Articles

Communication Challenges, Their Impact on Employee Satisfaction, and Recommendations for Improvement

Author: Tatiana Abigail, M.A. Ed. 

Organizational communication has been a subject of great interest and research by healthcare leaders in the last century. The complexity of modern healthcare systems, due in part to advancements in informational technology, has resulted in constant changes in healthcare structure and has created a challenging environment for leaders to distribute information effectively, efficiently, and to appropriate audiences. 

Effective internal communication was critical during the COVID-19 pandemic as it informed frontline staff of the most recent updates in clinical workflows. Even though the pandemic has officially ended, the volume of communication received by the average healthcare worker has not decreased. In fact, it has become so burdensome that it affects their productivity, results in burnout, and impacts their job satisfaction. Understanding factors that contribute to communication challenges will help leaders find better ways to communicate.

Direction of communication

Traditionally, the healthcare industry has utilized vertical top-down communication to distribute information to its stakeholders. During the COVID-19 pandemic, this was the most effective way to quickly disseminate policy updates and new workflows. Outside of times of crisis, however, leaders must remember to use all available directions of information exchange.

Vertical bottom-up communication approaches are useful in receiving feedback from the frontline staff and middle managers. Leaders should encourage their teams to share feedback to help improve the current processes and the healthcare environment. By promoting the message that ‘every voice matters’ and then taking action upon receiving their feedback to ‘walk the talk’, leaders will ensure that employee feedback is valued and employees will trust that THEY (themselves) act as change agents in their organization. Leaders must be careful to not solely rely on yearly employee surveys, but instead actively seek feedback during team meetings, huddles, 1:1s, and offer virtual tools to provide timely recommendations for improvement.

A diagonal communication approach may be beneficial in situations where information needs to be clarified or precise information is needed from a specific individual or department. In such situations, it is beneficial when an organization’s culture supports circumventing a traditional ‘chain of command’ approach for needed information. For example, if a manager or a supervisor needs to get some specific information from a director from another department and her own director does not have the necessary information, it should be acceptable for this manager to reach out to the director who has the information foregoing the usual chain of command. This approach of communication reduces unnecessary email burden to those who do not have the answer and it helps eliminate waste (of time).

Finally, a horizontal communication approach is appropriate for peer-to-peer or leader-to-leader communication when sharing best practices or looking for common solutions. It helps break down silos and allows groups to learn about one another.

Redundancy of communication

Due to the large size and complexity of healthcare organizations, many organizations may rely heavily on emails to keep employees informed. Middle managers often receive a continuous stream of emails from their leaders. They often combine several communications into one in order to decrease the time needed by frontline teams to review information and to continue allowing teams to focus on providing quality patient care. In many cases, this process of combining communications may alter the meaning of the original message.

To understand the degree of communication redundancy in their organizations, managers/leaders might ask themselves the following:

1. In the last week, how often did I receive cascading communications with the same information, but from different leaders? 
2. Did these emails fail to identify to whom the message was addressed? 
3. Did other leaders forward this communication to me because they weren’t certain if I was part of the original distribution group?

Redundant communications contribute to email fatigue, take away valuable time from other projects, and lead to job dissatisfaction. As a response to job stress and limited time, employees may withdraw psychologically without actually quitting, rejecting personal responsibility for their performance¹.

When I recently met with the communications manager at my own organization to discuss communication redundancy, we came up with a quick and simple remedy: to avoid repeating emails, the sender must identify the distribution list at the beginning of the group communication. This was a small, but very effective win for the ambulatory department where I now see this recommendation in practice.

Know your audience

As an advocate for equality and diversity in the workplace, I truly believe in building teams that consist of many cultures and backgrounds, various levels of education, and economic status. It is our diversity that makes us stronger. However, because of our inherent communication preferences, not every team member processes information the way it is offered. Transformational leaders should know their audience and use storytelling as a way to teach values and norms.

I recall a recent team meeting where our group was discussing the value of teamwork. I started the discussion by presenting the story of “The Miracle on Ice” from the Lake Placid Olympic Games in 1980. As I was narrating the story about a group of college students who put their heart and soul into their team and beat the famous USSR Red Army hockey team, I could see the sparkle in the eyes of my team and the inspiration that arose from the context of the story. Another example of storytelling comes from our Patient Experience team where during presentations they used a segment on “A Walk in Their Shoes”. By sharing examples of being patients, Patient Experience Champions used narration that is relatable to people, practices, and visions, which allows them to effectively engage with the team. The value added by sharing stories and metaphors can be significant because stories provide a personal touch to communication and allow understanding and connections that statistics alone may not achieve.

In summary, organizations must have a well-functioning information exchange process to have a unified culture and align employees with the strategy and the vision. Successful organizations should utilize all available directions of information exchange, identify their distribution group and know their audience to effectively and efficiently share important information that provides education, reinforces priorities to all levels of stakeholders, and drives results.

References

¹Georgetown University scholar Michael Lipsky: Street Level Bureaucracy: Dilemmas of an Individual in Public Services

About the author

Tatiana Abigail, M.D. Ed. currently serves as a Practice Administrator overseeing several ambulatory clinics at UCHealth’s University of Colorado Hospital. She is pursuing a Doctor of Education in Leadership for Organizations degree at the University of Dayton. Tatiana is also a Certified Professional Coder, and she holds a Green Belt certificate in Lean Six Sigma. Tatiana is passionate about international travel, learning new cultures, and sharing new knowledge with her teams.

Build a Culture of Learning and Improvement to Reduce Burnout

Author: Pradipta Komanduri, FACHE

Burnout is a pervasive issue in the healthcare industry, at all levels of the organization.  Factors such as long hours, demanding workloads, challenging patients and customers, and stressful work environments can take a significant toll on mental health, leading to decreased well-being and potentially compromising the quality of care provided to patients.  To combat burnout, creating a culture of learning and improvement is crucial, as it can lead to improved team morale and better patient outcomes.  As Leonardo da Vinci said, “Learning never exhausts the mind.” 

A culture of learning and improvement is one in which team members engage in ongoing personal reflection, professional development, and collaboration.  It creates a supportive environment where individuals feel comfortable learning from their mistakes and sharing their expertise to improve systems, which can help foster a sense of community and engagement in the success of the organization.  Learning can also help manage controllable stressors and build resilience. 

One of the most stressful times of my career was years ago when our hospital was facing significant financial pressures that threatened our survival. Instead of making sweeping decisions, we opted to involve our teams in identifying ways to improve our operations. We used a robust improvement methodology that allowed our front-line team members and leaders to contribute their ideas and leave their imprints on our processes and structures. We held strong to the belief that improving patient care was our core mission and that would yield better financial results along the way. 

Together, we decreased our hospital length-of-stay, increased access to care in our ambulatory setting, improved quality measures, optimized our front-line team's ability to work at maximum potential, implemented projects that reduced waste, developed standard work to support our revenue cycle, and established clearer governance structures for more effective decision-making. By creating a culture of continuous learning and improvement, we became stronger as a team and overcame our challenges together.

One way to promote continuous improvement and create a psychologically safe environment is by asking questions that seek opportunities for system-based improvements during meetings, rounds, and other interactions. This encourages front-line staff to discuss challenges, iterate on process changes, and share learnings without fear of retribution.

Another way to support staff growth is by making performance feedback a habit. Rather than waiting for annual reviews or corrective action, provide real-time feedback that is specific, timely, and actionable. Incorporate a standing agenda item during 1:1 meetings to discuss what team members should start doing, stop doing, or continue doing. Additionally, it's important to be vulnerable and ask for feedback from others to role model a personal learning journey.

Offer ongoing training and education opportunities for team members to continuously develop their skills and explore their interests. This includes various options like workshops, conferences, online courses, mentorship programs, and career pathways. By encouraging healthcare workers to attend such events, engaging in active career conversations, and providing them with support, the organization can demonstrate its commitment to the growth and development of its workforce. In addition to skills and career development, it's crucial to provide resources that help team members manage their stress levels, prioritize self-care, and recognize when they need additional support, given the demanding nature of working in healthcare.

Recognize and celebrate achievements frequently, both big and small. Expressing gratitude and acknowledging successes can help build a sense of accomplishment and inspire continued growth and development. It's important to also recognize and learn from potential errors and near misses, as they can serve as valuable opportunities to improve systems. Celebrations can take many forms, such as public recognition, rewards, or promotions. Providing timely and specific appreciation can help team members feel valued, regain a sense of purpose towards the organization's mission, and promote a psychologically safe work environment.

To create a culture of learning, strong leadership is essential. Leaders must demonstrate the behaviors they want to see in others. This means being transparent in communication, open to feedback, and willing to admit mistakes. Leaders should prioritize self-care, actively seek out opportunities for growth and development, and make themselves present, visible, and accessible to all team members.

Leaders should also learn to ask thoughtful questions to better understand the complexities of healthcare delivery and the challenges that team members face daily.  By creating a psychologically safe environment, team members can feel comfortable being authentic, speaking up, taking ownership of improvements that impact their work environment and personal wellness, and asking for help when needed.

In conclusion, a learning and improvement culture can significantly alleviate burnout in healthcare professionals.  Encouraging professional growth, teamwork, feedback, introspection, and acknowledgment contributes to higher job satisfaction and lower stress levels.  Amid growing challenges within healthcare, focusing on team progression and system enhancement can foster a supportive work environment, decrease staff attrition, and lead to improved patient care.

About the Author

Pradipta Komanduri, FACHE, currently serves as the Chief Operating Officer at UCHealth University of Colorado Hospital.  In her role, she leads hospital operations, patient flow, surgical services, clinical service lines, ambulatory operations, major capital and construction projects, and other non-clinical operational departments.  Pradipta was a six-time examiner for the national Malcolm Baldrige Award and holds certifications in diversity and inclusion, health equity, and Lean Six Sigma.