Communication is a bit like Magic….. Some people seem to have been born magically as good communicators and then there are those that although they put all the same ingredients into the cauldron they are still left with a frog.  So this post is going to try and demystify some of the components of communication…so that you too can conjure a communication prince…or princess.

How hard can it be??

After all if I can paraphrase the late, great Terry Pratchett … communication is essentially “100% recycled words”.  But getting them in the right sequence to ensure that you get your message across can be tricky particularly when there are distractors and confounders along the way.  Take the following example.

You are in the shopping centre trying to find a coat to match the bridesmaid dress for your sister’s wedding with your 4yo in tow.  Your sister has gone all bridezilla over a few miniscule details lately so you figure you had better get the exact right shade of royal blue.  Your 4yo has so far been placated with snacks and drinks while playing Octonauts on YouTube on your smartphone.  You are hopeful you are almost done as the shop assistant is  just popping out to get the coat she assures you will be perfect one…The only catch is that it is a sale item i.e. no returns, so you are thinking you must get this right when your phone rings…

Snatching it off your wailing 4yo you answer a call from the bank who were supposed to be doing a balance transfer to allow you to deactivate your old credit card.  You can feel your blood pressure rise as this is the fourth time it has been delayed with each delay costing you more money.  It seems they lodged the form with the wrong amount so now they want you to look at the new form and scan it back to them before they lodge the corrected form.   At this moment the shop assistant returns with the coat for you to look at.   You wave her off with your hand and say to the bank “no I don’t want to look at it, just run it through”….

Your 4yo (who has been tugging at your skirt and wailing through this entire call) now starts wailing “mummy – I need you” even louder.  You try and hand him a snack to quieten him and sultanas fall over the floor.   While you are picking up the sultanas you put your wallet and card on the counter.  The shop assistant asks something that sounds very much like “paypass?” Just as the bank asks if you are sure you don’t want to look at it.  In frustration you rant “yes, Yes, of course” at them….

You straighten up only to have your 4yo start trying to drag you away to look at god knows what wailing “ I need you NOW MUMMY” You pick up your wallet and card and are just thinking that maybe that you will abandon this shopping trip when you are dragged from the counter…  You say “Ok, Ok I will look at it” to try and stop him toppling you…

At that moment the bank clerk says “ok that’s great.  We will delay transfer till you can look at it” and hangs up.  The shop assistant hands you a shopping bag and pulls down the shutters for the day and your 4yo wees all over the floor wailing “I told you mummy – I needed you” .  Whilst you are deep breathing, you distract yourself by peeking in the bag you appear to be mysteriously holding and find you have just purchased a very expensive coat that is almost iridescent in its blueness and not at all the right colour….

And you wonder exactly how exactly you managed to get in this disaster if you are such a good communicator.

This is a good example of how communication in a crisis can go very wrong if you don’t practise a few key things.  Making communication “clear, concise, citing names and closing the loop” may have avoided the wrong message being delivered on all fronts.  Using eye contact and being aware of your posture and gestures may have assisted with directing your communication.  Active listening and responding to cues may have avoided the puddle and prioritising tasks and minimising distractions may have allowed you to complete tasks successfully in sequence.

General Communication tips (with some classic quotes from Terry Pratchett to keep you entertained)

Communication needs to be fit for purpose so it is difficult to cover every scenario however the following general tips should be used to improve your communication. (see the resources below for more examples, videos and articles from experts in communication)

  • Use direct and indirect questions appropriately. There is a time for both. You need to know what they are and when to use them well.  Direct or leading questions generate short answers “Do you have pain here? – Yes” compared with “Tell me how you are feeling” See the resources below for more details.

“Albert grunted. “Do you know what happens to lads who ask too many questions?”
Mort thought for a moment.
“No,” he said eventually, “what?”
There was silence.
Then Albert straightened up and said, “Damned if I know. Probably they get answers, and serve ’em right.”
― Terry Pratchett, Mort

  • Signposting can make things more obvious. A bit like the introduction sentence to a paragraph “ now I will talk about x and then later we will talk about y”– it lets people follow where you are in the conversation.

“Some things are fairly obvious when it’s a seven-foot skeleton with a scythe telling you them”
― Terry Pratchett, Hogfather

  • Listen and employ active listening. Unless you have actually “heard” the question or the response you won’t be able to appropriately reply.  Use clarifying questions and rephrasing to ensure you have understood everything correctly and to ensure that your partner in the conversation knows they are being heard.  These would really have helped in the example above

“Many people could say things in a cutting way, Nanny knew. But Granny Weatherwax could listen in a cutting way. She could make something sound stupid just by hearing it.”
― Terry Pratchett

  • Practice the 3 C’s: Closed loop, Cite names, Clear instructions. Again in the example above, if you had said “bank teller please don’t show me, just run it through” then confirmed they understood you may not have had further delays.  See the Crisis Resource Management videos below for some more examples of this.

“In an instant he became aware that the tourist was about to try his own peculiar brand of linguistics, which meant that he would speak loudly and slowly in his own language.”
― Terry Pratchett, The Color of Magic

  • Use non-verbal cues appropriately and pick up on other’s non-verbal cues: Eye contact, body position, tone of voice, facial expressions are all important and must be congruent to the words you are delivering. Giving eye contact to the shop assistant or pointing to the phone or walking away from someone would indicate you were not talking to them.  See the video for exaggerated examples from Friends.

“The whole of life is just like watching a film. Only it’s as though you always get in ten minutes after the big picture has started, and no-one will tell you the plot, so you have to work it out all yourself from the clues.”
― Terry Pratchett, Moving Pictures

  • Be aware of Graded Communication. Both when you need to use it and when someone else is using it graded communication should be noted, acknowledged and appropriately addressed both to prevent deterioration in communication between parties and also for the safety of the patient.  In the example above your 4yo was exhibiting very good graded communication but unfortunately you were not picking up the cues.
    • Graded assertiveness : The four levels (and some possible words) are:
      • Probe (also nicely called a ‘hint’) “I’m just not sure…”
      • Alert (or offer alternative) “Could we check double?”
      • Challenge Ask a question. “Is there a reason for…?”
      • Emergency action “For the safety of the patient, we must…!”

“There are times in life when people must know when not to let go. Balloons are designed to teach small children this.”
― Terry Pratchett

  • Use Checklists especially in a crisis to help you remember the vital things
    • ISBAR or SBAR or ISoBAR are all talking about keeping the communication concise and to the point and are very effective communication tools

“Chaos is found in greatest abundance wherever order is being sought. It always defeats order, because it is better organized.”

― Terry Pratchett, Interesting Times: The Play

  • Keep your stress levels in check. You need to be aware when you are becoming stressed and ensure that you try and manage that stress.  Prioritise your tasks.  Divert non urgent tasks (such as answering the phone in the middle of a transaction or reprioritising with your wailing child) and communicate that they will be dealt with later.  Focus your team and fall back on your rehearsed ways of clearly communicating in a crisis.

“Pets are always a great help in times of stress. And in times of starvation too, o’course.”

– Terry Pratchett, Small Gods

Communication Resources and Checklists links to other pages

  • With parents tips for communicating with parents
  • General guide to improving effective communication. Actually a very helpful article with links to many other communication resources (though do take the exercising your middle ear muscles advice with a grain of salt).  Takes you through the steps of effective communication.
  • Very good link on active listening
  • Non-verbal skills
  • Handling complaints – aimed at practice managers but a whole heap of articles on complaint management, managing difficult patients

Crisis Resource Management

  • Review article from the EMA 2011. Very good summary of the principles.
  • CRM video drilling it down to 5 things to concentrate on in CRM in simulation – you may need to watch it in fast forward but it is an exaggerated example of what you need to do in particular some good demonstrations of closed loop communication for those struggling with the concept.

So that’s all folks…..hope you have enjoyed the post and may all of your communications be magical and remember…

“It’s still magic even if you know how it’s done.”
― Terry Pratchett, A Hat Full of Sky