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Communication in Successful Supervision
COMMUNICATION IN SUCCESSFUL SUPERVISION Wilbur D. Crosley Communication encompasses a broad spectrum of definitions including the processes of transferring, sending and receiving, transmission, reception, interchange, and a system of symbols which represents information such as thoughts, ideas, opinions, and meanings. It is also a specialization which deals with various levels of understanding. The difference between the two following situations lies in communication. At the hospital business office, a new patient was asked multiple questions-name, address, birth date, place employed, insurance policy, doctor, etc. He was taken to his room on the third floor by a young lady with long black hair who was chewing gum and dressed in a bright mini-skirt. On the elevator two employees were talking about a patient who was in a great deal of pain. They felt that he should have received better care. Because the house was full and for various other reasons, the new patient had to wait until the bed could be made and the room could be cleaned. On the day of surgery the patient was moved into what seemed to be a very unfriendly climatenurses, doctors, orderlies, technicians-all going about their stoic tasks preparing for their assigned schedules. The patient waited in the surgical lob~~
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Wilbur D. Crosley, B.A., M.B.A., is an associate Administrator at St. Mary’s Memorial Hospital, Knoxville, Tennessee. He has been administrator at Northern State Hospital, Sedro Woolley, Washington. He received his B.A. from Miami University and his M.B.A. from Xavier University. Mr. Crosley is a member of the American Hospital Association, the Tennessee Hospital Association and the American College of Hospital Administrators. This paper was presented at St. Mary’s Memorial Hospital, Knoxville, Tennessee.
SO
by and was finally pushed down the corridor to a very cold, sterile-looking room where a gowned lady was ritualistically organizing trays of instruments. I n all of this there was no warm, personal identification. There was no explanation-just a new frightful experience. The very same day of surgery, the surgical nurse awakened early in the morning to prepare breakfast for her husband and two teenage children. After breakfast it was usual for the nurse to leave the kitchen, in order to get herself ready for work. It was the chore of the two teenage children to make the beds and rinse the dishes. It was the chore of the husband to get his shaving done and be as orderly as possible. This particular morning, however, the nurse woke up with a headache and there was much less time than usual for the family to accomplish all of their designated chores. The eggs burned, the children were grouchy, the husband was messy, and the wife wanted to either quit her job or give up her home responsibilities. This same morning the beds went unmade, the dishes went unrinsed, and the nurse came to work in a very irritated humor. At the hospital she yelled at a friend who took one of the last parking spaces just ahead of her. She had words with another co-worker who accidentally bumped an elbow into her back at the time-card station; and to really get the day started right, she had words with her supervisor in surgery who had to move her from urological services to help with a resection of an aortic aneuryism. The chest surgeon on this case had spent
AORN Journal
most of the night at the hospital working on two patients who had been in a car wreck earlier the evening before. He had time to get home for a short nap prior to having breakfast with his wife and six children. The children ranged in ages from 3 to 15 years and each brought problems representing their age groups to the breakfast table. By the time this overworked man reached the hospital, he was much too tired to be expected to do surgery. The switchboard operator had him return what seemed to be an emergency call home and he found that one of the children had missed the school bus. In the dressing room the doctor had trouble finding shoe covers large enough to fit and after an exasperating search, gave up and came to surgery without them.The hospital regulation in the surgical suite forbids this to occur and again the nursing supervisor had to intercede and find a clean pair of sneakers for the physician.
All seemed to go quite well after the operation began until the surgeon requested a portable X-ray film in surgery. The written and expected procedure for this was that the nurse would call the X-ray department and they would send an X-ray technician immediately. However, the nurse was familiar with one of the X-ray technicians who was working in one of the other operatin,0 rooms. The nurse asked this technician to take the portable X-rays, but he was unable to get there immediately. Time elapsed and the surgeon completed his work and the patient was removed from surgery without X-rays. The physician made a note on the chart “unable to test patency of vessel with dye because X-ray services were not available.” In some hospitals, such examples may be stretching it quite a bit, and in others, these may be mild examples. Contrast this situation with one in which an operating room team has been working together for some time and has developed the ultimate in team communications as op-
October 1968
posed to normal communications through channels of command. Consider the example of a surgical team where each member has such a grasp of the total situation and his role in it, that the needs of a patient dictate his actions directly. A small artery is cut and begins to spurt. In a normal chain of command organization, the surgeon would note this and say to the surgical nurse, “Give me a hemostat,” and thus coordinated effort would be achieved. What actually happens is that the bleeder gives a simultaneous command to members of the team, all of whom have been watching the progress of the operation with equal attention. In this case, it is the spurting artery that says to the assistant, “Get your hand out of the way until this is under control.” It says to the instrument nurse, “Get a hemostat ready” and it says to the surgeon, “Clamp that off.” This is the highest and most efficient type of cooperation known?
ORAL COMMUNICATIONS Effective day-to-day communications may be oral or written. Oral communications may include the grapevine, personal interviews, or group conferences. The grapevine usually comes into the category of organizational gossip; it is impossible to stop and can always be depended upon to operate speedily, efficiently, and without particular regard for truth or consequences. Personal interviews or day-today personal contacts provide the opportunity for every one in the organization to exchange greetings in the hall or become involved in unexpected meetings or planned interviews. Personal interviews require a manager who will find time to listen. Group conferences or meetings provide people within the organization an opportunity to talk things over and ask questions; most employees want the chance to express themselves, but they prefer to let their boss make the final decisions. I feel reasonably
51
sure that it is necessary for most every supervisor to give oral presentations to personnel rather frequently. Informal communications are usually the most effective and should be presented in a manner which will get the message across. Internal group sessions may arise when there is a need to instruct on new procedures, rules of safety, a new vacation policy, or just to give a report.* The following fundamentals always help in presenting material in an effective manner: “know yourself,” “know your subject,” and, if possible “know your listener.” Knowing oneself essentially involves a self-appraisal-a personal, critical inventory-What are my strong points? What are my weak points? What can I do to improve? None of us is perfect, but we can constantly try to improve. Part of knowing oneself involves examining personality-that quality which gives distinction to the individual ; that which makes one person welcome-another unwelcome. The following may be kept in mind: appearance, clothing, personal characteristics, smile, voice, manners, and mannerisms.3 Self-confidencethe “I know I can do it” approach, and tact-knowing what, when, and how to say it-are the most important traits in the personality. It is interesting to note the pros and cons of telephone and face-to-face types of oral communication. The telephone provides speed, but does not provide a record and words are easily misunderstood. In face-to-face communication it is easier to show and explain. Such communication often develops a rapport which would otherwise not be possible. Telephone and face-to-face communications usually occur at inconvenient times and require spontaneity and an unusual type of thinking. WRITTEN COMMUNICATIONS Written communications may include informal notes or formal reports. Informal notes provide a record. However, this is a
52
one-way communication and there is danger that the expected return information may be delayed. An example of the informal note is the written complaint or suggestion. The formal report can be complete and well organized, but again, this is a one-way communication and, in addition, can be very time-consuming. Important examples of this type include job evaluations which let the individual know how he is meeting standards. Other examples include sick leave patterns and work assignments. An important part of a supervisor’s job is preparing reports and other written communications.
THE SEVEN ‘‘C‘s’’ It is an important asset to be able to build a communication bridge which will provide a direct link to other people’s minds. To evaluate the success of this, we may consider the seven “C” qualities : completeness, courtesy, consideration, clearness, conciseness, concreteness, and correctness.
Completeness involves a detailed outline which insures the writer that no important topics have been overlooked. Courtesy will take you further in this world and cost you less than any other single quality you can possess. Courtesy is far more than the generous use of the words, “please” and “thank you.” It is an attitude or frame of mind which is expressed in the manner you assume, the attitude you take, and the language and tone i n which you express yourself. Consider the following letter from a customer of a safety razor blade company who writes: “I know you can’t make magic blades and I know it is human to make a mistake. I just got a package of five of those mistakes-each one duller than the one before. Of course, I didn’t get the shaving mileage you intended I should. Enclosed is the guilty package so you can find out what went wrong-and I wish you luck.” Consideration is known as the “you” attitude. This is the ability to release onself
AORN Journal
from self-centered attention and to see through your reader’s eyes or assume his point of view. The old saying, “put yourself in his shoes,” reflects this “you” attitude. Clearness demands the use of good English and helps make a good impression. Careful planning aids clearness and limits poor sentences which cause hazy thinking in the minds of the reader. The clearer the plan, the simpler the language, the more quickly a message can be understood. Conciseness refers to the length of a written communication. An editorial writer once said, “If half the words used by my staff were cut out, the news would be clearer.” In achieving brevity without sacrificing completeness, there is the problem of how much to put in, what to leave out, and when to quit. It is generally best to strike a happy medium.
To be concrete is to build a word picture in the mind of the reader which will allow him to visualize what your message is about. Being concrete is the opposite of being abstract or general. Consider the following message prepared by a real estate company: “Come out where the trees abound, where fresh air is cool and plentiful, where children play undisturbed.” Compare this with “Come out where there are three to ten giant oaks, a hundred years old, on every lot; where the year-around temperature is seven degrees cooler than downtown, so cool that residents have had to sleep under blankets 17 nights in August; where not a single child has been injured in five years by passenger car or truck.’’ Correctness is the final and most important “C” quality. Mistakes due to errors have cost companies and the government millions of dollars. Once a government clerk copied a tariff bill under consideration and entered a comma that was not in the original draft. The bill, with the extra comma, was passed. The original intention was “all foreign fruit plants.” The extra comma was put
October 1968
in thusly “all foreign fruit, plants.” The latter meant that all foreign fruit and all foreign plants would gain entry duty-free. The one extra comma cost some two million dollars before the error could be corrected at the following session of Congress.’ Good communication techniques between supervisor and employee include removing roadblocks, such as a poorly organized desk, or trying to do too many things at one time. The supervisor should empathize with his employee. Does he have a home problem? Does he really know what is expected of him? After the roadblocks are removed, a supervisor should be as brief as possible, to the point, using simple words, and avoiding meaningless jargon. In this regard, we might say that brevity is to understanding as verbosity is to confusion. The use of simple versus multi-syllabic words might include “help” instead of “assistance,” “pay” for “remuneration,” “find-out” instead of “ascertain,” “get” instead of “obtain,” “try” rather than “endeavor,” “make easy” rather than “facilitate,” and “read” rather than “peruse.” As a supervisor, make yourself understood; avoid fuzzy ideas, poor expression, and carelessness. Using these methods will result in the supervisor understanding the subordinate and the subordinate understanding the supervisor.G
THE LISTENER On one side of the communication bridge, we have identified the sending process. Let us now turn to the other side of the bridge where we find the listener. Listening is an art which requires a receptive state of mind to facilitate understanding. Unfortunately, most of us listen through a screen of resistance which includes prejudices, worries, desires, and fears. We listen only to our own noise, to our own sound, and not to what is being said. It is quite difficult to put aside training, prejudice, inclinations, and resistance, to reach beyond verbal expression in order to understand instantaneously.
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Herein lies one of our major difficulties. There is a point in every conversation when it is necessary to stop talking. One cannot listen or receive if he is talking. Shakespeare’s Hamlet believed that you should listen more than talk when he said, “Give every man thine ears, but few thy voice.” There are seven important “I” levels of listening: isolation, no registering of thought; identification, the information becoming meaningful; integration, the application of information into the thought process; inspection, a critical evaluation of the object rather than the subject; and the last three which are most important-interpretation, relating what has been heard to yourself; interpolation, which engenders understanding; and introspection, which encompasses insight and a total experience.”
A listener should try to put the person who is talking at ease. A supervisor can stymie communications by an imposing silence. In a conversation, a listener should show that he wants to listen. The purpose in listening is to understand, not just to reply. The emphasis here should be in trying to see things from the other side of the fence whether the issue is a request for a pay raise or a question about a simple procedure such as mopping the floor. At the stage where the listener develops questions, he is geared to replies and not only to understanding. It is always necessary to be on guard against tempers and emotions, regardless of how justified they may seem, in order to prevent unnecessary criticisms and arguments. If a subordinate is called on the carpet, a supervisor may expect a reaction ranging from “clamming up” to open rage.7 Looking at other aspects we learn that listening may be authoritative, restrictive, or evaluative. When one listens authoritatively, the main purpose seems to be to enhance one’s own station, rather than to he helpful to the other person. Authoritative listening is a certain kind of listening developed by
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managers who evaluate the technical aspects of the work their people do, as well as their personal behavior, attitudes, expectations, and especially their individual self-concepts. As a result, managers may tend to listen differently, advise differently, and in general establish a communication relationship which limits free expression. Restrictive listening is developed within managers who feel they have arrived at a particular level and can do no wrong. This kind of attitude makes “yes” men out of subordinates and they can become more interested in keeping their pay checks than their integrity. Evaluative listening involves free expression and critical thinking. In this process, it is necessary to listen for total meaning, respond to feelings without criticizing, listen to words and actions, and develop skills in reflective feelinp8
COMMUNICATION PROBLEMS WITHIN THE HOSPITAL The process of communication in a hospital setting is extremely difficult because of the variety of personnel who comprise the organization. Within the hospital we are daily confronted with the person who jumps to conclusions. This is the person who confuses the fact he has heard with inferences he has made and behaves on the basis of the inferences rather than the facts. The trouble here does not come because the inference has been made, but because the inference is believed to be the same as a factual observation. In addition to the conclusion jumper, there is the person with a closed mind-the person who thinks he has said all there is to say on a subject, when in fact he has said only all he can think of at the moment. This person usually stops thinking, stops listening, and closes his mind. Like the man with a “kn~w-it-all’~ look who said to a woman, “So you are a nurse, eh?” “Certainly,” she answered, “and a wife, and a mother, and a
AORN Journal
cook, and a golf addict, and a student.”g Also within the hospital, we see communication problems which are due to lack of adequate and accurate downward communication. It is not lack of information, but misinterpreted information or failure of persons to listen carefully or to understand information, that creates problems in hospital communication. And finally, we see stereotyped thinking, which tends to block our cornmunication system by focusing on a conclusion about the character or personality of an individual, and thus, limiting the freedom with which we can communicate.I0
HABITS AND MISCONCEPTIONS In the process of management, generally, supervisors at all levels are caught in the business of 1 ) performing common habits which annoy other people and 2) adopting misconceptions which reduce healthy cornmunication effectiveness. Common habits which annoy other people include interrupting when another person is talking, asking questions which demand agreement, throwing cold water on suggestions, being rushed for time, giving the feeling that time is being wasted, obviously anticipating the speaker’s conclusion in order to inject a personal comment, developing a poker face and manner which indicates neither listening nor understanding, rephrasing (“what he meant to say was.. .”), passing the buck, treating people as though they were children, asking questions which communicate doubt and pushing the speaker into a corner with questions which attempt to make a fool of him. From these examples, it is easy to see that good listening habits can mean better relationships between the supervisor and the people with whom she deals. Poor listening habits can antagonize people, which will cause loss of respect and be a detriment to future eff0rts.l’
A few misconceptions commonly occurring in the communication process include: 1) the
October 1968
idea that once you have sent your message or said it, your responsibility is completed, 2) the desirability of stating everything in a positive way, 3) the feeling that we don’t need all the feedback, 4) the attitude that YOU need only tell employees “what” and not “why,” 5) the notion that if the communication signer is “high up,” the messages will have more impact and accuracy, and 6) the idea that if someone has the need to know, he will ask.12
INTERDEPARTMENTAL HARMONY It is important for individuals within each hospital department to look at the broader scope of things and realize that departments are groups of people which work in either conflict or harmony. Each individual’s personal communication habits add UP to a department’s image. Each supervisor should be aware of all the personality types in her department and at the same time should set standards regarding the contacts these persons make with other department personnel. The central Supply department, for example, deals with nursing units, Purchasing, accounting, laboratory, Pharmacy, emergency, obstetrics, surgery, and laundry- Any individual within the central service department, when conducting the business of CSR with an employee in another department, will be setting an image of not only the individual but also the department which he represents in the eyes of the person with whom he is communicating. It becomes necessary, therefore, to build interdepartmental respect and co~fidencethrough healthy communications between individuals in those departments. In developing better relationships, it is good to examine the particular role a department plays in the operation of another department to see how each fits into a pattern of work. When mistakes are made, it is best to admit them and let those concerned know that a plan will be developed to cor-
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rect them. If any of you have experienced going into a total disposable system versus a disposable system involving multiple vendors, then I am sure you have experienced the identification of problems which had not been anticipated but all of a sudden became very real. From this kind of example, we can realize that change will bring about employee reactions, both favorable and unfavorable. More favorable reactions will result when larger numbers of people are involved, have a chance to respond, and know why changes are going to occur. Recently, we experienced this. The central supply department received individual needling from personnel at all levels. Some nursing personnel felt that CSR had imposed this system on them. After CSR collected many complaints and many imperfect products, particularly
needles and syringes, two questionnaires were designed for those who were using the disposable products. The results were that 34 per cent recommended continuation of the new total disposable program and less than half felt the products were as good as previously used ones. Needless to say, we were more concerned with making our internal operations more effective and efficient than having a total disposable system provided by a single vendor. We developed a plan of action which resolved the problem by using multiple vendors. From this experience we learned that a great deal of caution will go a long way in making sure that each person involved has a chance to evaluate and communicate his objective feelings before a final decision is
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made.
REFERENCES 1. Korolenko, Harold, “Three Barriers to Communication,” AORN Journal, Vol. 111, #3, May-June 1965, pp. 90-96. 2. Dull, Verna, “The Employee Speaks LJp: Communication Channels from Employees to Management,” Hospitals, Vol. XXXIII, #2, August 16, 1957, p. 51. 3. Timmons, Lynn R., “Department Training Program, 1960,” (Unpublished manual, Department of Mental Hygiene and Corrections, State of Ohio). 4. lbid. 5. Wester, William C., 11, Ed.D., “10 Commandments for Meaningful Communication,” Hospital Progress, Vol. XLIX, #4, April 1968, pp. 14-16. 6. lbid.
7 . Op. Cit., Korolenko. 8. Deunk, Norman H., “Active Listening: A Forgotten Key to Effective Communication,” Hospital Administration, Vol. XII, #2, Spring 1967, pp. 34-45. 9. O p . Cit., Timmons. 10. Glass, Herman J., “Communication-A Vital Tool in Hospital Administration and Medicine,” Journal of The National Medical Association, Vol. LIX, March 1967, pp. 142-145. 11. Posz, A. Conrad, Ph.D., “Do You Irritate Others When You Listen?” Journal of The American Dietetic Association, Vol. XXXIV, July 1958, p. 730. 12. Op. Cit., Deunk.
‘THE W A L R U S A N D THE CARPENTER’ revisited ( W i t h apologies to Lewis Carroll) “The time has come,” the doctor said, “to speak of many things: Of nurses’ changing notions; of their strophying wings; Of why they’re neither what they were nor what they’d like to b e ; Of w h y they think they’ve got to have that overstressed degree. The time has come, in other words, for reconsideration, Lest nurses ruin nursing in their yen for higher station.” “The time has come,” the nurse replied, “to strike a compromise: Regard us, Sir, as people-and we’ll measure u p to size!”
Joan Fried, R.N.
(R.N. March 1959)
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AORN Journal
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Wilbur D. Crosley, B.A., M.B.A., is an associate Administrator at St. Mary’s Memorial Hospital, Knoxville, Tennessee. He has been administrator at Northern State Hospital, Sedro Woolley, Washington. He received his B.A. from Miami University and his M.B.A. from Xavier University. Mr. Crosley is a member of the American Hospital Association, the Tennessee Hospital Association and the American College of Hospital Administrators. This paper was presented at St. Mary’s Memorial Hospital, Knoxville, Tennessee.
SO
by and was finally pushed down the corridor to a very cold, sterile-looking room where a gowned lady was ritualistically organizing trays of instruments. I n all of this there was no warm, personal identification. There was no explanation-just a new frightful experience. The very same day of surgery, the surgical nurse awakened early in the morning to prepare breakfast for her husband and two teenage children. After breakfast it was usual for the nurse to leave the kitchen, in order to get herself ready for work. It was the chore of the two teenage children to make the beds and rinse the dishes. It was the chore of the husband to get his shaving done and be as orderly as possible. This particular morning, however, the nurse woke up with a headache and there was much less time than usual for the family to accomplish all of their designated chores. The eggs burned, the children were grouchy, the husband was messy, and the wife wanted to either quit her job or give up her home responsibilities. This same morning the beds went unmade, the dishes went unrinsed, and the nurse came to work in a very irritated humor. At the hospital she yelled at a friend who took one of the last parking spaces just ahead of her. She had words with another co-worker who accidentally bumped an elbow into her back at the time-card station; and to really get the day started right, she had words with her supervisor in surgery who had to move her from urological services to help with a resection of an aortic aneuryism. The chest surgeon on this case had spent
AORN Journal
most of the night at the hospital working on two patients who had been in a car wreck earlier the evening before. He had time to get home for a short nap prior to having breakfast with his wife and six children. The children ranged in ages from 3 to 15 years and each brought problems representing their age groups to the breakfast table. By the time this overworked man reached the hospital, he was much too tired to be expected to do surgery. The switchboard operator had him return what seemed to be an emergency call home and he found that one of the children had missed the school bus. In the dressing room the doctor had trouble finding shoe covers large enough to fit and after an exasperating search, gave up and came to surgery without them.The hospital regulation in the surgical suite forbids this to occur and again the nursing supervisor had to intercede and find a clean pair of sneakers for the physician.
All seemed to go quite well after the operation began until the surgeon requested a portable X-ray film in surgery. The written and expected procedure for this was that the nurse would call the X-ray department and they would send an X-ray technician immediately. However, the nurse was familiar with one of the X-ray technicians who was working in one of the other operatin,0 rooms. The nurse asked this technician to take the portable X-rays, but he was unable to get there immediately. Time elapsed and the surgeon completed his work and the patient was removed from surgery without X-rays. The physician made a note on the chart “unable to test patency of vessel with dye because X-ray services were not available.” In some hospitals, such examples may be stretching it quite a bit, and in others, these may be mild examples. Contrast this situation with one in which an operating room team has been working together for some time and has developed the ultimate in team communications as op-
October 1968
posed to normal communications through channels of command. Consider the example of a surgical team where each member has such a grasp of the total situation and his role in it, that the needs of a patient dictate his actions directly. A small artery is cut and begins to spurt. In a normal chain of command organization, the surgeon would note this and say to the surgical nurse, “Give me a hemostat,” and thus coordinated effort would be achieved. What actually happens is that the bleeder gives a simultaneous command to members of the team, all of whom have been watching the progress of the operation with equal attention. In this case, it is the spurting artery that says to the assistant, “Get your hand out of the way until this is under control.” It says to the instrument nurse, “Get a hemostat ready” and it says to the surgeon, “Clamp that off.” This is the highest and most efficient type of cooperation known?
ORAL COMMUNICATIONS Effective day-to-day communications may be oral or written. Oral communications may include the grapevine, personal interviews, or group conferences. The grapevine usually comes into the category of organizational gossip; it is impossible to stop and can always be depended upon to operate speedily, efficiently, and without particular regard for truth or consequences. Personal interviews or day-today personal contacts provide the opportunity for every one in the organization to exchange greetings in the hall or become involved in unexpected meetings or planned interviews. Personal interviews require a manager who will find time to listen. Group conferences or meetings provide people within the organization an opportunity to talk things over and ask questions; most employees want the chance to express themselves, but they prefer to let their boss make the final decisions. I feel reasonably
51
sure that it is necessary for most every supervisor to give oral presentations to personnel rather frequently. Informal communications are usually the most effective and should be presented in a manner which will get the message across. Internal group sessions may arise when there is a need to instruct on new procedures, rules of safety, a new vacation policy, or just to give a report.* The following fundamentals always help in presenting material in an effective manner: “know yourself,” “know your subject,” and, if possible “know your listener.” Knowing oneself essentially involves a self-appraisal-a personal, critical inventory-What are my strong points? What are my weak points? What can I do to improve? None of us is perfect, but we can constantly try to improve. Part of knowing oneself involves examining personality-that quality which gives distinction to the individual ; that which makes one person welcome-another unwelcome. The following may be kept in mind: appearance, clothing, personal characteristics, smile, voice, manners, and mannerisms.3 Self-confidencethe “I know I can do it” approach, and tact-knowing what, when, and how to say it-are the most important traits in the personality. It is interesting to note the pros and cons of telephone and face-to-face types of oral communication. The telephone provides speed, but does not provide a record and words are easily misunderstood. In face-to-face communication it is easier to show and explain. Such communication often develops a rapport which would otherwise not be possible. Telephone and face-to-face communications usually occur at inconvenient times and require spontaneity and an unusual type of thinking. WRITTEN COMMUNICATIONS Written communications may include informal notes or formal reports. Informal notes provide a record. However, this is a
52
one-way communication and there is danger that the expected return information may be delayed. An example of the informal note is the written complaint or suggestion. The formal report can be complete and well organized, but again, this is a one-way communication and, in addition, can be very time-consuming. Important examples of this type include job evaluations which let the individual know how he is meeting standards. Other examples include sick leave patterns and work assignments. An important part of a supervisor’s job is preparing reports and other written communications.
THE SEVEN ‘‘C‘s’’ It is an important asset to be able to build a communication bridge which will provide a direct link to other people’s minds. To evaluate the success of this, we may consider the seven “C” qualities : completeness, courtesy, consideration, clearness, conciseness, concreteness, and correctness.
Completeness involves a detailed outline which insures the writer that no important topics have been overlooked. Courtesy will take you further in this world and cost you less than any other single quality you can possess. Courtesy is far more than the generous use of the words, “please” and “thank you.” It is an attitude or frame of mind which is expressed in the manner you assume, the attitude you take, and the language and tone i n which you express yourself. Consider the following letter from a customer of a safety razor blade company who writes: “I know you can’t make magic blades and I know it is human to make a mistake. I just got a package of five of those mistakes-each one duller than the one before. Of course, I didn’t get the shaving mileage you intended I should. Enclosed is the guilty package so you can find out what went wrong-and I wish you luck.” Consideration is known as the “you” attitude. This is the ability to release onself
AORN Journal
from self-centered attention and to see through your reader’s eyes or assume his point of view. The old saying, “put yourself in his shoes,” reflects this “you” attitude. Clearness demands the use of good English and helps make a good impression. Careful planning aids clearness and limits poor sentences which cause hazy thinking in the minds of the reader. The clearer the plan, the simpler the language, the more quickly a message can be understood. Conciseness refers to the length of a written communication. An editorial writer once said, “If half the words used by my staff were cut out, the news would be clearer.” In achieving brevity without sacrificing completeness, there is the problem of how much to put in, what to leave out, and when to quit. It is generally best to strike a happy medium.
To be concrete is to build a word picture in the mind of the reader which will allow him to visualize what your message is about. Being concrete is the opposite of being abstract or general. Consider the following message prepared by a real estate company: “Come out where the trees abound, where fresh air is cool and plentiful, where children play undisturbed.” Compare this with “Come out where there are three to ten giant oaks, a hundred years old, on every lot; where the year-around temperature is seven degrees cooler than downtown, so cool that residents have had to sleep under blankets 17 nights in August; where not a single child has been injured in five years by passenger car or truck.’’ Correctness is the final and most important “C” quality. Mistakes due to errors have cost companies and the government millions of dollars. Once a government clerk copied a tariff bill under consideration and entered a comma that was not in the original draft. The bill, with the extra comma, was passed. The original intention was “all foreign fruit plants.” The extra comma was put
October 1968
in thusly “all foreign fruit, plants.” The latter meant that all foreign fruit and all foreign plants would gain entry duty-free. The one extra comma cost some two million dollars before the error could be corrected at the following session of Congress.’ Good communication techniques between supervisor and employee include removing roadblocks, such as a poorly organized desk, or trying to do too many things at one time. The supervisor should empathize with his employee. Does he have a home problem? Does he really know what is expected of him? After the roadblocks are removed, a supervisor should be as brief as possible, to the point, using simple words, and avoiding meaningless jargon. In this regard, we might say that brevity is to understanding as verbosity is to confusion. The use of simple versus multi-syllabic words might include “help” instead of “assistance,” “pay” for “remuneration,” “find-out” instead of “ascertain,” “get” instead of “obtain,” “try” rather than “endeavor,” “make easy” rather than “facilitate,” and “read” rather than “peruse.” As a supervisor, make yourself understood; avoid fuzzy ideas, poor expression, and carelessness. Using these methods will result in the supervisor understanding the subordinate and the subordinate understanding the supervisor.G
THE LISTENER On one side of the communication bridge, we have identified the sending process. Let us now turn to the other side of the bridge where we find the listener. Listening is an art which requires a receptive state of mind to facilitate understanding. Unfortunately, most of us listen through a screen of resistance which includes prejudices, worries, desires, and fears. We listen only to our own noise, to our own sound, and not to what is being said. It is quite difficult to put aside training, prejudice, inclinations, and resistance, to reach beyond verbal expression in order to understand instantaneously.
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Herein lies one of our major difficulties. There is a point in every conversation when it is necessary to stop talking. One cannot listen or receive if he is talking. Shakespeare’s Hamlet believed that you should listen more than talk when he said, “Give every man thine ears, but few thy voice.” There are seven important “I” levels of listening: isolation, no registering of thought; identification, the information becoming meaningful; integration, the application of information into the thought process; inspection, a critical evaluation of the object rather than the subject; and the last three which are most important-interpretation, relating what has been heard to yourself; interpolation, which engenders understanding; and introspection, which encompasses insight and a total experience.”
A listener should try to put the person who is talking at ease. A supervisor can stymie communications by an imposing silence. In a conversation, a listener should show that he wants to listen. The purpose in listening is to understand, not just to reply. The emphasis here should be in trying to see things from the other side of the fence whether the issue is a request for a pay raise or a question about a simple procedure such as mopping the floor. At the stage where the listener develops questions, he is geared to replies and not only to understanding. It is always necessary to be on guard against tempers and emotions, regardless of how justified they may seem, in order to prevent unnecessary criticisms and arguments. If a subordinate is called on the carpet, a supervisor may expect a reaction ranging from “clamming up” to open rage.7 Looking at other aspects we learn that listening may be authoritative, restrictive, or evaluative. When one listens authoritatively, the main purpose seems to be to enhance one’s own station, rather than to he helpful to the other person. Authoritative listening is a certain kind of listening developed by
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managers who evaluate the technical aspects of the work their people do, as well as their personal behavior, attitudes, expectations, and especially their individual self-concepts. As a result, managers may tend to listen differently, advise differently, and in general establish a communication relationship which limits free expression. Restrictive listening is developed within managers who feel they have arrived at a particular level and can do no wrong. This kind of attitude makes “yes” men out of subordinates and they can become more interested in keeping their pay checks than their integrity. Evaluative listening involves free expression and critical thinking. In this process, it is necessary to listen for total meaning, respond to feelings without criticizing, listen to words and actions, and develop skills in reflective feelinp8
COMMUNICATION PROBLEMS WITHIN THE HOSPITAL The process of communication in a hospital setting is extremely difficult because of the variety of personnel who comprise the organization. Within the hospital we are daily confronted with the person who jumps to conclusions. This is the person who confuses the fact he has heard with inferences he has made and behaves on the basis of the inferences rather than the facts. The trouble here does not come because the inference has been made, but because the inference is believed to be the same as a factual observation. In addition to the conclusion jumper, there is the person with a closed mind-the person who thinks he has said all there is to say on a subject, when in fact he has said only all he can think of at the moment. This person usually stops thinking, stops listening, and closes his mind. Like the man with a “kn~w-it-all’~ look who said to a woman, “So you are a nurse, eh?” “Certainly,” she answered, “and a wife, and a mother, and a
AORN Journal
cook, and a golf addict, and a student.”g Also within the hospital, we see communication problems which are due to lack of adequate and accurate downward communication. It is not lack of information, but misinterpreted information or failure of persons to listen carefully or to understand information, that creates problems in hospital communication. And finally, we see stereotyped thinking, which tends to block our cornmunication system by focusing on a conclusion about the character or personality of an individual, and thus, limiting the freedom with which we can communicate.I0
HABITS AND MISCONCEPTIONS In the process of management, generally, supervisors at all levels are caught in the business of 1 ) performing common habits which annoy other people and 2) adopting misconceptions which reduce healthy cornmunication effectiveness. Common habits which annoy other people include interrupting when another person is talking, asking questions which demand agreement, throwing cold water on suggestions, being rushed for time, giving the feeling that time is being wasted, obviously anticipating the speaker’s conclusion in order to inject a personal comment, developing a poker face and manner which indicates neither listening nor understanding, rephrasing (“what he meant to say was.. .”), passing the buck, treating people as though they were children, asking questions which communicate doubt and pushing the speaker into a corner with questions which attempt to make a fool of him. From these examples, it is easy to see that good listening habits can mean better relationships between the supervisor and the people with whom she deals. Poor listening habits can antagonize people, which will cause loss of respect and be a detriment to future eff0rts.l’
A few misconceptions commonly occurring in the communication process include: 1) the
October 1968
idea that once you have sent your message or said it, your responsibility is completed, 2) the desirability of stating everything in a positive way, 3) the feeling that we don’t need all the feedback, 4) the attitude that YOU need only tell employees “what” and not “why,” 5) the notion that if the communication signer is “high up,” the messages will have more impact and accuracy, and 6) the idea that if someone has the need to know, he will ask.12
INTERDEPARTMENTAL HARMONY It is important for individuals within each hospital department to look at the broader scope of things and realize that departments are groups of people which work in either conflict or harmony. Each individual’s personal communication habits add UP to a department’s image. Each supervisor should be aware of all the personality types in her department and at the same time should set standards regarding the contacts these persons make with other department personnel. The central Supply department, for example, deals with nursing units, Purchasing, accounting, laboratory, Pharmacy, emergency, obstetrics, surgery, and laundry- Any individual within the central service department, when conducting the business of CSR with an employee in another department, will be setting an image of not only the individual but also the department which he represents in the eyes of the person with whom he is communicating. It becomes necessary, therefore, to build interdepartmental respect and co~fidencethrough healthy communications between individuals in those departments. In developing better relationships, it is good to examine the particular role a department plays in the operation of another department to see how each fits into a pattern of work. When mistakes are made, it is best to admit them and let those concerned know that a plan will be developed to cor-
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rect them. If any of you have experienced going into a total disposable system versus a disposable system involving multiple vendors, then I am sure you have experienced the identification of problems which had not been anticipated but all of a sudden became very real. From this kind of example, we can realize that change will bring about employee reactions, both favorable and unfavorable. More favorable reactions will result when larger numbers of people are involved, have a chance to respond, and know why changes are going to occur. Recently, we experienced this. The central supply department received individual needling from personnel at all levels. Some nursing personnel felt that CSR had imposed this system on them. After CSR collected many complaints and many imperfect products, particularly
needles and syringes, two questionnaires were designed for those who were using the disposable products. The results were that 34 per cent recommended continuation of the new total disposable program and less than half felt the products were as good as previously used ones. Needless to say, we were more concerned with making our internal operations more effective and efficient than having a total disposable system provided by a single vendor. We developed a plan of action which resolved the problem by using multiple vendors. From this experience we learned that a great deal of caution will go a long way in making sure that each person involved has a chance to evaluate and communicate his objective feelings before a final decision is
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made.
REFERENCES 1. Korolenko, Harold, “Three Barriers to Communication,” AORN Journal, Vol. 111, #3, May-June 1965, pp. 90-96. 2. Dull, Verna, “The Employee Speaks LJp: Communication Channels from Employees to Management,” Hospitals, Vol. XXXIII, #2, August 16, 1957, p. 51. 3. Timmons, Lynn R., “Department Training Program, 1960,” (Unpublished manual, Department of Mental Hygiene and Corrections, State of Ohio). 4. lbid. 5. Wester, William C., 11, Ed.D., “10 Commandments for Meaningful Communication,” Hospital Progress, Vol. XLIX, #4, April 1968, pp. 14-16. 6. lbid.
7 . Op. Cit., Korolenko. 8. Deunk, Norman H., “Active Listening: A Forgotten Key to Effective Communication,” Hospital Administration, Vol. XII, #2, Spring 1967, pp. 34-45. 9. O p . Cit., Timmons. 10. Glass, Herman J., “Communication-A Vital Tool in Hospital Administration and Medicine,” Journal of The National Medical Association, Vol. LIX, March 1967, pp. 142-145. 11. Posz, A. Conrad, Ph.D., “Do You Irritate Others When You Listen?” Journal of The American Dietetic Association, Vol. XXXIV, July 1958, p. 730. 12. Op. Cit., Deunk.
‘THE W A L R U S A N D THE CARPENTER’ revisited ( W i t h apologies to Lewis Carroll) “The time has come,” the doctor said, “to speak of many things: Of nurses’ changing notions; of their strophying wings; Of why they’re neither what they were nor what they’d like to b e ; Of w h y they think they’ve got to have that overstressed degree. The time has come, in other words, for reconsideration, Lest nurses ruin nursing in their yen for higher station.” “The time has come,” the nurse replied, “to strike a compromise: Regard us, Sir, as people-and we’ll measure u p to size!”
Joan Fried, R.N.
(R.N. March 1959)
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AORN Journal