CHAPTER 6 Interpersonal Communication Strangers’ Conversations Briefly describe the people in the conversation? Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. NOTE: How a supervisor treats an employee may influence how co-workers interact with that person.
Issues around gender differences in communication styles, values, and expectations are common in all workplacesituations. Many of these unwanted effects can be traced back to poorcommunication and collaboration, and ineffective teamwork. 19–22Unfortunately, many health care workers are used to poor communication and teamwork, as a result of a culture oflow expectations that has developed in many health care settings. During the course of a 4-dayhospital stay, a patient may interact with 50 different employees, including physicians, nurses, technicians, andothers. This culture, in which health care workers havecome to expect faulty and incomplete exchange of information, leads to errors because even conscientiousprofessionals tend to ignore potential red flags and clinical discrepancies. Hierarchy differences can come into play and diminish thecollaborative interactions necessary to ensure that the proper treatments are delivered appropriately.
Effective clinical practice thus involves many instances where critical information must be accuratelycommunicated.
When hierarchydifferences exist, people on the lower end of the hierarchy tend to be uncomfortable speaking up about problems orconcerns. At its best, good communication encourages collaboration, fosters teamwork, and helps preventerrors.Barriers to Effective CommunicationHealth professionals tend to work autonomously, even though they may speak of being part of a team. Intimidating behavior by individuals at the top of a hierarchy can hinder communication and give theimpression that the individual is unapproachable.1, 38Staff who witness poor performance in their peers may be hesitant to speak up because of fear of retaliation or theimpression that speaking up will not do any good.


When health care professionals are not communicating effectively,patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclearorders over the telephone, and overlooked changes in status.
29 Efforts toimprove health care safety and quality are often jeopardized by the communication and collaboration barriers thatexist between clinical staff. Relationships between the individuals providing patient care canhave a powerful influence on how and even if important information is communicated. Research has shown thatdelays in patient care and recurring problems from unresolved disputes are often the by-product of physician-nursedisagreement.39 Our research has identified a common trend in which nurses are either reluctant or refuse to callphysicians, even in the face of a deteriorating status in patient care. Even though doctors and nurses interact numerous times a day, they often havedifferent perceptions of their roles and responsibilities as to patient needs, and thus different goals for patient care.One barrier compounding this issue is that because the United States is one of the most ethnically and culturallydiverse countries in the world, many clinicians come from a variety of cultural backgrounds. Reasons for this include intimidation, fear ofgetting into a confrontational or antagonistic discussion, lack of confidentiality, fear of retaliation, and the fact thatnothing ever seems to change.
Medical errors, especially those caused by a failure to communicate, are apervasive problem in today’s health care organizations. In all interactions,cultural differences can exacerbate communication problems.1 For example, in some cultures, individuals refrainfrom being assertive or challenging opinions openly.
Many of these issues have to deal more with personality and communicationstyle.40 The major concern about disruptive behaviors is how frequently they occur and the potential negative impactthey can have on patient care. According to the Joint Commission (formerly the JointCommission on Accreditation of Healthcare Organizations, JCHAO), if medical errors appeared on the NationalCenter for Health Statistic’s list of the top 10 causes of death in the United States, they would rank number 5—ahead of accidents, diabetes, and Alzheimer’s disease, as well as AIDS, breast cancer, and gunshot wounds. As a result, it is very difficult for nurses from such cultures tospeak up if they see something wrong.
Our research has shown that 17 percent of respondents to our survey research in2004–2006 knew of a specific adverse event that occurred as a result of disruptive behavior.
The fact that most health professionals have at least one characteristic incommon, a personal desire to learn, and that they have at least one shared value, to meet the needs of their patientsor clients, is a good place to start.


2 Even more disturbing,communication failures are the leading root cause of the sentinel events reported to the Joint Commission from 1995to 2004. For example, some cultures ascribespecific meaning to eye contact, certain facial expressions, touch, tone of voice, and nods of the head. More specifically, the Joint Commission cites communication failures as the leading root cause formedication errors, delays in treatment, and wrong-site surgeries, as well as the second most frequently cited rootcause for operative and postoperative events and fatal falls.1Traditional medical education emphasizes the importance of error-free practice, utilizing intense peer pressure toachieve perfection during both diagnosis and treatment. This literature concurs thatwhen a team needs to communicate complex information in a short period of time, it is helpful to use structuredcommunication techniques to ensure accuracy. Structured communication techniques can serve the same purposethat clinical practice guidelines do in assisting practitioners to make decisions and take action.
This atmosphere creates an environment that precludes the fair, open discussion of mistakes required iforganizational learning is to take place. In the early 1990s, Donald Berwick wrote about patients needing an opencommunication system instead of experiencing adverse events stemming from communication failures. 3 More than adecade later, this concept still has profound implications on our method of health care delivery. As such, this chapterwill review the literature on the important role of communication and team collaboration in helping to reducemedical errors and increase patient safety.



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