• calendar_month July 10, 2023
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Developing Effective Communication Skills

Be an Active Listener

The starting place for effective communication is effective listening. “Active listening is listening with all of one's senses,” says physician communication expert Kenneth H. Cohn, MD, MBA, FACS. “It's listening with one's eyes as well as one's years. Only 8% of communication is related to content—the rest pertains to body language and tone of voice.” A practicing surgeon as well as a consultant, Cohn is the author of Better Communication for Better Care and Collaborate for Success!

Cohn suggests creating a setting in which “listening can be accommodating.” For example, don't have a conversation when one person is standing and one person is sitting—make sure your eyes are at the same level. Eliminate physical barriers, such as a desk, between you and the other party. Acknowledge the speaker with your own body language: lean forward slightly and maintain eye contact. Avoid crossing your arms, which conveys a guarded stance and may suggest arrogance, dislike, or disagreement.

When someone is speaking, put a premium on “being present.” Take a deep breath (or drink some water to keep from speaking) and create a mental and emotional connection between you and the speaker. “This is not a time for multitasking, but to devote all the time to that one person,” Cohn advises. “If you are thinking about the next thing you have to do or, worse, the next thing you plan to say, you aren't actively listening.”

Suspending judgment is also part of active listening, according to Cohn. Encourage the speaker to fully express herself or himself—free of interruption, criticism, or direction. Show your interest by inviting the speaker to say more with expressions such as “Can you tell me more about it?” or “I'd like to hear about that.”

Finally, reflect back to the speaker your understanding of what has been said, and invite elaboration and clarification. Responding is an integral part of active listening and is especially important in situations involving conflict.

In active listening, through both words and nonverbal behavior, you convey these messages to the speaker:

• I understand your problem

• I know how you feel about it

• I am interested in what you are saying

• I am not judging you

Communication Is a Process

Effective communication requires paying attention to an entire process, not just the content of the message. When you are the messenger in this process, you should consider potential barriers at several stages that can keep your intended audience from receiving your message.

Be aware of how your own attitudes, emotions, knowledge, and credibility with the receiver might impede or alter whether and how your message is received. Be aware of your own body language when speaking. Consider the attitudes and knowledge of your intended audience as well. Diversity in age, sex, and ethnicity or race adds to the communication challenges, as do different training backgrounds.

Individuals from different cultures may assign very different meanings to facial expressions, use of space, and, especially, gestures. For example, in some Asian cultures women learn that it is disrespectful to look people in the eye and so they tend to have downcast eyes during a conversation. But in the United States, this body language could be misinterpreted as a lack of interest or a lack of attention.

Choose the right medium for the message you want to communicate. E-mail or phone call? Personal visit? Group discussion at a meeting? Notes in the margin or a typed review? Sometimes more than one medium is appropriate, such as when you give the patient written material to reinforce what you have said, or when you follow-up a telephone conversation with an e-mail beginning, “As we discussed.…”

For one-on-one communication, the setting and timing can be critical to communicating effectively. Is a chat in the corridor OK, or should this be a closed-door discussion? In your office or over lunch? Consider the mindset and milieu of the communication receiver. Defer giving complex information on someone's first day back from vacation or if you are aware of situations that may be anxiety-producing for that individual. Similarly, when calling someone on the phone, ask initially if this is a convenient time to talk. Offer to set a specific time to call back later.

Finally, organize content of the message you want to communicate. Make sure the information you are trying to convey is not too complex or lengthy for either the medium you are using or the audience. Use language appropriate for the audience.

Be Attuned to Body Language—Your Own and Others

Many nonverbal cues such as laughing, gasping, shoulder shrugging, and scowling have meanings that are well understood in our culture. But the meaning of some of these other more subtle behaviors may not be as well known.1

Hand movements. Our hands are our most expressive body parts, conveying even more than our faces. In a conversation, moving your hand behind your head usually reflects negative thoughts, feelings, and moods. It may be a sign of uncertainty, conflict, disagreement, frustration, anger, or dislike. Leaning back and clasping both hands behind the neck is often a sign of dominance.

Blank face. Though theoretically expressionless, a blank face sends a strong do not disturb message and is a subtle sign to others to keep a distance. Moreover, many faces have naturally down turned lips and creases of frown lines, making an otherwise blank face appear angry or disapproving.

Smiling. Although a smile may show happiness, it is subject to conscious control. In the United States and other societies, for example, we are taught to smile whether or not we actually feel happy, such as in giving a courteous greeting.

Tilting the head back. Lifting the chin and looking down the nose are used throughout the world as nonverbal signs of superiority, arrogance, and disdain.

Parting the lips. Suddenly parting one's lips signals mild surprise, uncertainty, or unvoiced disagreement.

Lip compression. Pressing the lips together into a thin line may signal the onset of anger, dislike, grief, sadness, or uncertainty.

Conclusion

Conflict is inevitable in times of rapid change. Effective communication helps one avoid conflict and minimize its adverse consequences when it does occur. The next issue of Strategies for Career Success will cover conflict management.

What Not to Do When Listening:

• Interrupt

• Allow distractions

• Judge

• Criticize

• Argue

• Use clichéd phrases such as “I know exactly how you feel,” “It's not that bad,” or “You'll feel better tomorrow”

• Get pulled into responding emotionally

• Change the subject or move in a new direction

• Rehearse in your head what you plan to say next

• Give advice

Make Meetings Work for Your Team

A good meeting is one in which team goals are introduced or reinforced and solutions are generated. The first rule—meet in person only if it's the best format to accomplish what you want. You don't need a meeting just to report information. Here are tips for facilitating an effective meeting:

Don't meet just because it's scheduled. If there are no issues to discuss, don't hold the meeting just because it's Tuesday and that's when you always meet.

Use an agenda. Circulate a timed agenda beforehand and append useful background information. Participants should know what to expect. If it's a short meeting or quickly called, put the agenda on a flipchart or board before people arrive.

Structure input. Promote the team culture by making different individuals responsible for specific agenda items. Follow-up on previous task assignments as the first agenda item to hold group members accountable for the team's success.

Limit the meeting time. Use the timed agenda to stay on track. If the discussion goes off on a tangent, bring the group back to the objective of the topic at hand. If it becomes clear that a topic needs more time, delineate the issues and the involved parties and schedule a separate meeting.

Facilitate discussion. Be sure everyone's ideas are heard and that no one dominates the discussion. If two people seem to talk only to each other and not to the group as a whole, invite others to comment. If only two individuals need to pursue a topic, suggest that they continue to work on that topic outside the meeting.

Set ground rules up front. Keep meetings constructive, not a gripe session. Do not issue reprimands, and make it clear that the meeting is to be positive and intended for updates, analysis, problem solving, and decision making. Create an environment in which disagreement and offering alternative perspectives are acceptable. When individuals do offer opposing opinions, facilitate open discussion that focuses on issues and not personalities.

Circulate a meeting summary before the next meeting. Formal minutes are appropriate for some meetings. But in the very least, a brief summary of actions should be prepared. Include decisions reached and assignments made, with deadlines for follow-up at the next meeting.

Thank You for reading my Blog 

Resources

Kenneth H. Cohn: Better Communication for Better Care: Mastering Physician-Administrator Collaboration. Chicago, IL, Health Administration Press, 2005, www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2038

Kenneth H. Cohn: Collaborate for Success! Breakthrough Strategies for Engaging Physicians, Nurses, and Hospital Executives. Chicago, IL, Health Administration Press, 2006, www.ache.org/hap.cfm

Suzette Haden Elgin: Genderspeak: Men, Women, and the Gentle Art of Verbal Self-Defense. Hoboken, NJ, Wiley, 1993

Jon R. Katzenbach, Douglas K. Smith: The Wisdom of Teams: Creating the High Performance Organization. New York, NY, Harper Business, 1994

Sharon Lippincott: Meetings: Do's, Don'ts, and Donuts. Pittsburgh, PA, Lighthouse Point Press, 1994

Kenneth W. Thomas: Intrinsic Motivation at Work: Building Energy and Commitment. San Francisco, CA, Berrett-Koehler Publishers, 2000