Tuesday, June 5, 2007


Prelude; This is chapter 4 from Sailing The Seven :Cs” of Hospital-Physician Relationships: Competence, Convenience, Clarity, Continuity, Competition, Control, and Cash. James Hawkins opens by expressing the views of a former hospital CEO; I respond with a physician’s point of view

Clear, unambiguous communications and straightforward processes are absolutely essential, if your hospital is to maintain positive relationships with physicians. Otherwise, you will find yourself dealing with unnecessary problems and confusion. Muddled messages and ambiguous processes simply don’t work.

Be Clear What It Takes

Often, physicians will not care what the process is to accomplish a particular task. They just want to know what it takes to get the job done. If a process is clear, straightforward and consistent, in most cases, they will adapt to it, assuming it doesn’t impact their convenience. Confusion over a process, however, wastes time and creates doubts about competence. It may generate concerns about your motives.

Achieving Clarity

So, how do you go about achieving clarity in your communications and methods? First, recognize that the potential for misunderstanding exists. Acknowledge that if misunderstanding occurs high costs may result. Innocent mistakes may be very costly. In a hospital, lack of clarity can easily lead to a patient’s death. Without appropriate appreciation of the critical need for clarity, you may treat communications and procedures casually. False assumptions may be made, “Oh, he knows what I’m talking about or he knows what I want to do” when in reality he has no clue of what is meant by a statement or what he should do next.

A Domestic Example

If you have teenagers, it’s highly likely you have had such an experience recently. You heard what was said. You know what all the words mean, at least you think you do, but you have no idea what your child was talking about. But one advantage of being befuddled from the onset is you know you’re confused. It gives you an opportunity to clarify the communication and to understand what was meant before any harm results from the misunderstanding.

Danger Lurks

A more dangerous situation is when you think there has been clear communication, but in reality you’re headed in two entirely different directions. For instance, suppose you tell your teenager not to stay out late. It’s highly possible that his definition of “late” may differ from yours. Consequently, you end up with different assessments of his behavior.

Know What You’re Trying to Say

To achieve clarity in your communications and to create processes understandable to those who use them, make sure you really know what you’re trying to say. Is that really what you want to communicate? And when you’re setting up a process, make sure you have a thorough grasp of each step in the process and of what it takes to go from start to finish.

If Every Administrator Were a Patient or a Doctor

Hospitals would run much more smoothly if every administrator was a patient and experienced first-hand the consequences of processes and procedures they create. Similar benefits could result from walking in the shoes of your physicians and experiencing their daily trails and challenges in your hospital.


So first, clarify your thinking. If what you want to say isn’t clear in your mind, it’s not likely to become any clearer when you start putting your ideas out for others to see. Once you have a solid understanding of what you want to say and do, we recommend you follow the KISS (keep it simple stupid) Principle. There are those who would reject such an approach. They suggest it denigrates audiences by talking down to them.

Simplicity Means You Value Your Audience

We suggest just the opposite. By taking the time to ensure your message is understandable and your process is doable, it shows how much you value your audience. They are worth the time and effort it takes to make your meaning clear. Anyone can make a subject complex and confusing. What takes real genius is to figure out how to make a complex subject clear and easy to grasp.

KISS and President Reagan

When President Reagan stood at the Berlin Wall, he issued this challenge, “Mr. Gorbachev, tear down this wall!” Everyone knew what he meant. There was no question where Mr. Reagan stood on the question of freedom and what should be done to improve Soviet-American relationships.

In contrast, former vice presidential candidate James Stockdale left a bewildering and confused image in the candidates’ debate in 1992. Admiral Stockade, a genuine, if relatively unknown war hero, left millions of voters perplexed when he opened the debate by saying, “Who am I? And why am I here?” and then never got around to answering these questions.

“Soon” Means Different Things to Different Folks

As you search for clarity, overcome an inherent difficulty of communications in our profession. Medicine has its own language and healthcare its own lingo. In what other fields, for example, are negative results good and positive results bad? In your search for clarity, minimize using ambiguous language. If you tell a physician a problem will be fixed “soon,” you may mean sometime within the next two weeks. The doctor, in contrast, may believe you have just made a promise to have the issue resolved in the next five minutes.

As a result of this different interpretation of “soon” you may have an irate physician who believes you have broken your word. So, while there may be some instances where ambiguity has its benefits, in most situations you will be far better off if you spell out specifically what you intend to do. This will enable you to resolve differences at the front end rather than after disappointments arise down the road.

Test Your Meaning on a Colleague

Next, as you seek clarity, have someone else check out what you’re saying or doing. Just because it’s clear to you, it doesn’t mean the rest of world will understand it. Have a colleague or associate listen to your message. Better yet, test it on someone who isn’t steeped in the subject matter. They can look at it with fresh eyes and give you an untainted perspective.

Have a Doctor Review Your Material

If possible, if you’re communicating with physicians, have a doctor review your material. If these alternatives are unavailable, let the material, and your mind, rest overnight or longer if possible. You can return to it with renewed energy and clarity. It will be more understandable in the morning. As a general rule, no one should serve as his or her own editor. It’s too easy to overlook a mistake. Your mind sees what you thought you said. It may not be apparent to others what you put down on the page.

Challenge Your Assumptions and Simplify, Simplify

When you’re creating or redesigning a process, challenge if each step is truly necessary. Could the same results be achieved with fewer steps or a simpler process? Too often, we’ve seen steps added to a process without anyone ever asking whether any of the existing steps could be removed. Consequently, the process just gets more and more complex.

Warning – Legalese Can Kill Understanding

One thing you don’t want to do once you have finished designing your process is to have your attorney write the instructions for it. While a lawyer can help you avoid legal pitfalls, the written material he produces is unlikely to be easily understood or user-friendly. So while you may not get sued, your hospital is unlikely to achieve the results that it seeks.

Forbes magazine conducted a campaign to have the writing of warning labels done by journalists, who are skilled in communicating, rather than by attorneys who were focused on other objectives. In the December 26, 2005 issue, William Baldwin noted, “Whatever our faults, and I know from the mail that we aren’t lacking in that regard, we journalists at least know how to draw the reader’s attention. A little secret: Long-winded stuff won’t get read. Nor will gimmicks. Capital letters and boldface fonts aren’t going to save your story if it’s boring. Don’t waste ink stating the obvious (‘Use only as directed’). You will lose the reader before you get to the important things.”

Be Vivid

Baldwin added, “What works? What works are real-life examples, described vividly with memorable details. Details count. What if a can of floor sealant label didn’t mention fumes are heavier than air and can catch on a pilot light in the basement, and a fellow dies as a result? Or if the gasoline-powered emergency generator came with a true-life story about what happened to the family who had one of these things running indoors?”

Know Your Audience

Finally, in figuring out what to say and how to say it, remember to fit your message to your audience. The following story illustrates our point. A contractor was showing a prospective buyer around a new house. The builder’s crew swarmed around the site putting the finishing touches on the property. As the contractor walked the house, he stopped at first one window and then another and shouted out, “Green side up.”

After this happened a third time, the customer asked, “What in the world are you doing that for?” The contractor replied, “Oh, I have some college students laying sod in the front yard.”

Just as the builder understood the level of communication he needed to have with his workers, you need to know your audience. For hospital administrators trying to communicate with physicians, this means you need to spend time with them so you can understand how they think and learn what the best ways to communicate with them really are.

Take Away Question for Clarity

1. What do you really want to say or do in your hospital? Is your own vision clear?
2. What are five specific steps you can take to improve your communication
3. How can various processes be broken down step-by-step?
4. How can you get to know your audience better?
5. Who can you use as a communications sounding board?
Physician Perspective—Clarity

Clarity in writing is one thing. William Strunk, Jr., a Cornell English professor, captured the essence of clarity in writing in The Elements of Style (MacMillan Publishing, second edition, 1972).

“Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences, for the same reason that a drawing should have no unnecessary lines and a machine no unnecessary parts. This requires not that the writer should make all his sentences short, or that he should avoid all detail or treat his subjects only in outline, but that he make every word count.”

Clarity in communicating with key physicians and clarifying hospital physician relationships may be quite another matter. Hospital CEOs live in two worlds – the world of mission-focused community hospital boards and the world of bare-knuckled competition with other hospitals and certain physicians. CEOs will communicate differently in these two worlds.

With physicians, the CEO’s mission is to use every communication means at his or her disposal – meetings, social gatherings, staff room conversations, and corridor encounters – to persuade physicians to be partners and supporters of the hospital enterprise.

In writing, brevity may be soul of wit, but in physician relations, repetition of a clear consistent message in multiple settings may be necessary.

You must win the physician’s trust. You must persuade him that you’re not meddling in his affairs, you know what you’re doing, you can deliver what you promise, your deal will not harm his relationship with peers or other facilities, and other physicians have profited from similar partnerships.

One final caveat: Hospital physician relationships are where two different cultures intersect. These relationships are therefore political. Clarity, unfortunately, may be the first casualty of politics. So tread lightly, use a sharp pen, and carry a small stick.

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