- Email: [email protected]
Communication skills for getting ahead
Jeanette A Griver
Communication skiIls for getting ahead
For operating room nurses, the question is how to survive and get ahead in a changing profession. You may be asking yourself some of these questions. Do you need more education to meet your goals? If you are a staff nurse, is management your goal? How can you make the transition t o management? If you are in management, can you communicate effectively with your
Jeanette A Griver, MA, is chief executive of-
ficer of Compsych Systems, Inc, Del Rey, Calif. She received a Bachelor of Arts in psychology from the University of California at Los Angeles, College of Letters and Science, and a Master of Arts in human factors psychology from the University of Southern California, Los Angeles. Compsych is a training and research corporation to improve personal and organization communication skills.This article incorporates some information from her workshop at the 26th A O R N Congress in St Louis.
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subordinates as well as superiors? How can you mesh your personal goals with those of the profession and its organizations? Nursing is a changing profession. The American Nurses’ Association has set a goal of the bachelor’s degree for entry into professional nursing practice. The Association of Operating Room Nurses (AORN) has endorsed the bachelor’s degree as a single entry level for nursing. Since about 65% of operating room nurses are diploma graduates, a n important consideration is whether t o get a degree t o meet anticipated future requirements. The first question to ask yourself is, “How long do I think I am going to continue in this job as supervisor or head nurse or staff nurse”? This question applies especially to the 57% of AORN members who are 40 and under, since they will work for a minimum of 25 more years.’ After considering this question, as well as your lifestyle and personality, you may decide you want to continue in nursing. You need to consider whether you will need a baccalaureate or higher degree to achieve your goals. Then, the search for educational development begins. One resource is the Directory of Career Mobility Programs in Nursing Education.2 This includes a description of the College Level Entrance Placement Exam (CLEP). This exam is especially useful for people who have been
AORN Journal, August 1979, V a l 30, No 2
on’t get caught in the merry-go-round of “if only.”
D
out of school for five years or more. By passing the series of exams, an individual can obtain up t o 30 units of credit toward a bachelor’s degree. These credits basically relate to elective courses. If you do not see your future as an operating room nurse, you may be interested in another area in the health care field. You might want to consider obtaining a degree in business administration, public health, or public administration. The combination of your OR experience and business might lead toward new challenges in hospital administration. However, keep in mind that if you intend to stay in nursing, a degree in nursing is usually necessary to move up the professional and academic ladder. The main point is not to get caught in the merry-go-round of “if only.” “If only I had gone back to school earlier.” “If only I had more time.” “If only I had the money.” “If only I didn’t have family responsibilities.” You may find it isn’t worth the time and money t o return t o school. But if you find yourself becoming a chronic complainer, remember it was your decision, but you can always change your mind. Remember that if you started working at age 20 and want to continue until you are 70, you will have devoted 104,000 hours of your life to your profession. If you are thinking about making a transition from a staff nursing role to management, this will require analysis.
What are the differences in the jobs? You must analyze differences in tasks and, in some cases, environments. You should look at your own emotional and psychological conditioning. What additional knowledge will you need about human behavior and business techniques? The operating room is a highly structured environment. It requires a taskoriented staff, which has developed straight-line thinking. The OR nurse develops an inner security from knowing how to perform certain tasks in sequence but with the flexibility to modify the tasks when necessary. In supervision, however, the tasks are varied and require different approaches. When the effects of the procedure are established and structured, it can be followed in sequence. But when the procedure is not established, more individual judgment is required. A manager lives with a certain degree of imbalance. He or she copes with the unstructured politics within the system and a variety of responses from individuals. In the operating room, you can count the instruments and supplies. You can concentrate on the task at hand and expect a direct outcome. In staff meetings, you can count the people present, but you can’t jump inside their minds and count their mental tools or decision-making processes. You cannot predict the outcome with any precision. The OR nurse devotes her emotional
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and psychological energies to sustaining the working of the operating room and reassuring the patient. The supervisor or manager spends her emotional and psychological energies in problem solving, decision making, and planning. Managers also use social and cultural skills to sell ideas to administration and subordinates. One process is not better than the other, just different. In some cases, nurses are doing both and are caught in a double bind. The knowledge and skills required to be an operating room nurse take years t o develop. Sometimes the skills required to become a supervisor or manager are seen as adjunct and easier t o acquire. The same energy, however, must be put into gaining an education in business and human behavior techniques. As you make the move from direct nursing care t o supervision, you will want to examine your communication techniques. There are three areas of communication that can mean success or failure in selling your ideas to subordinates, reducing costs, and eliminating conflict among employees. Examine yourself 1. Do you commit the error of omission? Do you omit vital information in your written and oral communications? 2. Do you use operational definitions? Do you use specific, precise words to say what you mean or express yourself in vague, general terms? 3. Do you use problem solving, dollarization, and completed staff work? The error of omission occurs when you leave out information essential to the accurate completion of a task. A supervisor may give vague, oral instructions and then wonder why what she wants didn’t happen. She may order supplies but omit the purchase order numbers. In transmitting procedural changes t o the staff, she may omit critical steps. The error of omission is costly in time, money, and human relations. Suppose
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you are telling someone you will pick them up at the airport, but you neglect to tell them where. At the gate? A t the baggage counter? What airline? What flight number? You search the airport; time is critical since both of you are about to miss an important meeting at work. The consequence of this error can be measured in time and money. On the job, error of omission frequently occurs when experienced personnel give instructions to new employees. The experienced personnel assumes prior basic knowledge on the part of the listener. For example, a nurse asks a new ward clerk to get 1 liter 5% glucose in water from the supply room. The nurse assumes the clerk knows the location of the supply room. The clerk probably walks out the door and stops short. She asks herself, “Where do I go? Down the hall? Should I turn left or right? I can’t see any signs that tell me where the supply room is. Should I ask someone? Will there be someone in the supply room to help me?” These are just questions about the location-additiona1 questions are usually asked about the item to be picked up. Why didn’t the clerk ask the nurse these questions? Not everyone asks questions. It’s the clerk’s first day, and some people are reluctant t o ask questions because they don’t want to appear inexperienced. Instead of asking the person who gave the instructions, the clerk asks several coworkers for directions and procedures to be followed. The clerk returns 20 minutes later from an errand that should have taken 5 minutes. The impact of the error can be measured by computing the time it took t o receive the supply and the other tasks that the person could have been doing during that time; the number of people the clerk had to ask to find the supply room; the possibility of the clerk returning with the wrong supplies; the time
AORN Journal, August 1979, Vol30, No 2
eep a list of errors of omission you may be making.
K
consumed by the nurse in explaining in greater detail what specific supplies were required; and the emotional frustration experienced by both parties involved in the communication. All this occurred because of a seemingly simple error of omission. If these errors are compounded throughout the organization, which is often the case, they have a direct impact on profit, cost effectiveness, and allocation of resources. Time and money are being taken away from patient care. The error of omission can also occur 1. when personnel become so familiar with procedure that they perform by rote memory and forget information 2. when personnel work together for a long time and find themselves not completing sentences or filling in sentences before the other person finishes the thought 3. when personnel concentrate on the task and do not listen to initial instructions because they do not think they are important to the correct outcome of the task 4. when personnel think the task is so simple and routine that they don’t need to listen 5 . when personnel do not believe the information being given to them. Individual performance will be improved and the error of omission decreased by the sender of the information assuming responsibility whenever pos-
sible for sending and receiving information. In other words, be sure to give personnel the information they need to get the job done. To determine whether you are committing errors of omission, for a t least one week keep a list of errors of omission you may be making. Record the type of error of omission made. Did it relate to time, location, or knowledge of subject? the persons involved in the error. Were they peers, employees, administration, staff, or persons outside the organization? when the errors occur. Are they during meetings, shift changes, o r other situations? 0 how frequently errors occur. 0 whether they are the same type of errors. 0 whether the errors are oral or written. At the end of the week, summarize the list and see if a pattern occurs. After analyzing the results, devise a plan to correct the errors. The use of operational definitionsprecise a n d useful definitions o r words-will also help your communication. For yourself and others, it is important to define in operational or working terms what you want t o do in your present job, goals you want to obtain within your organization, and solutions to specific problems. How many times have you said to
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your supervisor, “I am bored with my job and unhappy with my status. I want a job that is challenging and recognizes my abilities”? As a supervisor, what is your reaction to this kind of statement? Do you see a whiner? A malcontent? The employee feels that she is expressing a specific need and that the manager is frustrating that need. The manager has only a vague idea of what the person wants. Time is wasted trying to clarify the needs of the employee. If the employee had thought out his or her needs by defining “challenge” and “recognition” in operational terms, the exchange might have sounded like this: “Iwant to devote 75% of my 40-hour work week to working in the cancer research laboratory. I want t o be part of the medical breakthrough for a cancer cure. I will then spend 25% of my time on ward duty.” As a manager, you can work with that statement. You can accept or reject it. You can see if there are staff openings in research. You have a more precise understanding of the employee’s needs, not just a vague emotional feeling. Less time is required to act on the request. You may notice a reluctance on the part of people to define terms operationally. It forces them from the comfort of fantasy and emotional security to reality. In this example, the employee may be transferred to research but will then have to prove him o r herself in a new job situation. A nonoperational term that usually evokes a positive emotional response within the health care field is “the objective of the hospital is to provide quality care to the patient.” If individual staff members were asked t o give an interpretation of that philosophy, you might hear responses such as, “We can’t give quality care t o patients when morale is low.” “Communication among department heads is poor; they’re always fighting.” “Administration only
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thinks of money, not the patient.” “We are understaffed.” “We spend too much time in meetings, not enough time with the patients.” The main purpose of operationally defining philosophical goals and vague terms is to refine the statements to the point where the words can be turned into action. Action then becomes measurable. The third area of communication involves problem solving-finding the cause, not the symptom, and solutions to problems completed staff work-the study of the problem and presentation of its solution in a form that only approval or disapproval by the manager of the completed activity is necessary dollarization-computing the dollar impact of the problem and solution. Over 80%of a manager’s time is spent in oral and written communication with others. If your suggestions are getting rejected or if your staff is continually telling you how to improve your operations without knowing all the facts, you may not be presenting your ideas objectively. You may not be doing completed staff work. Problem solvers are quick to find the true-operationally definedreasons behind complaints and suggestions. This example incorporates all the communication concepts we have discussed. A nurse notices that a number of personnel are asking for stethoscopes. She observes there is a need for additional stethoscopes. She communicates this to the supervisor saying, “We need more stethoscopes t o improve the quality of patient care.” The supervisor replies, “We can’t buy more stethoscopes because we don’t have the money in the budget.” The nurse retreats and discusses the problem with other personnel. “Which
AORN Journal, August 1979, Vol30, No 2
ocus will be on the patient not the problem.
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is more important-money or patient care?’ she asks angrily. The problem becomes the center of conversation among the physicians and nurses. Several nurses now approach the supervisor but get the same response, “It is not in our budget.” The supervisor, however, approaches the director of nursing during a staff meeting and passes on the request. The director tells the supervisor there is not enough money in the budget; the staff will have to do the best it can. The cycle continues. Finally the director of nurses asks the administrator if it is possible t o allocate some money for the stethoscopes as it will add t o the quality of patient care in the hospital. The administrator says no flatly and dismisses the idea. How much time has been wasted in this exercise? Had the nurse used the communication concepts described in this article, this is what would have happened. 1. She would have recognized that the problem had been stated in nonoperational terms, ie, “We need more stethoscopes for better patient care.” 2. She would have gathered facts about the problem, including opinions. Why do we need more stethoscopes? What is the impact on the staff? What is the dollar and emotional impact on the staff and patient? What are the cost factors? Multiply the time spent locating stethoscopes
by the number of people involved. Consider not only salaries but overhead costs. 0 Are the stethoscopes kept in a central location? What is the physical setup of the room? If I changed the setup, would t h a t solve the problem? How much time is spent by how many people in trying to locate someone who has a stethoscope? How much of the time spent searching for equipment could have been spent assessing patients’ conditions, perhaps resulting in savings t o patients? How much time has been spent by nurses, clerks, physicians, and others talking about why the stethoscopes were not purchased? How much time have supervisors spent explaining in oral and written communication why the stethoscopes cannot be purchased? 3. She would have reviewed all terms and defined them operationally, eg, time = one hour, one nurse = $40, including overhead. She would have checked to make sure important information was not missing. 4. She would have analyzed solutions to the problems such as purchase of new stethoscopes at the cost of x dollars; transfer of stethoscopes from other departments at the cost of x dollars; requesting physicians to use their own stethoscopes.
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5. She would have determined what benefits are to be derived from each solution. Costs savings? Better use of nurses’ time? Closer observation of patient’s condition? Removal of minor frustration? Focus will be on the patient rather than the problem. After completing the study, the next step is to put the information in a format that will allow the supervisor t o make a decision. This might be a one-page letter of transmittal with the following information. Date: To whom: Name, title, department From whom: Name, title, department Subject: Request for stethoscopes Problem statement or request: “Department H can save a n estimated minimum of $6,000 and a maximum of $10,000 per year by purchasing 20 stethoscopes a t a total cost of $400 Alternatives: Company A stethoscopes @ $400, immediate delivery Company B stethoscopes @ $639, immediate delivery Company C scopes @ $219, threemonths delivery Recommendation: Company A stethoscopes @ $400, immediate delivery Approved by: Name and title (usually approved by several people). The letter is accompanied by the following information on separate sheets of paper in case the person who approves the request wants to verify costs and background material. Background: identify all relevant information basic to the study, including statistical-financial information how the problem developed opinions expressed by the individuals involved in the problem factual information on how t h e problem will affect other departments
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Analysis of options advantages and disadvantages costs and benefits economic and social impact Recommendation specify which option would be most appropriate Enclosures bulky data, references, and documents. Does this seem like a great deal of work for 20 stethoscopes? Perhaps, b u t t h i s method will increase t h e probability t h a t you will get t h e stethoscopes. The generalized “I want” statements for better patient care are easier to say, but the results are usually negative. Cost reduction is becoming increasingly necessary in health care. With the described tools, the effectiveness of individual cost effectiveness can be increased. These communication skills can help you develop skilled leadership, one of the requirements of management. One of the measures of effective leadership is having a group that accomplishes its assigned tasks as accurately as possible. It is not only a n important function for OR management to lead subordinatesto perform a t their best, but also to mold subordinates into a team to reach goals. This requires time-time for the leader to act as a catalyst to speed up results and to analyze the skills and needs of the subordinates. OR managers must also be able to communicate and persuade subordinates of the value of new plans and changes within the organization. How can individuals improve their leadership skills? Many studies have been conducted to learn whether leaders are born or developed and to find the magic formula for developing leaders. Is it personality? Physical characteristics? The ability to communicate w i t h others? Early childhood experiences? Intelligence? Wanting to change the
AORN Journal, August 1979, V o l 3 0 , No 2
way people think? No one seems t o k n o w . Today's researchers a r e s p e n d i n g m o r e t i m e a n a l y z i n g t h e leader within specific o r g a n i z a t i o n s - t h e personal t r a i t s o f t h e individual, t h e n a t u r e o f t h e w o r k o f t h e organization, a n d t h e philosophy and objectives o f t h e people t o be led. E x p l o r a t i o n o f these areas i n cludes assessment o f t h e personal t r a i t s , interests, and needs o f t h e individual. I f y o u a r e i n t e r e s t e d in developing y o u r leadership abilities, a s k y o u r s e l f some o f these questions. Do y o u find it easy t o c o m m u n i c a t e o r a l l y w i t h people? A r e y o u shy? Withdrawn? Outgoing? A r e y o u m o r e interested in t h e tasks in t h e o p e r a t i n g room? Do y o u bel i e v e p a p e r w o r k and b u d g e t s a r e a waste o f t i m e ? I s y o u r philosophy o f l i f e compatible with that o f t h e a d m i n i s t r a tion? A n o t h e r decision y o u face i s t h e size o f t h e organization. Do y o u f u n c t i o n b e t t e r in a s m a l l o r l a r g e organization? Do y o u r objectives and philosophy m a t c h those o f t h e people t o be led? U l t i m a t e l y , y o u w i l l succeed as a leader i f y o u pull together t h e answers t o these questions and y o u r communicat i o n r e s o u r c e s and focus t h e m i n t o specific o p e r a t i n g channels. T h i s i s a c o n t i n u i n g self-education process. 0 Notes 1. "AORN, ANA leaders discuss entry level," AORN Journal 29 (February 1979) 484. 2. Directory of Career Mobility Programs in Nursing Education (New York: NationalLeague for Nursing, 1976) 5. Suggested reading Damos, Virginia. "Management skill: Objectivity." AORN Journal 25 (February 1977) 195-196. Griver, Jeanette; Robinson, Margot. "Multimedia strategies for improving the effectivenessof man-
agerial staff meetings." Human Factors 13 (February 1971) 11-16. Huse, Edgar F. The Modern Manager. St Paul, Minn: West Publishing Co, 1979. Kneedler, Julia. "Management styles dictate OR interaction." AORN Journal 25 (January 1977) 19-22.
Documents requested for nursing data base The National Health Planning Information Center (NHPIC) is requesting nurse manpower planners, educators, and practitioners to submit reports of their research. The material is used by NHPIC to expand its data base, which now contains approximately 5,000 documents related to nurse manpower and planning for nursing services. The computer-based information system includes current and historical information related to nurse planning issues, including systems modeling, utilization and cost studies, forecasting methods, and health care studies. Material accepted for the data base is announced in Health Planning, a weekly abstract series available from the National Technical Information Service, US Department of Commerce, 5285 Port Royal Rd, Springfield, Va 22161. Documents should be submitted to NHPlCiAcquisitions (Nursing Information), PO Box 1600, Prince George's Plaza Branch, Hyattsville, Md 20788.
Satellite TV system to provide education A satellite television system has been established to provide health education for patients in hospital rooms. The service, set to begin July 1, includes two hours of educational programs a day: Selected by the Greater Cleveland Hospital Association, the programs will cover topics such as arthritis, child care, coronary care, hospital procedures, hypertension, mental health, nutrition, strokes, and over-the-counter drugs. The Public Service Satellite Consortium, which is providing the service, said some 500 hospitals are connected to cable television systems that are equipped to receive the satellite transmissions. Hospitals would pay on the basis of the number of patients watching per hour of programming. In addition to patient teaching, education programs for physicians, nurses, and other personnel will also be transmitted to hospitals on the National Satellite Network.
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Communication skiIls for getting ahead
For operating room nurses, the question is how to survive and get ahead in a changing profession. You may be asking yourself some of these questions. Do you need more education to meet your goals? If you are a staff nurse, is management your goal? How can you make the transition t o management? If you are in management, can you communicate effectively with your
Jeanette A Griver, MA, is chief executive of-
ficer of Compsych Systems, Inc, Del Rey, Calif. She received a Bachelor of Arts in psychology from the University of California at Los Angeles, College of Letters and Science, and a Master of Arts in human factors psychology from the University of Southern California, Los Angeles. Compsych is a training and research corporation to improve personal and organization communication skills.This article incorporates some information from her workshop at the 26th A O R N Congress in St Louis.
242
subordinates as well as superiors? How can you mesh your personal goals with those of the profession and its organizations? Nursing is a changing profession. The American Nurses’ Association has set a goal of the bachelor’s degree for entry into professional nursing practice. The Association of Operating Room Nurses (AORN) has endorsed the bachelor’s degree as a single entry level for nursing. Since about 65% of operating room nurses are diploma graduates, a n important consideration is whether t o get a degree t o meet anticipated future requirements. The first question to ask yourself is, “How long do I think I am going to continue in this job as supervisor or head nurse or staff nurse”? This question applies especially to the 57% of AORN members who are 40 and under, since they will work for a minimum of 25 more years.’ After considering this question, as well as your lifestyle and personality, you may decide you want to continue in nursing. You need to consider whether you will need a baccalaureate or higher degree to achieve your goals. Then, the search for educational development begins. One resource is the Directory of Career Mobility Programs in Nursing Education.2 This includes a description of the College Level Entrance Placement Exam (CLEP). This exam is especially useful for people who have been
AORN Journal, August 1979, V a l 30, No 2
on’t get caught in the merry-go-round of “if only.”
D
out of school for five years or more. By passing the series of exams, an individual can obtain up t o 30 units of credit toward a bachelor’s degree. These credits basically relate to elective courses. If you do not see your future as an operating room nurse, you may be interested in another area in the health care field. You might want to consider obtaining a degree in business administration, public health, or public administration. The combination of your OR experience and business might lead toward new challenges in hospital administration. However, keep in mind that if you intend to stay in nursing, a degree in nursing is usually necessary to move up the professional and academic ladder. The main point is not to get caught in the merry-go-round of “if only.” “If only I had gone back to school earlier.” “If only I had more time.” “If only I had the money.” “If only I didn’t have family responsibilities.” You may find it isn’t worth the time and money t o return t o school. But if you find yourself becoming a chronic complainer, remember it was your decision, but you can always change your mind. Remember that if you started working at age 20 and want to continue until you are 70, you will have devoted 104,000 hours of your life to your profession. If you are thinking about making a transition from a staff nursing role to management, this will require analysis.
What are the differences in the jobs? You must analyze differences in tasks and, in some cases, environments. You should look at your own emotional and psychological conditioning. What additional knowledge will you need about human behavior and business techniques? The operating room is a highly structured environment. It requires a taskoriented staff, which has developed straight-line thinking. The OR nurse develops an inner security from knowing how to perform certain tasks in sequence but with the flexibility to modify the tasks when necessary. In supervision, however, the tasks are varied and require different approaches. When the effects of the procedure are established and structured, it can be followed in sequence. But when the procedure is not established, more individual judgment is required. A manager lives with a certain degree of imbalance. He or she copes with the unstructured politics within the system and a variety of responses from individuals. In the operating room, you can count the instruments and supplies. You can concentrate on the task at hand and expect a direct outcome. In staff meetings, you can count the people present, but you can’t jump inside their minds and count their mental tools or decision-making processes. You cannot predict the outcome with any precision. The OR nurse devotes her emotional
AORN Journal, August 1979, V o l 3 0 , N o 2
243
and psychological energies to sustaining the working of the operating room and reassuring the patient. The supervisor or manager spends her emotional and psychological energies in problem solving, decision making, and planning. Managers also use social and cultural skills to sell ideas to administration and subordinates. One process is not better than the other, just different. In some cases, nurses are doing both and are caught in a double bind. The knowledge and skills required to be an operating room nurse take years t o develop. Sometimes the skills required to become a supervisor or manager are seen as adjunct and easier t o acquire. The same energy, however, must be put into gaining an education in business and human behavior techniques. As you make the move from direct nursing care t o supervision, you will want to examine your communication techniques. There are three areas of communication that can mean success or failure in selling your ideas to subordinates, reducing costs, and eliminating conflict among employees. Examine yourself 1. Do you commit the error of omission? Do you omit vital information in your written and oral communications? 2. Do you use operational definitions? Do you use specific, precise words to say what you mean or express yourself in vague, general terms? 3. Do you use problem solving, dollarization, and completed staff work? The error of omission occurs when you leave out information essential to the accurate completion of a task. A supervisor may give vague, oral instructions and then wonder why what she wants didn’t happen. She may order supplies but omit the purchase order numbers. In transmitting procedural changes t o the staff, she may omit critical steps. The error of omission is costly in time, money, and human relations. Suppose
244
you are telling someone you will pick them up at the airport, but you neglect to tell them where. At the gate? A t the baggage counter? What airline? What flight number? You search the airport; time is critical since both of you are about to miss an important meeting at work. The consequence of this error can be measured in time and money. On the job, error of omission frequently occurs when experienced personnel give instructions to new employees. The experienced personnel assumes prior basic knowledge on the part of the listener. For example, a nurse asks a new ward clerk to get 1 liter 5% glucose in water from the supply room. The nurse assumes the clerk knows the location of the supply room. The clerk probably walks out the door and stops short. She asks herself, “Where do I go? Down the hall? Should I turn left or right? I can’t see any signs that tell me where the supply room is. Should I ask someone? Will there be someone in the supply room to help me?” These are just questions about the location-additiona1 questions are usually asked about the item to be picked up. Why didn’t the clerk ask the nurse these questions? Not everyone asks questions. It’s the clerk’s first day, and some people are reluctant t o ask questions because they don’t want to appear inexperienced. Instead of asking the person who gave the instructions, the clerk asks several coworkers for directions and procedures to be followed. The clerk returns 20 minutes later from an errand that should have taken 5 minutes. The impact of the error can be measured by computing the time it took t o receive the supply and the other tasks that the person could have been doing during that time; the number of people the clerk had to ask to find the supply room; the possibility of the clerk returning with the wrong supplies; the time
AORN Journal, August 1979, Vol30, No 2
eep a list of errors of omission you may be making.
K
consumed by the nurse in explaining in greater detail what specific supplies were required; and the emotional frustration experienced by both parties involved in the communication. All this occurred because of a seemingly simple error of omission. If these errors are compounded throughout the organization, which is often the case, they have a direct impact on profit, cost effectiveness, and allocation of resources. Time and money are being taken away from patient care. The error of omission can also occur 1. when personnel become so familiar with procedure that they perform by rote memory and forget information 2. when personnel work together for a long time and find themselves not completing sentences or filling in sentences before the other person finishes the thought 3. when personnel concentrate on the task and do not listen to initial instructions because they do not think they are important to the correct outcome of the task 4. when personnel think the task is so simple and routine that they don’t need to listen 5 . when personnel do not believe the information being given to them. Individual performance will be improved and the error of omission decreased by the sender of the information assuming responsibility whenever pos-
sible for sending and receiving information. In other words, be sure to give personnel the information they need to get the job done. To determine whether you are committing errors of omission, for a t least one week keep a list of errors of omission you may be making. Record the type of error of omission made. Did it relate to time, location, or knowledge of subject? the persons involved in the error. Were they peers, employees, administration, staff, or persons outside the organization? when the errors occur. Are they during meetings, shift changes, o r other situations? 0 how frequently errors occur. 0 whether they are the same type of errors. 0 whether the errors are oral or written. At the end of the week, summarize the list and see if a pattern occurs. After analyzing the results, devise a plan to correct the errors. The use of operational definitionsprecise a n d useful definitions o r words-will also help your communication. For yourself and others, it is important to define in operational or working terms what you want t o do in your present job, goals you want to obtain within your organization, and solutions to specific problems. How many times have you said to
AORN Journal, August 1979, V o l 3 0 , No 2
245
your supervisor, “I am bored with my job and unhappy with my status. I want a job that is challenging and recognizes my abilities”? As a supervisor, what is your reaction to this kind of statement? Do you see a whiner? A malcontent? The employee feels that she is expressing a specific need and that the manager is frustrating that need. The manager has only a vague idea of what the person wants. Time is wasted trying to clarify the needs of the employee. If the employee had thought out his or her needs by defining “challenge” and “recognition” in operational terms, the exchange might have sounded like this: “Iwant to devote 75% of my 40-hour work week to working in the cancer research laboratory. I want t o be part of the medical breakthrough for a cancer cure. I will then spend 25% of my time on ward duty.” As a manager, you can work with that statement. You can accept or reject it. You can see if there are staff openings in research. You have a more precise understanding of the employee’s needs, not just a vague emotional feeling. Less time is required to act on the request. You may notice a reluctance on the part of people to define terms operationally. It forces them from the comfort of fantasy and emotional security to reality. In this example, the employee may be transferred to research but will then have to prove him o r herself in a new job situation. A nonoperational term that usually evokes a positive emotional response within the health care field is “the objective of the hospital is to provide quality care to the patient.” If individual staff members were asked t o give an interpretation of that philosophy, you might hear responses such as, “We can’t give quality care t o patients when morale is low.” “Communication among department heads is poor; they’re always fighting.” “Administration only
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thinks of money, not the patient.” “We are understaffed.” “We spend too much time in meetings, not enough time with the patients.” The main purpose of operationally defining philosophical goals and vague terms is to refine the statements to the point where the words can be turned into action. Action then becomes measurable. The third area of communication involves problem solving-finding the cause, not the symptom, and solutions to problems completed staff work-the study of the problem and presentation of its solution in a form that only approval or disapproval by the manager of the completed activity is necessary dollarization-computing the dollar impact of the problem and solution. Over 80%of a manager’s time is spent in oral and written communication with others. If your suggestions are getting rejected or if your staff is continually telling you how to improve your operations without knowing all the facts, you may not be presenting your ideas objectively. You may not be doing completed staff work. Problem solvers are quick to find the true-operationally definedreasons behind complaints and suggestions. This example incorporates all the communication concepts we have discussed. A nurse notices that a number of personnel are asking for stethoscopes. She observes there is a need for additional stethoscopes. She communicates this to the supervisor saying, “We need more stethoscopes t o improve the quality of patient care.” The supervisor replies, “We can’t buy more stethoscopes because we don’t have the money in the budget.” The nurse retreats and discusses the problem with other personnel. “Which
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ocus will be on the patient not the problem.
F
is more important-money or patient care?’ she asks angrily. The problem becomes the center of conversation among the physicians and nurses. Several nurses now approach the supervisor but get the same response, “It is not in our budget.” The supervisor, however, approaches the director of nursing during a staff meeting and passes on the request. The director tells the supervisor there is not enough money in the budget; the staff will have to do the best it can. The cycle continues. Finally the director of nurses asks the administrator if it is possible t o allocate some money for the stethoscopes as it will add t o the quality of patient care in the hospital. The administrator says no flatly and dismisses the idea. How much time has been wasted in this exercise? Had the nurse used the communication concepts described in this article, this is what would have happened. 1. She would have recognized that the problem had been stated in nonoperational terms, ie, “We need more stethoscopes for better patient care.” 2. She would have gathered facts about the problem, including opinions. Why do we need more stethoscopes? What is the impact on the staff? What is the dollar and emotional impact on the staff and patient? What are the cost factors? Multiply the time spent locating stethoscopes
by the number of people involved. Consider not only salaries but overhead costs. 0 Are the stethoscopes kept in a central location? What is the physical setup of the room? If I changed the setup, would t h a t solve the problem? How much time is spent by how many people in trying to locate someone who has a stethoscope? How much of the time spent searching for equipment could have been spent assessing patients’ conditions, perhaps resulting in savings t o patients? How much time has been spent by nurses, clerks, physicians, and others talking about why the stethoscopes were not purchased? How much time have supervisors spent explaining in oral and written communication why the stethoscopes cannot be purchased? 3. She would have reviewed all terms and defined them operationally, eg, time = one hour, one nurse = $40, including overhead. She would have checked to make sure important information was not missing. 4. She would have analyzed solutions to the problems such as purchase of new stethoscopes at the cost of x dollars; transfer of stethoscopes from other departments at the cost of x dollars; requesting physicians to use their own stethoscopes.
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5. She would have determined what benefits are to be derived from each solution. Costs savings? Better use of nurses’ time? Closer observation of patient’s condition? Removal of minor frustration? Focus will be on the patient rather than the problem. After completing the study, the next step is to put the information in a format that will allow the supervisor t o make a decision. This might be a one-page letter of transmittal with the following information. Date: To whom: Name, title, department From whom: Name, title, department Subject: Request for stethoscopes Problem statement or request: “Department H can save a n estimated minimum of $6,000 and a maximum of $10,000 per year by purchasing 20 stethoscopes a t a total cost of $400 Alternatives: Company A stethoscopes @ $400, immediate delivery Company B stethoscopes @ $639, immediate delivery Company C scopes @ $219, threemonths delivery Recommendation: Company A stethoscopes @ $400, immediate delivery Approved by: Name and title (usually approved by several people). The letter is accompanied by the following information on separate sheets of paper in case the person who approves the request wants to verify costs and background material. Background: identify all relevant information basic to the study, including statistical-financial information how the problem developed opinions expressed by the individuals involved in the problem factual information on how t h e problem will affect other departments
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Analysis of options advantages and disadvantages costs and benefits economic and social impact Recommendation specify which option would be most appropriate Enclosures bulky data, references, and documents. Does this seem like a great deal of work for 20 stethoscopes? Perhaps, b u t t h i s method will increase t h e probability t h a t you will get t h e stethoscopes. The generalized “I want” statements for better patient care are easier to say, but the results are usually negative. Cost reduction is becoming increasingly necessary in health care. With the described tools, the effectiveness of individual cost effectiveness can be increased. These communication skills can help you develop skilled leadership, one of the requirements of management. One of the measures of effective leadership is having a group that accomplishes its assigned tasks as accurately as possible. It is not only a n important function for OR management to lead subordinatesto perform a t their best, but also to mold subordinates into a team to reach goals. This requires time-time for the leader to act as a catalyst to speed up results and to analyze the skills and needs of the subordinates. OR managers must also be able to communicate and persuade subordinates of the value of new plans and changes within the organization. How can individuals improve their leadership skills? Many studies have been conducted to learn whether leaders are born or developed and to find the magic formula for developing leaders. Is it personality? Physical characteristics? The ability to communicate w i t h others? Early childhood experiences? Intelligence? Wanting to change the
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way people think? No one seems t o k n o w . Today's researchers a r e s p e n d i n g m o r e t i m e a n a l y z i n g t h e leader within specific o r g a n i z a t i o n s - t h e personal t r a i t s o f t h e individual, t h e n a t u r e o f t h e w o r k o f t h e organization, a n d t h e philosophy and objectives o f t h e people t o be led. E x p l o r a t i o n o f these areas i n cludes assessment o f t h e personal t r a i t s , interests, and needs o f t h e individual. I f y o u a r e i n t e r e s t e d in developing y o u r leadership abilities, a s k y o u r s e l f some o f these questions. Do y o u find it easy t o c o m m u n i c a t e o r a l l y w i t h people? A r e y o u shy? Withdrawn? Outgoing? A r e y o u m o r e interested in t h e tasks in t h e o p e r a t i n g room? Do y o u bel i e v e p a p e r w o r k and b u d g e t s a r e a waste o f t i m e ? I s y o u r philosophy o f l i f e compatible with that o f t h e a d m i n i s t r a tion? A n o t h e r decision y o u face i s t h e size o f t h e organization. Do y o u f u n c t i o n b e t t e r in a s m a l l o r l a r g e organization? Do y o u r objectives and philosophy m a t c h those o f t h e people t o be led? U l t i m a t e l y , y o u w i l l succeed as a leader i f y o u pull together t h e answers t o these questions and y o u r communicat i o n r e s o u r c e s and focus t h e m i n t o specific o p e r a t i n g channels. T h i s i s a c o n t i n u i n g self-education process. 0 Notes 1. "AORN, ANA leaders discuss entry level," AORN Journal 29 (February 1979) 484. 2. Directory of Career Mobility Programs in Nursing Education (New York: NationalLeague for Nursing, 1976) 5. Suggested reading Damos, Virginia. "Management skill: Objectivity." AORN Journal 25 (February 1977) 195-196. Griver, Jeanette; Robinson, Margot. "Multimedia strategies for improving the effectivenessof man-
agerial staff meetings." Human Factors 13 (February 1971) 11-16. Huse, Edgar F. The Modern Manager. St Paul, Minn: West Publishing Co, 1979. Kneedler, Julia. "Management styles dictate OR interaction." AORN Journal 25 (January 1977) 19-22.
Documents requested for nursing data base The National Health Planning Information Center (NHPIC) is requesting nurse manpower planners, educators, and practitioners to submit reports of their research. The material is used by NHPIC to expand its data base, which now contains approximately 5,000 documents related to nurse manpower and planning for nursing services. The computer-based information system includes current and historical information related to nurse planning issues, including systems modeling, utilization and cost studies, forecasting methods, and health care studies. Material accepted for the data base is announced in Health Planning, a weekly abstract series available from the National Technical Information Service, US Department of Commerce, 5285 Port Royal Rd, Springfield, Va 22161. Documents should be submitted to NHPlCiAcquisitions (Nursing Information), PO Box 1600, Prince George's Plaza Branch, Hyattsville, Md 20788.
Satellite TV system to provide education A satellite television system has been established to provide health education for patients in hospital rooms. The service, set to begin July 1, includes two hours of educational programs a day: Selected by the Greater Cleveland Hospital Association, the programs will cover topics such as arthritis, child care, coronary care, hospital procedures, hypertension, mental health, nutrition, strokes, and over-the-counter drugs. The Public Service Satellite Consortium, which is providing the service, said some 500 hospitals are connected to cable television systems that are equipped to receive the satellite transmissions. Hospitals would pay on the basis of the number of patients watching per hour of programming. In addition to patient teaching, education programs for physicians, nurses, and other personnel will also be transmitted to hospitals on the National Satellite Network.
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