American Association for Physician Leadership

Operations and Policy

Seven Communication Mistakes in Medical Practices: How Poor Communication Kills Positivity, Productivity, and Profitability

Skip Weisman

June 8, 2017


Communication in the medical practice work environment can make or break both the patient experience and the employee experience. This article outlines the cost of poor and ineffective communication in medical practices today and provides insights into the seven most damaging interpersonal communication habits that undermine trust among coworkers, between employees and management, and between the management team and physicians. If you are not aware of these communication mistakes, your practice is not functioning optimally. This article explains why and offers solutions to each of the communication mistakes that you can implement immediately.

The Challenge With Medical Practice Communication

“From a medical practice standpoint we’re typically way too focused on technology and left-brain hard skills like procedures, medications, patient treatment plans, etc., and we don’t focus enough on the ‘soft skills’ of communication,” said Greg Bartoo, practice administrator for Easton Eye Care in Easton, Maryland (personal communication).

Bartoo continued, “We believe communication can be a differentiator by leveraging the internal customer service of our staff so that we leave a more positive impression on patients.”

In my seminars and keynote addresses on “The Seven Deadliest Communication Sins,” audience members estimate that they waste from 40 to 90 minutes per day due to poor and ineffective communication, negative and resistant attitudes, and low morale and low motivation in their workplace. This lost productivity affects patient care and practice profitability. The seven deadliest communication sins are a primary cause and are too often ignored as a “soft cost.” Practice managers and practice owners must translate this lost productivity into hard dollars and cents (number of employees × 40 minutes per day × number of workdays/year × hourly wage/benefits).

When it comes to practice managers’ communication, “nothing is more productive than investing time to communicate to have a motivated staff,” Dr. Norman Levine, CEO/Practice Manager for Orthopedic & Sports Medicine, P.C., in New Windsor, New York, told me.

Levine spends 15 minutes every morning greeting his staff, connecting with them on a personal and professional level to build and maintain trust, morale, and motivation.

Quentin Davis, practice manager at Mid-Maryland Musculoskeletal Institute in Frederick, Maryland, does something similar, suggesting “management by walking around” (personal communication).

These best practices espoused by Levine and Davis are important to show team members they are cared for as human beings and are not just a cog in the practice’s wheel. Yet despite everyone’s best efforts, the seven deadliest communication sins still occur daily in even the best medical practice work environments, eroding or destroying trust, motivation, and morale. They are:

  • A lack of specificity;

  • A lack of desirable behaviors;

  • A lack of immediacy, urgency, and promptness;

  • A lack of respectful reBUTtals;

  • A lack of appropriate tone and body language;

  • A lack of focused attention; and

  • A lack of directness and candor.

Understanding these seven damaging work environment communication mistakes is vital, because only three outcomes can result from any interpersonal communication. A practice manager’s communication with team members either:

  • Slowly builds trust in the relationship;

  • Slowly erodes trust in the relationship; or

  • Instantly destroys trust in the relationship.

Only one of those three outcomes is desirable. This means that in every interaction practice managers incur a 67% risk of damaging their relationship with a team member.

The Seven Deadliest Communication Sins

Two factors affect whether a communication interaction builds, erodes, or instantly destroys trust, morale, and motivation: what is communicated, and how it is communicated. The seven deadliest communication sins speak to both factors.

1. A Lack of Specificity

This lack of specificity refers to the details of a communication and whether the parties involved have enough information to be successful. It can be as simple as confirming dates, times, locations for meetings, appointments, or the patient’s birthdate, insurance, and affliction.

At a higher level, it means, as Davis said, that “one of our biggest challenges, because things change so quickly and we have a lot of moving parts in our customer experience, is communicating pertinent information to our team members, structured so that they get the high points for their specific function to be successful.” This challenge creates a lack of specificity. Most times it occurs due to time pressures and is a result of basic human nature and oversight in the “heat of battle.” Other times, in low-trust work environments, it may be malicious, purposeful, and passive-aggressive, as certain team members attempt to control information for personal gain.

2. A Lack of Desirable Behaviors

Bartoo said, “Whether talking to employees about performance and behavior issues, or patients about implementing their treatment plans, we tend to focus on what not to do and what we want people to stop doing. This communication sin stood out for our team once we started discussing The 7 Communication Sins in staff meetings after I heard you speak, Skip.”

Bartoo told me that his staff members were beginning to change their communication approach to focus on the alternative, positive, desirable behaviors they wanted to encourage staff members to bring into the work environment. Additionally, they have begun to identify, describe, and articulate the necessary behaviors patients need to engage in to successfully treat their own medical condition.

When human beings’ communication focus is just on changing negative, undesirable behaviors, those behaviors tend to be repeated because they get reinforced in the mind without an alternative to replace them. Begin communicating the desirable behavior you want people to engage in, and you will begin getting more of it.

3. A Lack of Immediacy, Urgency, and Promptness

A lack of immediacy, urgency, and promptness is “communication procrastination.” It is typically caused by fear: for example, fear of delivering bad news, fear of being rejected, or fear of or not being liked as the deliverer of the bad news or asking someone to change a behavior. Often it can be fear of doing something wrong or making a mistake due to lack of confidence or perceived lack of ability.

Additionally, many practice managers tell me they wish their team members had a greater sense of urgency in communicating situations or when assigned a task. All communication must take place at the first most appropriate time, and although that is nonspecific, most people know when they’re acting with less than immediacy, urgency, and promptness for procrastination purposes. A good rule of thumb is to communicate about an issue of importance within 48 hours.

4. A Lack of Respectful ReBUTtals

The lack of respectful reBUTtals refers to those conversations where people try to be supportive and also desire to get their point across. Statements like, “You did a really good job, but . . .” or “That’s a really great idea, but . . .” are disrespectful. The “but” negates whatever comes before it and causes the victim of the statement to feel something counter or negative is coming next. This communication style either shuts down conversation because the victim will stop listening and engaging, or it raises the emotional intensity of the conversation because the person feels undermined.

This is one of the communication sins that can instantly destroy trust between people because the person delivering the statement comes across as disingenuous.

Bartoo recently engaged in a performance conversation with a relatively new team member who was technically great at his job and also in need of constructive feedback. After learning about this concept he changed his approach. The “but”-less conversation went like this:

Bartoo: You’re a great team player, everyone loves how you engage with them internally on the team, and also with patients . . .

Employee: Yes, I know that’s all great, but I’m not really effective . . .”

Bartoo: It is great that you communicate in way that everyone loves working with you, and it does create some challenges for you. So let’s work on overcoming those to make you even more effective.

The “and” as the transition allowed his employee to stay open to the constructive feedback and to continue the discussion toward improvement strategies. (Note: the words “however,” and “although” are “but” in disguise and should also be avoided in these types of discussions.)

5. A Lack of Appropriate Tone and Body Language

Inappropriate tone and body language are common in the heat of battle (i.e., under stress) in medical practices, as team members can sometimes communicate in this manner. It manifests in many ways, such as eye rolling, finger-pointing, sighing, raising voices, or even yelling. This is also one of the most dangerous in terms of instantly destroying relationships in work environments, and it is very difficult to repair.

When it comes to communicating there is no such thing as multitasking.

Because this communication style often is habitually ingrained, those who use it typically do not realize they are communicating this way, nor do they understand the impact of their behavior on others. Usually this is because no one has ever pointed it out to them, enabling the behavior until someone finally confronts them. One cause or source of this communication sin is low levels of emotional intelligence, low self-esteem, and low self-confidence.

6. A Lack of Focused Attention

A lack of focused attention is an epidemic in 21st-century society due to smartphone technology. This comes in three contexts of interruptions: technology, people, and mind:

  • The smartphone or instant messaging on computers that send a tone we react to like Pavlov’s dog;

  • People stop by your office unannounced, desiring your attention, distracting you from what you were doing, expecting you to drop everything to pay attention to their immediate needs; and

  • Your own mind interrupting you even as you are physically engaged, maybe even with solid eye contact, yet your mind is somewhere else missing the message.

The cure for this starts with avoiding multitasking when communicating. When it comes to communicating there is no such thing as multitasking. Something has to take the hit, and it is always the other person. It devalues them, eroding trust in the relationship.

Davis said, “Doctors weren’t paying attention to the financial reports during our meetings. It was 40 pages so I cut it to two. I told them, ‘I need your hyper-focus for 10 minutes on these two pages.’ Now you can hear a pin drop as I go over the report, and they ask questions because what I’m asking of them is a limited amount of time and only about things that have the most impact on them and the practice.”
Davis is practicing my “focused attention” strategy of both commanding attention and respectfully demanding (requesting) attention from his doctors. It works for all communication interactions.

7. A Lack of Directness and Candor

A lack of directness and candor may be the most damaging of the communication sins in undermining a high-trust work environment. As Levine said, “Everyone on our staff knows what I think about them—good, bad, or indifferent.” Levine said that his team members all know what is expected of them and are never surprised by his feedback.

Davis said, “Surprise is bad, doctors don’t like surprises. I have a rule: ‘no surprises.’ People are going to know what’s going on as soon as the information is available.” In too many medical practices and traditional work environments managers beat around the bush, and they wish and hope people “get it”; they never do.
Levine said, “Many practice managers don’t communicate directly and candidly out of fear: fear of how people are going to react, fear of not being liked, or worse, fear that they’re going to hear something that they have to address.”

Communication Strategies

Every practice manager should be using the following communication strategies to overcome the seven deadliest communication sins:

  • Davis: Manage by walking around—keep it positive. Find things to provide specific positive feedback to team members. Speaking with people only when there are problems develops negative anchors between the practice manager and the team member.

  • Davis: No surprises. Communicate at the first most appropriate time to keep everyone abreast of situations, both individually, for teams, and for practice-wide issues as appropriate.

  • Levine: Treat everyone as if his or her job is important, because it is. Engage them in authentic conversations by asking about the problems they are facing and how the practice can do things even better. Then explore ways to resolve those issues, solve the problems they’re facing. You will be surprised by what you hear and how easy it will be to get it for them.

  • Bartoo: Have the staff discuss and assess communication in the practice against the seven communication sins and work on transforming one each month.

  • Levine, Davis, and Bartoo: Have consistent, sacred team meetings with a tight agenda. In large practices, have a rotating department rep attend a regularly scheduled department rep meeting that reports back on the larger practice issues to their respective departments.

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