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12 COMMUNICATING Developing Outstanding Interpersonal Skills

Starting Point

Go to www.wiley.com/college/Lombardi to assess your knowledge of basic communication skills. Determine where you need to concentrate your effort.

What You’ll Learn in This Chapter ▲ Key elements of the communication process ▲ Typical sources of communication messaging ▲ Common communication barriers ▲ Perceptions that affect communication ▲ Strategies for improving communications ▲ Conflict management techniques ▲ Steps and pitfalls in the negotiation process

After Studying This Chapter, You’ll Be Able To ▲ Compare effective communications and efficient communication ▲ Differentiate between incoming and outgoing communication ▲ Analyze the ways in which perceptions can alter a communication message ▲ Apply the strategies for improving communications ▲ Practice techniques for effective conflict management ▲ Compare negotiation methods and tools

Goals and Outcomes ▲ Master the terminology, tools, and techniques associated with the

communication process ▲ Use effective communication techniques ▲ Respond to communication barriers ▲ Evaluate perceptions and their effects on communication ▲ Choose and use effective communication strategies ▲ Employ conflict management tools ▲ Apply common negotiating principles

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INTRODUCTION As a health care manager, the strength of your communication skills directly connects to your overall performance effectiveness. The communication process happens almost constantly during the workday because the sources of com- munication messages are numerous. A range of communication barriers and per- ceptions can negatively impact the communication process. Savvy managers can improve communications by focusing on mutual benefit, tailoring their messages, actively listening, and using effective communication techniques. Workplace con- flict may be inevitable, but proactive managers can respond effectively to conflicts, often improving situations. In particularly, negotiation is complex set of tools that managers can utilize to minimize conflict and encourage positive workplace interaction and communication.

12.1 Understanding the Communication Process

The ability to communicate well, both orally and in writing, is a critical man- agement skill. Through communication, people exchange and share information with one another, and influence one another’s attitudes, behaviors, and under- standings. Communication allows one to establish and maintain interpersonal relationships, listen to others, and gain information. No manager can handle conflict, negotiate successfully, and succeed at leadership without being a good communicator. It is no wonder that “communication skills” often top the list of attributes employers look for in job candidates.

12.1.1 Communication Essentials

Formally defined, communication is an interpersonal process of sending and receiving symbols with messages attached to them. The key elements in the communication process are shown in Figure 12-1. They include a sender, who is responsible for encoding an intended message into meaningful symbols, both verbal and nonverbal. The message is sent through a communication channel to a receiver, who then decodes or interprets its meaning. This interpretation may or may not match the sender’s original intentions. Feedback, when pre- sent, reverses the process and conveys the receiver’s response back to the sender.

Another way to view the communication process is as a series of questions. “Who?” (sender) “says what?” (message) “in what way?” (channel) “to whom?” (receiver) “with what result?” (interpreted meaning).

Effective communication occurs when the intended message of the sender and the interpreted meaning of the receiver are one and the same. Although this may seem like the goal in any communication attempt, it is not always achieved. Efficient communication occurs at minimum cost in terms of resources

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12.1.2 IDENTIFYING COMMUNICATION SOURCES 341

expended, such as the amount of time involved. Efficiency is one reason why so many people rely on voice mail and e-mail, rather than visiting others person- ally to communicate a message.

Efficient communication is not always effective. A low-cost approach such as an e-mail note to a distribution list may save time, but it does not always result in everyone getting the same meaning from the message. Without oppor- tunities to ask questions and clarify the message, erroneous interpretations are possible.

By the same token, an effective communication may not always be efficient. If a manager visits each team member individually to explain a new change in office procedures, this process may guarantee that everyone truly understands the change. But it may also be very costly in the demands it makes on the manager’s time. A team meeting is more efficient. In these and other ways, poten- tial trade-offs between effectiveness and efficiency must be recognized in com- munication.

12.1.2 Identifying Communication Sources

Two types of communication are important to all members of health care teams, especially managers:

▲ Incoming communication includes directives, mandates, directions, guidance, support, feedback, questions, consultation, advice, demands, and expectations.

▲ Outgoing communication includes compliance, professional develop- ment, action, growth, support, team insight, leadership, contribution and expertise, and finally satisfaction and expectation fulfillment.

The process of interpersonal communication.

Figure 12-1

Sender

• Semantic problems • Absence of feedback • Improper channels • Physical distractions • Status effects • Cultural differences

Noise

Message Channel

Feedback/Channel

Receiver

Decodes Perceived meaning

Encodes Intended meaning

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For health care managers, six sources provide most incoming communication and are the target of outgoing communication: the organization, supervisors, family and friends, staff, peers, and patients. Figure 12-2 depicts incoming chan- nels (from the six specific sources to the manager), and Figure 12-3 shows out- going channels (from manager to the six sources).

Figure 12-2

Incoming communication for health care managers.

Figure 12-3

Outgoing communication for health care managers.

Job Dissatisfaction

Influenced by job context, or hygiene factors

• Working conditions • Interpersonal relations • Organizational policies • Quality of supervision • Base wage or salary

Rule Poor job context increases dissatisfaction.

Job Satisfaction

Influenced by job content, or motivator factors

• Sense of achievement • Feelings of recognition • Sense of responsibility • Opportunity for advancement • Feelings of personal growth

Rule Good job content increases satisfaction.

To Maximize Expectancy

To Maximize Instrumentality

Make the person feel competent and capable of achieving the desired performance level

To Maximize Valence

Clarify psychological contracts Communicate performance–outcome possibilities Demonstrate what rewards are contingent on performance

Identify individual needs Adjust rewards to match these needs

Select workers with ability Train workers to use ability Support work efforts Clarify performance goals

Make the person confident in understanding which rewards and outcomes will follow

performance accomplishments

Make the person understand the value of various possible rewards and work outcomes

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12.1.2 IDENTIFYING COMMUNICATION SOURCES 343

Additionally, communication can be classified by the source of the message. Some of the common communication sources include

▲ the organization itself: All health care organizations generate direc- tives to managers regarding how to manage staff, the ways to conduct technical activities, and the quality of contributions expected from staff. These directives may be presented in written or oral form, and the information may be implicit or explicit. For example, an implicit directive may be that you maintain the highest moral and ethical stan- dards in the delivery of your particular segment of health care service. However, if this directive is written into the organization’s code of conduct, its mission statement, or a set of organizational standards, it is explicit. Additionally, newsletters, annual reports, newspaper articles, and other sources of information can clarify the values of a health care organization;

▲ supervisors: Your manager provides you with a certain amount of direction in how to conduct your job. This direction may include a history of departmental responsibilities, background into the depart- ment’s prior performance, or some insight into individual members. Supervisor also should provide a set of detailed expectations they hold for your department.

▲ family and friends: The demands of a health care management job pretty much dictates a manager’s working hours. For example, if an emergency requires your presence, most likely you will be there— even if it is your scheduled day off or hours past the end of your shift. Being a manager can put a strain on personal relationships, and family and friends may have difficulty adjusting to health care man- agement work hours. Take a proactive, rather than reactive, approach to this potential problem. From the start, orient family and friends to the realities and expectations of your job. Remind them that a health care management job is not a 9-to-5 position; rather, job demands are the primary determinants of your working hours. Above all, keep communication constant and open between with your family and friends;

▲ staff: As a manager, you seek and receive feedback from your staff on a variety of issues. Feedback can include technical issues involving your department, individual concerns relative to the job, and suggestions on improving performance across the department. Conversely, as a manager, share information as appropriate with your staff and get their input and suggestions. This vital exchange can help you form a progressive frame of reference for dealing with management issues. For example, suppose your organization plans to implement a bonus-incentive compensation system. After attending several management meetings on this issue, you

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are curious about employee reaction to the new program. You may choose to discuss the issue in a department meeting, in one-on-one meetings with key employees, or informally within the context of ongo- ing discussions with staff. These communication efforts can give you a frame of reference that you can then use in your management discus- sions to help further refine the bonus-incentive compensation system within the organization;

▲ peers and colleagues: Peers and colleagues—that is, fellow managers— rely on you to provide technical expertise in key areas. In exchange, they provide their technical expertise and real-life management experiences to you, when appropriate;

▲ patients: The most important source of incoming information is the patient. In a sense, health care managers receive all communications from patients—or at least are party to all communications. Managers must take the lead in answering patients’ requests, handling their com- plaints, and incorporating their input into the general management strategy of patient service. For example, the manager of a physical rehabilitation department of a small hospital may receive specific complaints or com- pliments about the way physical therapy was provided for a particular patient. However, the same patient may also comment on the hospital’s billing system, its parking facilities, or how cooperative the security and reception personnel were in helping the patient find your department. All feedback—both positive and negative—should be incorporated into a manager’s ongoing notes and relayed to appropriate individuals within the organization.

F O R E X A M P L E

Wireless Communication Systems As wireless technology becomes cheaper and more reliable, hospitals are beginning to incorporate wireless computer networks and various hand-held devices into their communication plans and day-to-day work procedures. For example, the nursing call system at St. Agnes Hospital in Baltimore (www.stagnes.org) recently switched to an all-wireless network system from a leading communications and technology manufacturer. In the new system, each patient is given a wireless call unit that transmits bedside calls to wireless badges worn by nurses and other staff. Within the first 6 months of use, the new call system radically improved patient/nurse communication, reducing the time it took caregivers to respond to patient requests by more than 50%.

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12.2.2 POOR WRITTEN OR ORAL EXPRESSION 345

12.2 Recognizing Communication Barriers

Communication is a two-way process that requires effort and skill on the part of both the sender and the receiver. Noise, as Figure 12-1 shows, is anything that interferes with the effectiveness of the communication process. Common sources of noise include poor choice of channels, poor written or oral expression, failure to recognize nonverbal signals, physical distractions, and status effects.

12.2.1 Poor Choice of Channels

A communication channel is the medium through which a message is conveyed from sender to receiver.1

In general, written channels are acceptable for simple messages that are easy to convey and for those that require quick delivery to a wide audience. Written channels are also important, at least as follow-up communications, when formal policy or authoritative directives are being conveyed.

Oral channels work best for messages that are complex and difficult to con- vey, where immediate feedback to the sender is valuable. Oral channels are also more personal and can create a supportive, even inspirational, emotional climate.

12.2.2 Poor Written or Oral Expression

Communication is effective only to the extent that the sender expresses a mes- sage in a way that can be clearly understood by the receiver. The sender must choose her words well in order to express her intentions.

Consider the following confusing communication found among some top- level managers.

▲ A report reads: “Customer-patient elements are continuing to stress the fundamental necessity of a stabilization of the price structure at a lower

• Identify and define communication, communication channel, and feedback.

• Describe the key aspects of the communication process, including sender, receiver, message, communication channel, and feedback.

• Compare characteristics of effective communication and efficient communication.

• Identify common incoming and outgoing sources of communication.

S E L F - C H E C K

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level than exists at the present time.” (Translation: Patients keep saying that service prices need to go down and stay down.)

▲ A manager says: “Substantial economies were affected in this division by increasing the time interval between distribution of data-eliciting forms to outside entities.” (Translation: The division was saving money by sending fewer questionnaires to suppliers.)

Both written and oral communication requires skill. It isn’t easy, for example, to write a concise letter or to express your thoughts in an e-mail report. Your mes- sage can easily be misunderstood. It takes practice and hard work to express yourself well. The same holds true for oral communication that takes place via the spoken word in telephone calls, face-to-face meetings, formal briefings, video conferences, and the like.

12.2.3 Failure to Recognize Nonverbal Signals

Nonverbal communication takes place through such things as hand move- ments, facial expressions, body posture, eye contact, and the use of interpersonal space. Nonverbal communication can be a powerful means of transmitting mes- sages. Eye contact or voice intonation can be used intentionally to accent spe- cial parts of an oral communication. Astute observers note how body language may express listeners’ attitudes, even while they’re maintaining silence.

When people do speak, a mixed message may occur when words communi- cate one message and actions, body language, appearance, or use of interper- sonal space communicate something else. For example, watch how people behave in a meeting. A person who feels under attack may move back in a chair or lean away from the presumed antagonist, even while expressing verbal agree- ment. Such actions are done quite unconsciously, but they send messages to oth- ers who are alert enough to pick them up.

F O R E X A M P L E

Center for Creative Leadership More than 30% of managers report some difficulties in dealing with com- munication and interpersonal relations. The Center for Creative Leadership (CCL; www.ccl.org), a not-for-profit training center in Greensboro, North Carolina, helps managers and other leaders address communication issues via role-playing exercises, self-evaluative tools, classes, online resources, and group exercises. Although participants in CCL programs come from a vari- ety of disciplines, developing good communication skills is part of every CCL program. As CCL’s Michael Wakefield notes, “Leaders who are trusted— even in times of great difficulty—are skilled communicators.”

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12.3 UNDERSTANDING HOW PERCEPTIONS AFFECT COMMUNICATION 347

• Identify and define noise, communication channel, nonverbal communication, and filtering.

• Discuss the impact of communication channel on a message.

• Explain the importance of good written and oral expression during the communication process.

• Describe how body language can lead to sending out a mixed message.

• Discuss how filtering and status effects can alter a message.

S E L F - C H E C K

12.2.4 Physical Distractions

Any number of physical distractions can interfere with the effectiveness of com- munication. Some, such as telephone interruptions, drop-in visitors, and lack of privacy, can be avoided or minimized with proper managerial attention.

12.2.5 Status Effects

“Criticize my boss? I don’t have the right to.” “I’d get fired.” “It’s her company, not mine.” These comments show how the hierarchy of authority creates another potential barrier to effective communications. Simply put, people often find it difficult to communicate with bosses and others of higher organizational status.

Filtering is the intentional distortion of information to make it appear favor- able to the recipient. Filtering most often involves someone telling the boss what he or she wants to hear. Whether the reason behind this is a fear of retribution for bringing bad news, an unwillingness to identify personal mistakes, or just a general desire to please, the end result is the same. The person receiving filtered communications can end up making poor decisions because of a biased and inac- curate information base.

12.3 Understanding How Perceptions Affect Communication

Communication is also influenced by the way people receive and interpret infor- mation from the environment, a process called perception.2 As Figure 12-4 shows, perception acts as a screen or filter through which information passes in interpersonal communication. The results of this screening process vary because individual perceptions are influenced by such things as values, cultural back- ground, and other circumstances of the moment.

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Because people can and do perceive the same things or situations very differ- ently, perception can be an important influence on communication and interper- sonal relations. In particular, a variety of tendencies toward perceptual distortions can impact communication. These tendencies include the use of stereotypes, halo effects, selectivity, and projections.

12.3.1 Stereotypes

A stereotype occurs when someone is identified with a group or category, and then oversimplified attributes associated with the group or category are attrib- uted to the individual. Common stereotypes are those of young people, old peo- ple, teachers, students, union members, males, and females, among others. The phenomenon in each case is the same: A person is classified into a group on the basis of one piece of information, such as age or gender.

Characteristics commonly associated with the group are then assigned to the individual. What is generalized about the group (for example, “Young people dis- like authority”) may or may not be true about the individual. Stereotypes based on such factors as gender, age, and race can, and unfortunately still do, bias perceptions in some work settings. Consider this example of gender stereotypes:3 “He’s talking with co-workers.” (Interpretation: He’s discussing a new business strategy.). “She’s talking with co-workers.” (Interpretation: She’s gossiping.)

12.3.2 Halo Effects

A halo effect occurs when one attribute is used to develop an overall impression of a person or situation. When meeting someone new, for example, the halo effect may cause one trait, such as a pleasant smile, to result in a positive first impression. By contrast, a particular hairstyle or manner of dressing may create a negative reac- tion. Halo effects, like stereotypes, cause individual differences to become obscured.

Figure 12-4

The process of interpersonal communication.

SENDER RECEIVER

Sender’s perceptions

Receiver’s perceptions

Perceptual Distortions • Stereotypes • Halo effects • Selective perception • Projection

Message

Feedback

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12.3.4 PROJECTION 349

Paying close attention to halo effects is especially significant in terms of com- munication about someone’s work performance. One factor, such as a person’s punctuality, may become the “halo” for a positive overall performance evalua- tion. Even though the general conclusion seems to make sense, it may or may not be true in a given circumstance.

12.3.3 Selectivity

Selective perception is the tendency to single out for attention those aspects of a situation or person that reinforce or appear consistent with one’s existing beliefs, values, or needs.4 What selectivity often produces in an organization is that peo- ple from different departments or functions—such as marketing and patient-care— tend to see things from their own points of view and fail to recognize or listen to other points of view. One way to reduce the impact of selectivity is to actively gather inputs from a variety of people and perspectives.

12.3.4 Projection

Projection is the assignment of personal attributes to other individuals. A clas- sic projection error is to assume that other people share your needs, desires, and values.

Suppose, for example, that you enjoy considerable responsibility and chal- lenge in your work. Suppose, too, that you are the newly appointed leader for a team whose work you consider dull and routine. You may move quickly to start a program of job enrichment to help members experience more responsibility and challenge. This action may or may not be a good decision. Instead of designing jobs to best fit others’ needs, you have designed their jobs to fit yours. In fact, team members may be quite satisfied with jobs that, to you, seem routine.

Projection errors can be minimized by self-awareness and a willingness to communicate and empathize with others—that is, to try to see things through their eyes.

F O R E X A M P L E

Toward Greater Workplace Fairness Unfortunately, the perceptions that section 12.3 covers continue to play a part in workplace discrimination. The not-for-profit news and advice resources Workplace Fairness.Org (www.workplacefairness.org) is a com- prehensive online destination for help identifying and responding effectively to negative perceptions from managers, co-workers, and employees. The site outlines every U.S. employee’s legal rights, recent news and research on dis- crimination, and recommended ways (both large and small) to take action against negative perceptions on the job.

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12.4 Improving Communication

A number of things can be done to overcome barriers, minimize perceptual dis- tortions, and improve the process of communication. They include active lis- tening, constructive feedback, open communication channels, the use of space and technology, and valuing diversity, among other techniques covered in the following section.

12.4.1 Underscoring Mutual Benefit

No matter what psychological or communication tactics you use to communi- cate messages as a health care manager, underscoring the mutual benefit of an action is a strong tactic for garnering the desired response. Generally five recip- ients receive the mutual benefit of a message:

▲ The message sender ▲ The message receiver ▲ The team-staff ▲ The organization ▲ The patient

Try to identify the individual and operational benefits of an action simply by asking, What are the benefits to each of these parties and to each facet of the business? Some possible answers (or payoffs) are

▲ greater effectiveness; ▲ increased efficiency; ▲ new programs or evidence of organization progress; ▲ short-term production gains; ▲ long-term positive gains; ▲ staff growth and development.

• Identify and define perception, stereotype, halo effect, selective perception, and projection.

• Discuss ways in which various perception impacts communication.

• Describe the potentially negative effects of stereotypes, halo effects, selectivity, and projection.

S E L F - C H E C K

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12.4.2 EVALUATING YOUR MESSAGE 351

By articulating the potential payoffs, you lend maximum clarity to the com- munication process and stress the contribution needed from each individual in the department. If potential recipients fail to respond to the appeal for mutual benefits, you can logically assume that they are not interested in the positive suc- cess of the organization. Put simply, if people cannot respond to an appeal to help their colleagues and organization, they probably should not be there.

12.4.2 Evaluating Your Message

Communication involves not only what is said or written but how information is delivered. As one hospital administrator notes, “If you really want your staff to get your message, tell them three different ways.” For example, a manager may communicate a change in policy via a group e-mail, the hospital newsletter, and an announcement at a quarterly meeting. (Ideally all three communications take place within a 2-week period or less.)

In addition to selecting the best delivery method, a message needs to be worded and presented in a clear, appropriate manner. As a manager, you can use the following to assess your communication style. Consider these 10 components as guidelines for analyzing all communication activity:

▲ Core: What is the root of the message? How direct is the message? Is it delivered clearly, understood easily, and capable of being acted on by the receiver?

▲ Clarity: Is the message clear in intent and purpose? What are its basic elements? What action must be undertaken to support this message?

▲ Comprehensiveness: What is the full scope of the message? Does it pro- vide all information needed for the desired outcome?

▲ Conciseness: Did I get to the point? What is the main point of my mes- sage? Did I get to the point quickly? Did I get to the point too quickly, without providing enough foundation? Am I taking too long to get to the point?

▲ Cleverness: Am I using an appropriate “hook” to get attention? Am I being too gimmicky in delivering this message? Can I be more creative in delivering this message?

▲ Character: Does this message support the basic mission of the organiza- tion? Does this message seem consistent with other activities in my department? Does this message relate to something that ultimately better serves patients?

▲ Credibility: How believable is this message? Do I have enough credibil- ity to garner support on the basis of this message? What points should I detail to get the receiver to buy in to this message?

▲ Conviction: Am I stressing the importance of this message enough? Am I displaying how much I believe in the action this message will generate?

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▲ Ability to compel: What action am I asking for? Am I providing enough direction on how to support this message? Am I specifying the time, money, and other quantitative elements of this message strongly enough?

▲ Consequence: What is the desired outcome of this message? What posi- tive consequences can be realized if this message is followed through? What are some secondary effects of this message? What impact does this message have on the receiver and other individuals in the department?

Prior to delivering any message, consider all 10 of the preceding C-guidelines. If you follow these guides in your management communications, the likelihood of misunderstanding and inaction will be diminished.

12.4.3 Making Successful Presentations

Presentations are a frequent responsibility for health care managers. Audiences for presentations can be your team, your peers, your supervisors, or perhaps a combination of the three groups.

Keep the following strategies in mind to make presentations as successful as possible:

▲ Be prepared: Know what you want to say; know how you want to say it; and rehearse saying it.

▲ Set the right tone: Give the audience your complete focus—make eye contact and be pleasant, confident, and engaging.

▲ Organize your message into points: State your purpose, make impor- tant points, follow with details, and then summarize.

▲ Support your points: Give specific reasons for your points and state them in understandable terms.

▲ Accent the presentation: Use good visual aids and provide supporting handouts when appropriate.

F O R E X A M P L E

Execugrams The use of periodic execugrams, which are correspondence from the CEO of an organization to all working staff members and volunteers, is an easily imple- mented management tool. At the Mercy Health System (www.mercyok.net) in Oklahoma City, execugram messages are coded in green and can contain information ranging from a favorable bond rating to news about the open- ing of a new clinic. The use of a color other than white for the execugram ensures that the document stands out from other notices, usually delivered on white paper stock.

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12.4.4 ACTIVE LISTENING 353

▲ Add the right amount of polish: Attend to the details, such as having the room, materials, and other arrangements ready to go.

▲ Check your technology: Check everything ahead of time. Make sure it works and know how to use it.

▲ Don’t bet on the Internet: Beware of plans to make real-time Internet visits during a presentation. Save Web site and other content on a disk or your hard drive and then use a browser to open the file.

12.4.4 Active Listening

When people talk, they are trying to communicate something. That “some- thing” may or may not be what they are saying. Active listening is the process of helping the source of a message say exactly what he or she really means.5

Active listening requires considerable effort, but the effects on the commu- nication process can be beneficial. Keep in mind the following guidelines for active listening:

▲ Stop talking: You can’t listen if you’re talking. ▲ Show that you want to listen: Remove any potential distractions and

try to physically put the other person at ease. ▲ Listen for message content: Try to hear exactly what content is being

conveyed in the message. ▲ Listen for feelings: Try to identify how the source feels about the con-

tent in the message. ▲ Respond to feelings: Let the source know that her or his feelings are

being recognized. Empathize with the other person, as appropriate. ▲ Note all cues: Be sensitive to nonverbal and verbal messages. Also, be

mindful of mixed messages. ▲ Take it easy: Don’t get mad; hold your temper. Go easy on arguments

and critical responses. ▲ Paraphrase and restate: State back to the source what you think you are

hearing.

Consider the following responses in terms of the active listening ideals previ- ously listed:

Question: “Don’t you think employees should be promoted on the basis of seniority?”

Passive listening response: “No, I don’t!”

Active listening response: “It seems to you that they should, I take it?”

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Question: “What does the supervisor expect us to do about these out- of-date computers?”

Passive listening response: “Do the best you can, I guess.”

Active listening response: “You’re pretty disgusted with those machines, aren’t you?”

The preceding examples show how active listening can facilitate and encourage communication in difficult circumstances, rather than discourage it.

12.4.5 Providing Constructive Feedback

The process of telling other people how you feel about something they did or said, or about the situation in general, is called feedback.

The art of giving feedback is an indispensable skill, particularly for those who must regularly give performance feedback to others. When poorly done, feedback can be threatening and cause resentment. When well done, feedback— even performance criticism—is listened to, accepted, and used to good advan- tage by the receiver.6

The following are guidelines for giving effective, constructive feedback:7

▲ Give feedback directly and with real feeling, based on trust between you and the receiver.

▲ Make sure that feedback is specific rather than general. Use good, clear, and preferably recent examples to make your points.

▲ Give feedback at a time and in a location where the receiver seems most willing or able to accept it.

▲ Make sure the feedback is valid and limit it to things the receiver can be expected to do something about.

▲ Give feedback in small doses; never give more than the receiver can handle at any particular time.

12.4.6 Using Space Appropriately

An important but sometimes neglected aspect of communication is proxemics, or the use of interpersonal space.8 The distance between people suggests vary- ing intentions in terms of intimacy, openness, and status.

The physical layout of an office is an often-overlooked form of nonverbal communication. For example, an office with two or more chairs available for side-by-side seating, for example, convey a different message than having the manager’s chair behind the desk and those for visitors directly in front.

Office and workspace layouts and architecture are becoming increasingly val- ued for their communicative qualities. Many work places (including some health

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12.4.8 VALUING CULTURE AND DIVERSITY 355

care organizations) now include public spaces designed to encourage communica- tion among people from different departments. In many work places, you must pass through a public space before reaching private offices. More meeting areas now have partial walls or glass walls to encourage greater openness and collaboration.

12.4.7 Using Technology Effectively

The new age of communication is one of e-mail, voice mail, online discussions, videoconferencing, virtual or computer-mediated meetings, and more. A related and important development is the growing use of in-house or corporate intranets to provide opportunities for increased communication and collaboration. Many progressive health care organizations use database programs to facilitate contin- uous electronic forums for communication, knowledge sharing, reference, and record keeping. The purpose of such programs is to encourage fast and regular communication and to provide a source of up-to-date information for problem- solving and work implementation.

Technology offers the power of the electronic grapevine, speeding messages and information from person to person within—as well as outside of—organi- zations. The results can be both functional—when the information is accurate, appropriate, and useful, as well as dysfunctional—when the information is false, private, distorted, or simply based on rumor.

Managers must be quick to correct misimpressions and inaccuracies. Managers need to model ways to utilize these modern grapevines as a means to quickly transfer factual and relevant information among organizational members.

12.4.8 Valuing Culture and Diversity

Health care workers don’t have to travel abroad to come fact-to-face with diver- sity. Just going to work today can be a cross-cultural journey. The workplace abounds with subcultures based on gender, age, ethnicity, race, and other fac- tors. As a result, the importance of cross-cultural communication skills applies at home just as well as it does in a foreign country.

Cultural skills are gained by reaching out, crossing cultural boundaries, and embracing and respecting differences. And they include an awareness of ethno- centrism, or the tendency to consider one’s culture superior to others. Ethnocen- trism can adversely affect communication in at least three major ways. Specially, ethnocentrism may

▲ cause someone to not listen well to what others have to say; ▲ cause someone to address or speak with others in ways that alienate them; ▲ lead to the use of inappropriate stereotypes when dealing with people

from another culture.

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12.5 Delving into Conflict Management

Among essential communication skills, the ability to deal with interpersonal con- flicts is critical. Conflict is a disagreement between people on substantive or emotional issues.9 Managers and leaders spend a lot of time dealing with con- flicts of various forms.

Substantive conflicts involve disagreements over such things as goals, the allocation of resources, the distribution of rewards, policies and procedures, and job assignments. Emotional conflicts result from feelings of anger, distrust, dis- like, fear, and resentment, as well as from personality clashes.

12.5.1 Responding to Conflict

In terms of interpersonal styles, people respond to conflict in different ways.10

Cooperativeness is the desire to satisfy another party’s needs and concerns; assertiveness is the desire to satisfy one’s own needs and concerns.

Figure 12-5 shows five interpersonal styles of conflict management that result from various combinations of cooperativeness and assertiveness. Briefly stated, the following conflict management styles (and behaviors) can result:

▲ Avoidance: Being uncooperative and unassertive. Behaviors include downplaying disagreement, withdrawing from the situation, or staying neutral at all costs.

▲ Accommodation, or smoothing: Being cooperative but unassertive. Behaviors include letting the wishes of others rule, smoothing over, or overlooking differences to maintain harmony.

• Identify and define active listening, feedback, proxemics, and ethnocentrism.

• Discuss the impact of mutual benefit on five key recipients.

• List examples of a mutual benefit messages.

• Describe 10 characteristics of an effective message.

• Explain strategies for giving strong presentations.

• Compare characteristics of active listening and passive listening.

• Offer tips for giving constructive feedback, using space appropri- ately, and using technology effectively.

• Explain the importance of diversity in today’s workplace.

S E L F - C H E C K

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12.5.1 RESPONDING TO CONFLICT 357

▲ Competition, or authoritative command: Being uncooperative but assertive. Behaviors include working against the wishes of the other party, engaging in win-lose competition, or forcing through the exercise of authority.

▲ Compromise: Being moderately cooperative and assertive. Behaviors include bargaining for acceptable solutions in which each party wins a bit and loses a bit.

▲ Collaboration, or problem-solving: Being both cooperative and assertive. Behaviors include trying to satisfy everyone’s concerns fully by working through differences; finding and solving problems so that every- one gains.11

The various conflict management styles can result in quite different outcomes.12

Conflict management by avoidance or accommodation often creates a lose-lose con- flict. No one achieves her or his true desires, and the underlying reasons for conflict often remain unaffected. Although a lose-lose conflict may appear settled or may even disappear for a while, it tends to recur in the future.

Competition and compromise tend to create win-lose conflict. Here, each party strives to gain at the other’s expense. In extreme cases, one party achieves its desires to the complete exclusion of the other party’s desires. Because win- lose methods fail to address the root causes of conflict, future conflicts of the same or a similar nature are likely to occur.

Collaboration uses problem-solving to reconcile underlying differences and is often the most effective conflict management style. It creates win-win conflict

Figure 12-5

Alternative conflict management styles.

Degree of Assertiveness

D eg

re e

of C

oo p

er at

iv en

es s

Low High Low

High

Compromise Bargaining for gains and losses

to each party

Playing down the conflict and seeking harmony among parties

Accommodation or Smoothing

Avoidance Denying the existence of conflict

and hiding one’s true feelings

Collaboration or Problem Solving Searching for a solution that meets

each other’s needs

Competition or Authoritative Command

Forcing a solution to impose one’s will on the other party

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whereby issues are resolved to the mutual benefit of all conflicting parties. This is typically achieved by openly confronting the issues and through the willing- ness of those involved to recognize that something is wrong and needs atten- tion. Win-win methods are preferred approaches to conflict management.

12.5.2 Separating Functional and Dysfunctional Conflicts

Conflict in organizations can have both positive and negative aspects. Figure 12-6 shows that conflict of moderate intensity can actually be good for performance. This functional conflict stimulates people toward greater work efforts, cooper- ation, and creativity.

At very low or very high intensities, dysfunctional conflict occurs. Too much conflict is distracting and interferes with other more task-relevant activi- ties; too little conflict may promote complacency and the loss of a creative, high- performance edge. For example, the negative side of conflict can occur when two team members are unable to work together because of interpersonal hostil- ities (an emotional conflict) or when members of a committee can’t agree on common goals (a substantive conflict).

12.5.3 Resolving Conflict

Conflicts can either be resolved, in the sense that their causes are corrected, or they can be suppressed, in that the causes remain but the conflict is controlled for a period of time. Suppressed conflicts run the risk of recurring at a later time.

Figure 12-6

Positive and negative relationship between conflict and performance.

Intensity of Conflict

Im p

ac t

on P

er fo

rm an

ce

Low Negative

High

Positive

Neutral

Too little or too much conflict is destructive

Dysfunctional Conflict

Moderate levels of conflict are constructive

Functional Conflicts

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12.5.3 RESOLVING CONFLICT 359

True conflict resolution, by contrast, eliminates the underlying causes of con- flict and reduces the potential for similar conflicts in the future. The following are ways that work situations can be restructured to resolve conflicts:

▲ An appeal to superordinate goals can focus the attention of conflicting parties on one mutually desirable objective. This approach offers a common frame of reference against which to analyze and reconcile disagreements.

▲ Expanding the resources available to everyone can resolve conflicts whose causes lie in competition for scarce resources.

▲ By altering one or more human variables—that is, by replacing or transferring one or more of the conflicting parties—conflicts caused by poor interpersonal relationships can be eliminated.

▲ By altering the physical environment—rearranging facilities, workspace, or workflows you can decrease opportunities for conflict.

▲ Using integrating devices—such as liaison personnel, special task forces, and cross-functional teams, and even the matrix form of organiza- tion (see section 3.1.4)—can change communication patterns and assist in conflict resolution.

▲ Changing the reward system may reduce the competition among indi- viduals and groups for rewards. Creating systems that reward cooperation can encourage teamwork and keep conflict within constructive limits.

F O R E X A M P L E

Conflict Coaching at John Hopkins As one of the most dynamic research hospitals in the United States, John Hopkins Hospital (www.hopkinsmedicine.org) also takes a dynamic approach to encouraging and facilitating employee conflict resolutions. What John Hopkins calls “conflict coaching” is the first of three officially recognized techniques within the organization. (Visit www.hopkinsmedicine.org/jhhr/ PoliciesProcedures/HR604 for details on the organization’s comprehensive conflict resolution program.) Conflict coaching, which is free and available to all employees, is confidential, voluntary, and one-on-one. A trained coach talks the employee through a past or present dispute, helping the employee identify options. After the employee selects a path of action, the coach can help the employee prepare for a “conflict conversation,” mapping out an agenda for a meeting and preparing responses to likely questions. If the employee is unable to resolve the conflict via conflict coaching, the employee can then move on to mediation, a process that John Hopkins can fully facilitate as well.

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▲ Creating new policies and procedures that direct behavior in ways that minimize the likelihood of negative conflict situations can help.

▲ Training can help prepare people to communicate and work more effec- tively in situations that are conflict-prone.

• Identify and define conflict, cooperativeness, and assertiveness.

• Compare substantive conflict and emotional conflict.

• Describe the five interpersonal styles of conflict management: avoid- ance, accommodation, competition, compromise, and collaboration.

• List characteristics of functional conflict and dysfunctional conflict, and resolved conflict and suppressed conflict.

• Discuss techniques for resolving conflict.

S E L F - C H E C K

12.6 Negotiating

As a manager, how would you behave, and what would you do if

▲ you have been offered a promotion and would really like to take it, but the pay raise offered is less than you hoped?

▲ you have enough money to order one new computer for your depart- ment, but you have requests for two new machines?

These are but two examples of the many situations in today’s health care work- place that involve negotiation, the process of making joint decisions when the parties involved have different preferences. People negotiate over such diverse matters as salary, merit raises and performance evaluations, job assignments, work schedules, work locations, special privileges, and many other considera- tions. All such situations are susceptible to conflict and require exceptional com- munication skills.

Most new health care managers are not born negotiators, skilled negotiators, or educated negotiators. Few health care curriculums offer courses of practicum experiences on negotiating.

And yet, in the course of a given day, health care managers may negotiate a fee-for-services contract, establish new performance standards for a nonper- forming employee, or set a new schedule for an operating room. All these inter- actions, like many of the interpersonal interactions managed by an effective physician leader, call for negotiation skill, strategy, and savvy.

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12.6.1 CHOOSING A NEGOTIATION APPROACH 361

This section, although hardly exhaustive, offers an overview of the negotia- tion process, as well as some basic strategies that health care managers can imple- ment into their daily managerial duties.

12.6.1 Choosing a Negotiation Approach

In general, two types of goals exist in the world of negotiation:

▲ Substance goals are concerned with outcomes. They are tied to the “content” issues of the negotiation.

▲ Relationship goals are concerned with processes. They are tied to the way people work together while negotiating and how they (and any constituen- cies they represent) will be able to work together again in the future.

Negotiation can be considered successful when issues of substance are resolved and working relationships among the negotiating parties are maintained or even improved.13

The way each party approaches a negotiation can have a major impact on its outcomes.14

▲ In distributive negotiation, each party makes claims for certain preferred results. This is a competitive win-lose approach in which one party can gain only if the other loses. Relationships are often sacrificed as the negotiating parties focus only on their respective self-interests.

▲ In principled negotiation, a win-win orientation operates.15 The interests of all parties are considered, and the goal is to base the final outcome on the merits of individual claims. Everyone looks for ways for all claims to be satisfied if possible, with no one “losing” in the process.

F O R E X A M P L E

Negotiation Teams Many workers within health care organizations today are forming negotiation teams to address major changes, such as new facility construction, contract negotiation, or operations expansion. Negotiating teams (typically three to eight members total) form for a limited time and have a specific goal. Successful teams often include a balance of listeners, talkers, presenters, and perceivers because the type of communicator brings something different and important to the negotiation process. For example, at Devon Health Services, Inc. (www. devonhealth.com), a “Claims Negotiation team” composed of nonmedical health care professionals was established to negotiate discounts on medical claim. The group has helped patients receive discounts of 25% and more on medical claims by negotiating special reimbursement solutions with doctors and hospitals.

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Many health care managers approach negotiation as a series of appeals that they make to the other party. Although appeals can be an effective way of gain- ing your opponent’s attention, appeals alone are not typically enough to reach a win-win agreement.

Essentially, negotiating appeals fall into the following basic types:

▲ Appeal to ego: A negotiator uses an array of compliments, ego-stroking, and other self-esteem gratification techniques to reach a favorable settle- ment. Using expressions like, “A smart individual like you,” “Someone who is a real go-getter,” or “An intelligent manager like yourself,” as pre- ambles to statements helps to build an appeal-to-ego strategy. This strat- egy may be effective in the short term, but over the long term it can be seen as manipulative, less than genuine, and basically phony.

▲ Appeal to authority: In this case, an individual uses an authority such as a state regulation board, the board of directors, or other proverbial “powers that be” as the driving factor in why a negotiation settlement should be reached quickly and favorably. This tactic is not only some- what disingenuous, as it connotes a power play by the negotiator who uses it, but is also an abdication of authority relative to the basic respon- sibility of the individuals present at the negotiation table.

▲ Appeal to the norm: This appeal is in evidence when one negotiator cites the need for commonality or normalcy as a driving force for reach- ing a settlement. Statements such as, “Most physicians would take this deal” or “Every hospital in the state does it” are examples of appeal-to- norm strategies. This technique may be effective in some cases, where standards and practices are the prominent feature of the need to reach a negotiated settlement, but in all cases it is a less-than-effective strategy.

▲ Appeal to emotion: Anger, pride, friendship, gravity (such as “If we don’t do this, the hospital will close!”), and other emotional drivers are used to trigger a negotiated settlement in an appeal-to-emotion ploy. Appealing to emotion is a perilous tactic for a health care leader to use. Fundamentally, most people who have had any sort of tenure in health care have witnessed a wide array of emotionalism displayed by patients and employees on any given day. Therefore, they are not likely to be motivated by someone crying, yelling, threatening, conjoining, or display- ing any other type of emotional behavior that is not specifically related to the negotiation objective at hand.

▲ Appeal to a vision: Here, a negotiator presents a picture of what the final negotiating outcome may be. Appealing to a vision is perhaps the only effective strategy among the appeal-process negotiation techniques. In painting a picture of a harmonious workplace, effective emergency room, progressive medical service organization, or any other favorable

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12.6.1 CHOOSING A NEGOTIATION APPROACH 363

vision of health care excellence, a negotiator can create a vision that is equally alluring to their opponent as to themselves. The vision can be not only the objective for the negotiation but also the driving motivation for reaching a settlement. However, the vision must be one that is equally shared and desired by both negotiation parties; otherwise the tactic is doomed to fail.

▲ Appeal to mission: A negotiator constantly cites the mission of the health care organization as the driving force for reaching a negotiated settlement. This can be an effective appeal only if coupled with the vision appeal and other artful negotiation.

▲ Appeal to personal relationships: Friendship, collegiality, past history, and other personal notes are used as catalysts for obtaining a progressive settlement. Though a certain amount of strength of interpersonal relation- ship can be drawn on in any negotiation, the effective negotiator does not rely strictly on personal friendship as the centerpiece for negotiation. Simply put, if an individual uses personal friendship as a mainstay of negotiation, her opponent can simply say something along the lines of “Friendship is one thing, business is another—let’s get down to the brass tacks of reaching a good agreement.”

Many elements of the psychological win-win approach can be incorporated into a more effective strategy of the mutual-benefit logical approach to negotiation.

The mutual-benefit logical approach is based on several basic beliefs:

▲ Preparation is key: If you are prepared and your opponent is not, or is not as well prepared as you are, the odds increase in your favor that you can prevail in the negotiation. Preparation takes several forms in logical negotiation: knowing your opponent, preparing your bargaining position, preparing counterarguments, and planning overall negotiation strategies are all examples of well-prepared negotiation techniques.

▲ Knowledge of your opponent is crucial: By understanding your oppo- nent’s position, analyzing potential methods and approaches of your opponent, and counteracting your opponent’s forays in the negotiation process, the likelihood of a negotiation victory is enhanced. Again, prepa- ration is key, and the requirement that the negotiator does the homework is paramount to success.

▲ Establish a negotiation range: Prepared negotiators understand the dif- ferences between wants and needs and negotiate by focusing on needs. Often, two negotiating parties reach an immediate impasse because both sides endeavor to move the other party toward the “want” position. By focusing on needs, there exists the opportunity for a well-negotiated set- tlement that can be favorable to both parties.

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12.6.2 Knowing an Opponent’s Position

At the outset of the negotiation process, a savvy negotiator tries to ascertain his or her opponent’s position. This can be achieved by asking your oppo- nent to prioritize the list of most important agenda items for the negotiation. You can then ascertain the primary and secondary agenda items for your opponent.

Furthermore, try to determine the strategic position of your opponent on mutually beneficial needs range. By asking a sequence of questions, you can elicit more specific information about your opponent’s desired outcomes for the nego- tiation. The following questions force your opponent to be more specific about his or her position:

▲ What do you need to have happen here at the negotiation table? ▲ Specifically what do you need from our discussions? ▲ Why is this particular initiative important to you? ▲ Which one of these items is the most important to you? ▲ What are you looking for from this negotiation? ▲ Would you please list for me—so we all understand—what your priorities

are, listed in numerical order? ▲ What do you need to get done here at the negotiating table, or what do

we need to get done? ▲ What do you want to get done, or what do we want to get done here at

the table? (Note: By using this and the preceding question in concert, you may be able to get a sense of an opponent’s “dream objective”.)

▲ How can we make this happen? ▲ Can you directly, honestly, and specifically tell us what your ultimate

objectives are for this negotiation?

In seizing the initiative in trying to unveil your opponent’s position, you are better prepared to list priorities for the negotiation and identify not only the primary and secondary needs of the opponent, but your potential trade-off positions for the negotiation.

Once again, by simply being prepared and taking a proactive stance in the negotiation process, you gain an upper hand that helps facilitate a more favor- able result to the negotiation process.

12.6.3 Avoiding Negotiating Pitfalls

The negotiation process is admittedly complex. Negotiators must guard against several common mistakes. Many obstacles can stand in the way of success in reaching an agreement.

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12.6.4 REACHING AGREEMENT 365

Pitfalls such as the following can too easily create win-lose situations, which can ultimately result in poor final results:16

▲ The myth of the fixed pie: When you fall prey to this pitfall in negoti- ation, you assume that in order for you to gain, the other person must give up something. Negotiating this way fails to recognize the possibility that sometimes the pie can be expanded or utilized to everyone’s advantage.

▲ Nonrational escalation of conflict: In this pitfall, the negotiator becomes committed to previously stated demands and allows concerns for ego and face-saving to increase the perceived importance of satisfying these demands.

▲ Overconfidence and ignoring the other’s needs: The error here is becoming overconfident that your position is the only correct one and failing to see the needs of the other party and the merits in its position.

▲ Too much telling, too little hearing: When committing a telling prob- lem, you don’t really make yourself or your side understood. When com- mitting a hearing problem, you don’t listen sufficiently to understand what the other is saying.

12.6.4 Reaching Agreement

At a certain point—a point that is difficult to define because each negotiation is different—you should move to close the deal.

Generally, you will want to close the deal when you have ascertained that your opponent has reached a position of agreement with you within the mutu- ally beneficial need range that is amenable to both parties. At that point, you can choose among the following options:

▲ Verify the position of both parties ▲ Take the deal ▲ Reject the deal ▲ Consider the long-range ramifications of accepting or rejecting the deal ▲ Consider alternative deals with other parties ▲ Reevaluate the benefits provided by the impending deal ▲ Perhaps most important, listen to and trust your gut-level comfort level

with the deal ▲ Summarize and reiterate the tenets of the deal so that both parties

understand

If the answers to all the items on this checklist are relatively positive, you should embrace the deal that has been generated through the negotiation strategy.

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Unfortunately, it may not always be possible to achieve integrative agree- ments. When negotiations reach the point of impasse, dispute resolution through mediation or arbitration can be useful.

▲ Mediation involves a neutral third party who tries to improve communi- cations between negotiating parties and keep them focused on relevant issues. This mediator does not issue a ruling or make a decision, but can take an active role in discussions. Mediation often includes making sug- gestions in an attempt to move the parties toward agreement.

▲ Arbitration is a stronger form of dispute resolution. Arbitration involves a neutral third party, the arbitrator, who acts as a judge and issues a binding decision. The arbitration process usually includes a formal hear- ing in which the arbitrator listens to both sides and reviews all facets of the case before making a ruling.

As in all leadership endeavors, no right or wrong answers exist in the negotia- tion process. However, by following the introductory guidelines in this chapter— and more important, trusting your intrinsic intelligence and negotiation savvy— the art of mutually beneficial negotiation is well within your grasp as a health care manager.

• Identify and define negotiation, mutual-benefit logical approach, mediation, and arbitration.

• Compare substantive goals and relationship goals within the negoti- ation process.

• Define distributive negotiation and principled negotiation approaches.

• Discuss the seven basic negotiating appeals.

• Describe three key strategies for successful negotiation.

• List questions that can help determine your opponent’s position.

• Contrast arbitration and mediation.

S E L F - C H E C K

SUMMARY Health care managers receive and send out communication in a variety of forms, all day, every day. At its most basic, communication involves a sender, a receiver, and a message. The sender, or source, of a message can include the organization,

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KEY TERMS 367

supervisors, staff, and others. Barriers (such as nonverbal signals or a poor choice of channel) and perceptions (such as stereotypes or projections) cause communi- cation messages to be blocked or distorted. Improving communication skills does take effort, but the results can increase the likelihood of a message being effec- tively, efficiently, and correctly received. Conflict naturally occurs in today’s dynamic health care workplace; proactive managers utilize conflict management techniques—especially negotiation—to help their departments continue to oper- ate smoothly.

KEY TERMS Accommodation In conflict management, being cooperative but

unassertive; also known as smoothing.

Active listening The process of helping the source of a message say exactly what he or she really means.

Arbitration A stronger form of dispute resolution than mediation, arbitration involves a neutral third party who acts as a judge and issues a binding decision.

Assertiveness The desire to satisfy one’s own needs and concerns.

Avoidance In conflict management, being uncooperative and unassertive.

Collaboration In conflict management, being both cooperative and assertive; problem-solving.

Communication An interpersonal process of sending and receiving symbols with messages attached to them.

Communication channel The medium through which a message is conveyed from sender to receiver.

Competition In conflict management, being uncooperative but as- sertive; also known as authoritative command.

Compromise In conflict management, being moderately cooperative and assertive.

Conflict A disagreement between people on substantive or emotional issues.

Cooperativeness The desire to satisfy another party’s needs and concerns.

Distributive negotiation Each party makes claims for certain preferred results; decisions are often win-lose.

Dysfunctional conflict Conflict at very low or high intensities that distracts and interferes with other more task-relevant acti- vities.

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Effective communication The intended message of the sender and the inter- preted meaning of the receiver are one and the same.

Efficient communication Communication that occurs at minimum cost in terms of resources expended and the amount of time involved.

Emotional conflicts Disagreements over feelings of anger, distrust, dis- like, fear, and resentment, as well as from person- ality clashes.

Ethnocentrism The tendency to consider one’s culture superior to others.

Feedback The reverse of the communication process; the re- ceiver responds back to the send.

Filtering The intentional distortion of information to make it appear favorable to the recipient.

Functional conflict Conflict of moderate intensity that can actually be good for performance, stimulating greater work ef- forts, cooperation, and creativity.

Halo effect Communication problem that occurs when one at- tribute is used to develop an overall impression of a person or situation.

Mediation A neutral third party tries to improve communica- tions between negotiating parties and keep them focused on relevant issues. The mediator does not issue a ruling or make a decision, but can take an active role in discussions.

Mutual-benefit logical A negotiation strategy that focus on win-win approach psychology.

Negotiation The process of making joint decisions when the parties involved have different preferences.

Noise Anything that interferes with the effectiveness of the communication process.

Nonverbal communication Communication takes place through such things as hand movements, facial expressions, body posture, eye contact, and the use of interpersonal space.

Perception The way people receive and interpret information from the environment.

Principled negotiation The interests of all parties are considered, and the goal is to base the final outcome on the merits of in- dividual claims; a win-win orientation operates.

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KEY TERMS 369

Projection The assignment of personal attributes to other individuals.

Proxemics The use of interpersonal space in communication.

Receiver In the communication process, the personal who decodes or interprets the meaning of a message.

Relationship goal In negotiation, a goal that is concerned with processes and is tied to the way people work together while negoti- ating and how they can work together again in the future.

Resolved conflict The causes of a conflict are corrected.

Selective perception The tendency to single out for attention those aspects of a situation or person that reinforce or appear consistent with one’s existing beliefs, values, or needs.

Sender In the communication process, the person who is re- sponsible for encoding an intended message into mean- ingful symbols, both verbal and nonverbal.

Stereotype Communication problem that occurs when someone is identified with a group or category, and then oversimpli- fied attributes associated with the group or category are attributed to the individual.

Substance goal In negotiation, a goal that is concerned with outcomes and is tied to content issues of the negotiation.

Substantive conflicts Disagreements over such things as goals, the allocation of resources, the distribution of rewards, policies and proce- dures, and job assignments.

Suppressed conflict The causes of a conflict remain, but the conflict is con- trolled for a period of time.

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ASSESS YOUR UNDERSTANDING Go to www.wiley.com/college/Lombardi to evaluate your knowledge of basic communication skills. Measure your learning by comparing pretest and post-test results.

Summary Questions

1. Communication is an interpersonal process of sending and receiving symbols with messages attached to them. True or false?

2. Managerial directives and organizational mandates are examples of (a) outgoing communication. (b) efficient communication. (c) incoming communication. (d) inefficient communication.

3. Communication sources for health care managers can include (a) supervisors, staff, and peers. (b) newspapers, memos, and e-mails. (c) human resources, public relations, and information technology. (d) consultants, technicians, and subject specialists.

4. Conducting an employee review primarily via e-mail is an example of which type of communication barrier? (a) Status effect (b) Poor written communication (c) Failure to recognize nonverbal signs (d) Poor choice of channels

5. Nonverbal communication includes all the following except (a) eye contact. (b) dress. (c) hand movements. (d) use of interpersonal space.

6. When an employee tells his or her boss only information the boss wants to hear, the communication barrier that occurs is known as fabrication. True or false?

7. Which of the following statements about stereotypes is true? (a) Stereotypes classify a person into a group based on one piece of

information. (b) Stereotypes about gender are the most common workplace stereotype. (c) Stereotypes are an exaggeration of a commonly held belief. (d) None of these

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SUMMARY QUESTIONS 371

8. An example of projection in the workplace is (a) blaming a low-performing staff member for not meeting a

departmental goal. (b) assigning unpopular tasks to a staff member who is difficult to get

along with. (c) preferring to hire male nurses for third-shift positions. (d) signing up a staffer for a management course that was helpful to

your own career. 9. A well-crafted piece of communication has credibility and sense of conse-

quence. True or false? 10. Active listening requires you block out all visual information and focus

on the message someone else is saying. True or false? 11. In order for constructive feedback to be effective, you should

(a) present the feedback in a public forum. (b) make sure the feedback is specific rather than general. (c) give four pieces of positive feedback for every negative piece. (d) ask the feedback recipient to repeat the feedback to you.

12. Substantive conflicts involve personality clashes and resentment, while emotional conflicts involve disagreements over goals, resources, rewards and assignments. True or false?

13. What conflict management strategy is coming into play when a receptionist refuses to get involved in a disagreement between the billing manager and the nursing staff manager? (a) Compromise (b) Accommodation (c) Competition (d) Avoidance

14. Collaboration and problem-solving strategies for conflict management tend to create win-lose situations. True or false?

15. Which of the following statements is true about principled negotiation? (a) Each party makes claims for a preferred result. (b) The interests of each party are considered. (c) A competitive, win-lose approach produces better results. (d) Negotiating teams prepare their cases in advance.

16. When a manager tells his emergency-room staff to reach a compromise quickly because the needs of the ER patients are a life-or-death matter, the manager is using an appeal to (a) honor. (b) mission.

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(c) emotion. (d) the norm.

17. In the negotiating pitfall known as the myth of the fixed pie, you believe that in order for anyone to gain, someone else must give up something. True or false?

18. Mediation involves a neutral third party who (a) listens to the situation and hands down a decision. (b) interprets legal codes and assigns responsibilities. (c) reviews decisions in previous cases. (d) tries to improve communication between parties.

Review Questions

1. The shift manager posts a memo in the break room that tells all staff to submit their time sheets a day earlier than originally scheduled. Who or what are the sender, message, channel, and receiver in this communication scenario?

2. A new manager reviews her department’s written handbook to determine the course of action to deal with a problem employee. What communica- tion source is the manager relying on?

3. For health care managers, what is the more important source of incoming communication?

4. In the communication process, anything that interferes with the effective- ness of a message is noise. What are the most common forms of noise?

5. Physical distractions are one form of noise that managers can typically deal with quite effectively. What are some common physical distractions related to a manager’s office space?

6. Over one weekend last year, a laboratory tech at a large urban hospital put in nearly 25 hours of overtime to keep the facility operating while several employees were ill or on vacation. The laboratory manager frequently recalls the tech’s service and praises her nearly a year after the event. What sort of perception issue is happening here?

7. Perceptions act as a screen through which information must pass during interpersonal communication. What influences a person’s perceptions?

8. Selectivity is the tendency to single out attention on those aspects of a situation or person that supports your beliefs, values, or needs. What is one way to minimize the impact of selectivity?

9. Highlighting a message of mutual benefit can dramatically improve your effectiveness as a communicator. What are the five typical recipients of a mutual benefit message?

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10. The layout of a workspace impacts a staff’s ability to communicate. What are same layout ideas that encourage greater communication?

11. Ethnocentrism, or the tendency to consider your culture superior to oth- ers, can negatively affect communication in the workplace. What are two ways that ethnocentrism has a negative impact?

12. When you disagree with team members, you tend to debate issues until you near the breaking point. You frequently use your authority to force the resolution you want. What sort of conflict management strategy do you tend to use?

13. An individual with a high degree of assertiveness and a high degree of coop- erativeness will more gravitate toward what type of conflict management?

14. During a health care benefits negotiation, your opponent tells you that “the board of directors is giving employees everything they possibly can” and that you must remember that the most important thing about your job is “providing outstanding services to hospital patients.” What sort of appeal is your opponent using?

15. During the process of negotiating for a pay raise, you try to focus on the interests of yourself and your department, creating a win-win situation. What approach to negotiation are you taking?

16. During negotiation, Ray tends to fixate on the one or two “injustices” that he feels were done against him, rather than trying to come up with solutions for the future. Which of the negotiating pitfalls is Ray experiencing?

Applying This Chapter

1. Effective communication isn’t always efficient, and efficient communication isn’t always effective. Can you provide an example of both situations?

2. Your staff has complained lately that your communication isn’t always clear. You send out daily status e-mails and frequently tell staff that your “door is always open,” and yet your messages don’t seem to be getting through. What are some communication barriers you should evaluate?

3. After successfully working in a fast-paced emergency room for 10 years, Janice was promoted to nursing staff manager for the entire hospital. Although Janice tries to assign tasks fairly and consistently among the hospital’s five nursing staffs, she tends to project her ER experiences on all employees, telling them to focus on efficiency and quick decision making. What could Janice do to minimize her projection tendencies and potentially improve staff effectiveness?

4. Due to recent changes in state law, the staff of the medical records department you manage must complete an additional piece of paperwork

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374 COMMUNICATING

for every patient treated and assign all accounts an additional billing code. What are some mutual benefits you might be able to highlight for your staff to ensure compliance?

5. The five-member customer service team that Bettina leads has two star representatives and three average workers. The two stars frequently try to outshine each other, bragging about their successes or diminishing the success of the other. The rest of the team sometimes takes sides with one or the other of the stars, but for the most part they’re annoyed by the stars’ egos and in-fighting. What is something Bettina can do to respond the ongoing conflict in her department?

6. As the nursing staff manager at a university hospital, the salary negotiation team you’ve been serving on for 8 months is deadlocked with the hospital’s upper management. Your staff has been working without a contract for 6 months and is threatening a strike. What options do you have to reach resolution?

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YOU TRY IT

Considering Multiple Information Sources Consider the most common information sources for health care managers (section 1.1.2). While each of these sources can provide you important, useful infor- mation, which sources do you anticipate will provide you with the most valuable information while working in a health care environment? Rank the information sources based on your own perspective, and then ask a full-time health care work or manager to rank the same list of information resources. In what ways did your rankings differ?

Boost Your Writing Skills Written communication skills are still key to managerial success. While managers today typically write fewer official memos than managers 10 years go, today’s managers write often dozens of e-mails each day. Each of these messages needs to effectively and efficiently communicate your meaning. Good grammar is essen- tial to crafting a good e-mail. Assess your grammar with more than 100 free, interactive quizzes available at http://grammar.ccc.commnet.edu/grammar/quiz_list. htm. The main site (http://grammar.ccc.commnet. edu/ grammar) is also a good resource if you have a ques- tion while writing a message.

360-Degree Roundup Three-hundred-sixty-degree feedback, an approach advocated by author and health care management consultant Donald N. Lombardi, helps managers be- come more aware of the feelings and perceptions of staff, peers, and supervisors. The technique involves gathering feedback from a manager’s subordinates, as well as from peers and bosses. A self-assessment is also part of the process. The goal of 360-degree feed- back is to gain awareness and information that can be used for constructive improvement. Conduct your own version of a 360-degree roundup, collecting feedback on a specific aspect of a job you have (your communi- cation style, or the overall quality of your charting or a specific type of report, perhaps). Seek out feedback from someone at your level, as well as from someone

below and above you. If you don’t have a job where you can conduct a roundup, use the information-gathering approach suggested here and have people at various levels evaluate your resume, a research paper, or school project.

Your Nonverbal Communication Style Nonverbal communication—body language, facial expressions, and body positioning—can say as much as the actual words you use. Identify your nonverbal communication traits by reading about 200 words of text in front of a mirror several times. (The text you use can be just about anything: the first few para- graphs of a paper you’ve written, a page or two from a favorite book, an interesting newspaper article.) First, read the piece as naturally as possible, attempt- ing to make eye contact with yourself in the mirror. What facial expressions did you use? Did you sit or stand as you read the piece? Did you use hand ges- tures or other physical actions? What felt natural and comfortable? What felt forced and uncomfortable? Now, read the piece several more times. Slouch in a chair and cross your arms. Stand perfectly straight with your arms behind your back and avoid any hand gestures. Read the piece with a big smile on your face. Again, which of these readings felt natural and comfortable? Which felt forced and uncomfortable? Finally, read the piece as naturally as possible, incor- porating what you’ve previously observed.

Your Response to Conflict Review the five types of responses to conflict based on personality type as outlined in 12.5.1. Each of these responses may be appropriate options for any given situation. Consider a conflict you recently experi- enced in your job, education, or personal life. How could you respond to the same situation using avoid- ance, accomodation, competition, compromise, or collaboration? Which response feels most appropriate for the situation? Do you feel that response fits best with your personality?

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Know Your Negotiation Strengths Successful negotiation is much more than being able to argue more aggressively than your opponent and get your way. Before you begin your next negotiation (perhaps for something as important as a pay raise, as critical as an extension on a homework deadline, or as mundane as which movie you and your friends will see), identify the strongest interpersonal skill or skills you bring to the negotiating table. Some effec- tive negotiation strengths include effective communi- cation, accurate presentation of complex facts, keen

observation of the other side, or compassionate lis- tening and understanding. After you identify your strength (or strengths), plan your negotiation around your skill. For example, if you identify that accurate presentation of complex facts is your greatest strength, plan ways to quickly summarize informa- tion, guide your opponent through complex data, and highlight accuracies (and inaccuracies) in the infor- mation you’re both reviewing. By capitalizing your strengths, you are more likely to reach a resolution that truly satisfies your personality.

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