.
To integrate ideas from different disciplines.
To avoid oversights by working as teams.
To keep the public informed about services and health issues.
To better understand health-related behaviors and communication
The term communication specialist is used in a general sense to refer to people
with expertise in communicating face to face, in small groups, with large audiences,
and/or through mass media. Health organizations often hire people with
communication backgrounds to be part of public relations, community relations,
in-house communication, human resources, personnel, education, and patient
advocacy departments. In addition, nonprofit and public institutions hire people
to conduct health communication research, educate the public, and work one-
on-one with professionals and clients. Let’s look at a few of the contributions
communication specialists are qualified to make in the health industry.
Reducing Uncertainty
Uncertainty is especially stressful in today’s health care system. With so many
changes occurring, people may worry about job security and other factors
(Porter-O’Grady et al., 1997). One way to bolster workplace morale is to keep
employees well informed. Research suggests that health care employees who
do not feel informed about changes in their organizations are typically less satisfied
than others (Salem & Williams, 1984).
Communication specialists can help reduce uncertainty by developing a free
flow of information throughout the organization. For example, in-house
newsletters help to make minor policy changes known (major changes should be
announced in person). They also include brief announcements about employees’
professional activities; news of births, deaths, and marriages; and information
about services available to employees, such as counseling or daycare. Some
organizations also create and distribute newsletters tailored to consumers, physicians,
office staff personnel, and other groups with a stake in the organization.
Bridging Boundaries
Physical distance, status differences, professional outlooks, and different working
hours may make it difficult for health care employees to communicate
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regularly with each other (Ray & Miller, 1990). However, employees are more
likely to work as teams if they are familiar with their co-workers and the work
they do. Communication specialists can help bridge organizational gaps by coordinating
opportunities for employees to get to know each other. Interpersonal
relationships may reduce status differences and make it easier for
employees to work as team members.
Providing Social Support
Communication can be a way to soothe feelings and encourage social support.
Nurses in Smith, Droppleman, and Thomas’s (1996) study reported being demoralized
by a lack of support among their co-workers. Feelings of isolation
may be even worse for people such as home health personnel and physician
marketers whose duties require them to work outside the organization most of
the time. Developing social events and other activities that include these personnel
may reduce their sense of isolation.
Building Skills
Communication skills training can help employees assume new roles in the organization
and manage the inevitable conflicts involved in change and teamwork.
Nursing professors Mary Farley and Martha Stoner (1989) encourage
nurses who wish to assume leadership roles to develop their skills in negotiation,
team building, facilitating discussions, and sharing ideas. A nurse quoted
by Apker (2001) attests: “My job is 25% direct patient care, 50% collaboration
with others, and 25% documentation of care” (p. 127). Nurses are not the only
ones whose success relies on communication. Communication skills training
can include these topics:
Managing conflict.
Facilitating meetings and discussions.
Listening and showing empathy.
Writing effective memos and press releases.
Handling complaints.
Making presentations.
Speaking in public.
Speaking with the media.
Even basic communication skills such as phone courtesy and message taking
can have an important influence on the organization’s success. Communication
skills affect the performance of every employee, not just those in
leadership roles. Chuck Appleby (1997) reminds health care organizations that
“everything is marketing, from greeters to nurses to the way someone’s bill is
paid” (p. 58). Courtesy and listening skills are essential.
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Working With the Media
Part of a health organization’s mission is to keep people informed about health
issues that concern them. This may involve publicizing a medical study, a new
treatment option, warning signs of disease, a special program or event, an interesting
occurrence, or some other noteworthy topic.
Wise public relations professionals go beyond issuing pat press releases.
Charles Salmon and Charles Atkin (2003) write:
Public relations in the health domain has moved beyond the traditional
distribution of press releases to aggressively place guests on talk shows,
regularly feed feature writers with compelling news stories, and creatively
stage pseudo-events to attract journalistic attention. (p. 463)
When communication specialists work effectively with the media, they are
in a good position to help the public and to meet organizational goals. Here
are some tips for establishing good media relations suggested by Hartman,
Gellert, Higgins, Maxwell, and Lowery (1994):
Establish close working relationships with media professionals.
Learn to recognize newsworthy topics.
Write professional-quality features and news stories.
Know and respect media deadlines.
Understand media objectives (such as promoting exciting stories,
human interest items, and local news).
Supply the media with good story ideas.
Recommend and arrange interviews with knowledgeable persons.
Health care and media organizations stand to benefit when they work together.
I know this from experience. As a health reporter on a city newspaper,
I was invited to cover many human interest stories by hospital public relations
personnel who knew the value of positive publicity. In one instance I was able
to interview an Argentinean woman whose sight was restored by cataract
surgery after 15 years of blindness. I’ll never forget the woman’s expression
when the bandages were removed from her eyes. She shrieked in glee, grinned
at her reflection in a mirror, and joyfully kissed her (slightly embarrassed) doctor
on both cheeks. Readers loved the story, and the medical center received
calls from people interested in more information about cataract surgery. When
I later accepted a position in health care public relations, I made it a point to
supply the media with great story ideas, arrange interviews with medical experts,
and make the medical center library available to reporters. Everyone
benefited—the media, the medical center, and the public.
Being visible in the media is good for business and helpful in educating
people about health matters. But it has another benefit as well. It boosts the
morale of people in the organization (Johnson, 1994). Most people love
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recognition, and despite the tireless efforts of many health care professionals
they are not often recognized or singled out for thanks.
Managing Crises
By their very nature, health organizations are apt to be part of crises. As Kathleen
Fearn-Banks (1996) defines it, a crisis is “a major occurrence with a potentially
negative outcome affecting an organization, company, or industry, as
well as its publics, products, services, or good name” (p. 1). In health care, the
crisis usually has an external origin: a natural disaster, an accident, or an outbreak
of contagious disease. In such cases, health care organizations (especially
hospitals and medical centers) may be called upon to explain the crisis and
keep the public informed about it. In some cases the crisis originates within
the organization—a fire, a baby kidnapped from the nursery, charges of extortion.
In any case, it is important to have a well-developed plan for handling
crises, collecting information, and making information available to members
of the organization, the media, and the public.
Communication Skill Builders: Crisis Management Crisis management is a
job for communication specialists, especially those in public relations. For a
helpful guide to preparing a crisis plan and managing publicity during a crisis,
see Fearn-Banks’s (1996) book Crisis Communication. Following are a few tips
from the book:
Let people within the organization know what constitutes a crisis and
who to contact at the first sign of crisis.
Educate people in the organization about how to handle a crisis, including
who talks to the media and when, and who to call for information.
Develop a crisis communication box, including key phone numbers,
emergency supplies like paper and pens, the names of designated
spokespersons, and plans for accommodating members of the media.
Develop good relationships with media professionals before a crisis occurs,
and do not play favorites during a crisis.
Designate a primary spokesperson for the organization (usually the
CEO) and help that person decide what information to release and
Promoting Community Outreach and Health Education
People in health care organizations possess important information, and most
are willing to share what they know. Communication specialists can help by
organizing community events, preparing educational materials, and developing
speakers’ bureaus composed of people who are willing to speak before
school, church, and civic groups or be interviewed by the media (Morris,
1989). Communication specialists can coordinate speakers’ bureaus and help
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participants plan their presentations, perfect their delivery skills, and prepare
audiovisual materials.
Marketing is a broad term concerned with assessing and meeting consumer
needs. Many people equate marketing with advertising, but that is only part of
the picture (and some marketers do not advertise at all). Marketing personnel
not only promote the organization but also work within it to help improve services
and plan for the future. As Philip Kotler and Roberta Clarke (1987) explain
it, “marketing involves the organization in studying the target market’s
needs and wants, designing appropriate products and services, and using effective
pricing, communication, and distribution to inform, motivate, and service
the market” (p. 36).
Marketing personnel draw upon communication skills to collect information
about consumer needs and preferences, help design and propose health
care services, and promote the organization to consumers. Some health organizations
are integrating their marketing philosophy into everyday operations.
For example, if a medical center prides itself on “caring for the whole family,”
it may examine its policies (such as visiting hours and family accommodations)
to make sure it is living up to that philosophy. Additionally, marketing
personnel and others can work with employees to make sure everyone shares
the philosophy and displays it in the service they provide.
Many health organizations are adjusting their thinking to consider that
they have many types of “customers.” Patients are customers, but so are physicians,
other organizations, and even the organization’s own employees. Success
requires that each of these groups be satisfied (Mitka, 1996b).
Advocating for Patients
Some health care organizations offer opportunities for patient advocates who
represent patients’ interests and serve as liaisons between patients and health
professionals (Greene, 1997; Maleskey, 1984). Patient advocates may be hired
by patients directly, but most of them are employed by hospitals.
Communication specialists may qualify to be patient advocates. The job
usually involves talking one-on-one with patients and their families to help explain
hospital procedures, make sure patients are receiving adequate information,
and handle any complaints they may have. A patient advocate’s role is not
to provide medical information (that should be provided by clinical personnel)
but to make sure patients are well informed and satisfied.
Another form of patient advocacy is less direct. Communication specialists
can help develop written information that is easy to read and understand.
This information may describe services offered by the organization or procedures
patients should follow. By working with clinicians, communication specialists
can help assure that information is accurate and understandable.
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Researching Health Communication
As we appreciate the impact of health communication it becomes especially important
to understand how such communication occurs and what effects it has.
Health communication scholars are involved in studying communication patterns,
cultural expectations, satisfaction levels, goals, treatment outcomes, and
more. Many health communication researchers work for academic or nonprofit
institutions. However, their work has influence in much larger sectors, especially
since most health care practitioners appreciate that they can save time,
money, frustration, and even lives by communicating more effectively. A good
example is Gillespie’s (2001) study of asthma patients for Jewish National Treatment
and Research Center. Administrators at the center commissioned Gillespie
to study and interview asthma patients to gain a better understanding of
how the patient perceive asthma, their satisfaction with care issues, and what
they do and do not tell their doctors. Using her talents as a researcher, Gillespie
was able to help the staff better understand patients’ concerns and decisions. In
this way and others, health communication scholars can help identify effective
communication strategies and help people become more sensitive to communication
cues and preferences. Considering this, health communication researchers
are most effective if their conclusions are “timely, accessible, and make
intuitive sense to the practitioner” (Brown, Stewart, & Ryan, 2003, p. 141).
Health educators, campaign designers, marketing professionals, and others
have integrated communication research into their everyday jobs. They use
research to gauge audience needs, preferences, abilities, and reactions before
embarking on new projects. As new programs and campaigns take shape, they
conduct preliminary research to test their effectiveness. This groundwork can
help professionals adapt to audiences and avoid launching projects that will be
needlessly costly, counterproductive, or just plain ignored. Finally, after a new
project or campaign, research can demonstrate its influence and effectiveness.
(See Chapters 12 and 13 for more on this topic.)
Communication specialists have many roles in health care. They can assist
with communication within an organization and help establish communication
between the organization and the community. Communication is a valuable
means of reducing uncertainty, establishing professional relationships,
and developing a sense of belonging. Communication specialists can help organizational
members improve their speaking, listening, and presentation
skills and help people adapt to new roles within health care organizations. Effective
media relations is important for sharing information and marketing
services as well as for managing organizational crises. Marketing specialists are
involved with assessing community needs and tailoring services to meet those
needs. At the same time, scholars and researcher/practitioners are increasing
our understanding and mastery of health communication. (For more about
careers in health communication, see Box 10.5.)
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More About Careers in Health Communication
See the following websites for information about communication-related
careers in the health care industry.
American College of Health Care Administrators:
American College of Health Care Executives:
American Society for Health Care Marketing and Public Relations:
Association of University Programs in Health Administration:
International Association of Business Communicators:
National Institute of Health Center of Excellence in Cancer Communication
Patient Advocate Foundation:
Public Relations Society of America:
Public Service Advertising Research Center:
Bureaucratic elements are still evident in most health organizations, and it is
doubtful that they can or should be completely abandoned. However, the need
to contain costs, respond to changing consumer demands, and diversify services
has led some health organizations to change their patterns of leadership
and teamwork. Many are reshaping their bureaucratic structures to become
more adaptive and innovative. The new emphasis is on participative decision
making, employee input, patient satisfaction, and interdisciplinary teamwork.
The factors that make health care such a dynamic field also make its members
vulnerable to stress and conflict. Communication specialists can help organizations
manage the uncertainty of change, assess consumer needs, make information
available to the public, manage crises, and enhance patient satisfaction.
integrated health systems division of labor
bureaucracy team
participative decision making groupthink
(PDM) communication specialist
rational-legal authority crisis
professional prejudice patient advocates
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1. What advice does Quint Studer (Box 10.1) offer for leading with
2. What current issues affect communication in health care organizations?
3. Why are some health care organizations breaking free of the bureaucratic
4. In your opinion, should physicians advertise? If not, why not? If so,
should their ads adhere to particular regulations or ethical guidelines?
5. What are advantages and disadvantages of a vertical hierarchy?
6. What is meant by participative decision making (PDM)? What are the
advantages of PDM? The challenges?
7. What suggestions do experts offer for training organizational leaders?
8. In what ways is rational-legal authority advantageous in health care
organizations? In what ways is it limiting? What is one alternative?
9. How can professional prejudice affect communication between health
10. What communication skills are involved in collaborative leadership?
11. How does a division of labor make people more productive? In what
ways does it interfere with communication? What are some ways to unite
people in pursuit of a common vision?
12. What are the advantages and disadvantages of relying on standardized,
written communication in health settings? What are some ways health
care organizations can use written communication effectively without
going overboard with paperwork?
13. What are the qualities exhibited by innovative leaders in Davenport and
colleagues’ (2003) study (Box 10.4)?
14. What are the advantages of teamwork in today’s health care
organizations? What factors make teamwork difficult to achieve?
15. What are some tips for making teamwork productive?
16. What are some functions communication specialists are qualified to
perform in health organizations? What are some tips for handling crises
Mending a Breach of Trust
After 8 years as a nurse, Leah took a prestigious job as a hospital administrator.
She was determined to be accessible and sympathetic to employees, and she
told them this every chance she got. Eventually, employees who had come to
distrust the administration began to open up to Leah.
But all of that changed in one day. At a high-level meeting, Leah mentioned
something an employee had told her in confidence. The unintended
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Chapter 10. Leadership and Teamwork 301
disclosure resulted in strained relations between the employee and her immediate
supervisor, who was also at the meeting.
Word got around and soon employees were incensed that Leah had encouraged
them to confide in her and then betrayed that trust. During a break-
room conversation between several aides, one remarked, “If one of the other
administrators had done this, I wouldn’t be nearly so mad. You expect it from
them. But for Leah to do it is a slap in the face. She knew better.” Someone else
took Leah’s side, saying, “She made a mistake, but Leah has been more receptive
than all the other administrators put together. Compared to them, she’s
still the best leader in the whole organization.”
What Do You Think?
1. What would you do at this point if you were Leah?
2. Why would the employees be angrier at Leah than at another
administrator who behaved the same way?
3. If you were an employee, what would you say to Leah?
4. Would you trust Leah with confidential information again? If so, under
what conditions?
5. Describe the relational contract (implied rules for the relationship)
between Leah and the employees:
a. What rules were inherent in the contract?
b. How were they formed and agreed upon?
c. What are the implications for breaking the contract?

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