recipients. Managers must understand that employ-ees may not all interpret an e-mail in exactly the same way. Interpretation will vary, depending on the topic, complexity of the message, position of the employee in the organization, and personal percep-tion. Sinickas (2004) notes that electronic commu-nication seems to reduce employees’ need for or expectation of face-to-face communication more than it decreases their desire for printed communi-cation. With the use of e-mail, employees seem to have fewer expectations that communications in the organization will occur face-to-face. Many peo-ple may still wish to have notices written and posted or provided to them by some means other than e-mail, however.
E-mail is an expedient way to communicate within organizations but less confidential and secure than some other forms of communication.
When using this mode of communication, there is need for security to avoid unauthorized disclosure of patient information or other privileged informa-tion. Because the very nature of e-mail encourages spontaneous communication, and because much information in a health-care organization warrants confidentiality, organizations should have an e-mail usage policy. The policy should be designed to pro-tect confidential information, ensure that the orga-nization is in compliance with all relevant national and state laws, and inform employees of the rules that apply to their appropriate use of e-mail.
Organizations may establish rules that deal with personal use of e-mail, including the kinds of mes-sages and material that are suitable for transmission in the workplace. Van Doren (1996) notes that while employers consider monitoring of e-mail as their responsibility to protect confidential informa-tion, employees may view the monitoring as an invasion of their privacy. Van Doren further observes that e-mail communication of employees in hospitals and long-term care facilities is being obtained by the legal system and used as evidence against them in lawsuits. The issue of liability points out the importance of policies to govern use of e-mail within an organization.
One major advantage of e-mail is that managers can provide immediate information to many people within the organization, for example, to counter the rumors spread through the grapevine. Managers should proofread their messages before they are sent to be sure they are accurate and carry the
intended message. E-mail is a convenient way for managers to keep employees feeling that they are well informed of issues of importance to them.
Importance of Organizational
of effective communication” (American Nurses Association, p. 26).
PRACTICE TO STRIVE FOR
Adena Health System in Chillicothe, Ohio, devel-oped an innovative way to meet the accred-itation requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Effective organizational communication was key to Adena’s innovative approach to the accreditation process.
JCAHO instituted a new process whereby sur-veyors selected approximately 11 active patients and retraced their care through different depart-ments. The surveyors observed care given, reviewed policies and procedures, and questioned staff and patients in different areas of the hospital. Because of the uniqueness of each patient and the differ-ences in each area of the hospital, preparing the facility for a survey was challenging. The unpre-dictable nature of tracer activities proved to be dif-ficult for even the most experienced managers and survey coordinators. Historically, Adena had used mock surveys and electronic communication to pre-pare the staff for the JCAHO visit, but these methodologies had failed to generate any enthusi-asm among the staff. Further, following the accred-itation visit, most practices returned to the way they had been prior to the visit.
The “Survivor Adena” concept was developed based on the popular Survivor television series. The objectives of Survivor Adena were to provide a framework to motivate and engage the organization in survey readiness to sustain the results of the preparation. A tribal council was developed to lay the groundwork for Survivor Adena, which focused on innovative ways to communicate effec-tively with staff to engage them in the accreditation process, empower staff to make changes, and pro-vide ongoing education needed to make the required organizational changes. Adena’s staff was given the task of developing over 120 “tribes.” Each tribe had the challenge of picking an area of focus that combined the concepts of JCAHO’s “Shared Visions” tracer methodology and any “hot button”
areas such as patient safety, medication manage-ment, and infection control. Tribes were encour-aged to collaborate with other departments and collaborate on a common goal.
Weekly, mini-challenges were electronically mailed to Adena’s staff. The mini-challenges were quizzes that focused on specific topics or standards of care. It was mandatory for staff to complete the weekly quizzes. A Survivor Adena Fair was held to bring various departments together to provide edu-cational booths and fun activities to promote sus-tained excitement and motivation concerning the upcoming survey. Complete participation was expected from the staff, and 99% indicated on a survey that the fair was beneficial and provided a good learning opportunity. Incentives were built into the plan, with people and tribes earning tickets that were cashed for various prizes at the end of the 18-month Survivor Adena project.
Adena had a successful survey and received very few requirements for improvement. Dawn Allen, Director of Quality Management and Medical Staff Services at Adena, stated that the participation, enthusiasm, and activity from the staff in preparing for the JCAHO survey were unprecedented in this system. She further noted that traditional methods of a unilaterally driven project will no longer meet the expectations of JCAHO’s Shared Vision frame-work and that creating a culture of continuous sur-vey readiness is crucial. The system believes that the shared vision at Adena of communicating effec-tively with employees and encouraging communica-tion between departments was instrumental in developing ownership of the concept of continuous survey readiness. The outcome of their efforts is a system with a culture of safety and quality that is imbedded within the organization.
All Good Things…
Communication is essential to the goal attainment and overall success of an organization. Effective organizational communication is challenging in many ways, given the complexity of health-care systems. Because good communication is such an important component of successful operation, it is well worth the time and effort it takes to develop effective communication strategies. Nurse adminis-trators and managers responsible for internal communication must recognize that people inter-pret messages differently, depending on several factors, including their experiential background
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and position in the organization. Further, there are gender and generational differences that must be recognized and accommodated when communicat-ing with many people in an organization. Managers must choose the correct mode of communicating messages depending on the intent of the message.
Some messages may need to be delivered face to face, and others may be sent by memo, e-mail, in a group setting in meetings, or some combination of modes. Managers also have the obligation to ascer-tain whether important information has been understood correctly by diverse employee groups.
Employees must understand their responsibility in the communication process and how the flow of information is to occur from the level of the employee to those at higher levels of the hierarchy.
Management is then obligated to address employee concerns in a timely and effective manner.
Communication has been shown to require a time commitment by managers in order for it to be effective throughout the organization. This commit-ment is well worth the effort as effective communi-cation influences employee satisfaction, quality care, and customer satisfaction. Effective communication within an organization improves the coordination of decision making and may decrease the use of the grapevine. Excellent organizational communication facilitates the attainment of organizational goals and is necessary for almost every aspect of operations.
Effective communication within the organization should be a priority of every nurse manager and is an essential component of effective leadership.
Let’s Talk
1. Name at least two benefits of effective organizational communication.
2. Think of an example of how interpersonal communication, small-group communication, and organizational communication can be used in the organization.
3. Identify at least three factors that might cause employees to interpret a message differently.
4. Provide an example of vertical, horizontal, and diagonal communication in a health-care organization.
NCLEX Questions
1. A chief nurse executive sends a memorandum to the nursing staff announcing a change in the policy concerning absenteeism. This represents an example of:
A. Horizontal communication.
B. Diagonal communication.
C. Upward communication.
D. Vertical communication.
2. Organizational communication involves relay-ing information to many people in order to accomplish organizational goals. Organizational communication includes small-group communi-cation and:
A. Interpersonal communication.
B. Repetition.
C. Discipline of employees.
D. Role development.
3. The act of extracting meaning from symbols is termed:
A. Encoding.
B. Symbolic code.
C. Transmission.
D. Decoding.
4. When communicating within an organization, employees are expected to respect the:
A. Use of technology.
B. Chain of command.
C. Decision-making method.
D. Time factor in the communication process.
5. From an employee perspective, the most difficult communication mode is often:
A. Horizontal communication.
B. Diagonal communication.
C. Verbal communication.
D. Upward communication.
6. If a nurse manager finds it necessary to termi-nate an employee, the most appropriate means of delivering this message would be by:
A. E-mail.
B. Written letter.
C. Face-to-face discussion.
D. Memorandum.
7. Which type of communication is most likely to be misinterpreted by employees?
A. Written messages.
B. Face-to-face communication.
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C. Nonverbal communication.
D. Diagonal communication.
8. Nonverbal communication includes:
A. Facial expression.
B. Vocal tone.
C. Gestures.
D. All of the above.
9. Factors that may cause different interpretation of messages by employees include personal experiences, socialization, educational back-ground, age, and ___________.
A. Years of service as an employee.
B. Gender.
C. Department in which employed.
D. Selective hearing.
10. Research has shown that e-mail seems to decrease employees’ need for face-to face com-munication but does not necessarily reduce their desire for:
A. Group meetings.
B. More confidential means of communication.
C. Written communication.
D. Phone messages.
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