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"THE TROUBLE WITH THIS PLACE[horizontal ellipsis]"

One of the barriers to successful interpersonal communication, perhaps the single greatest barrier encountered in the transfer of meaning between and among people, lies within us. This largely psychological barrier can be described in one simple statement: We inherently tend to believe that we are better communicators than we really are.


Consider the times you might have said the likes of: "The trouble with this place is there's no communication." You were surely not speaking about yourself. When you miss information that you feel would have been of interest or importance to you, you feel excluded because other parties did not fulfill their communication responsibilities. With a feeling of having been wronged or ignored, you might be likely to say something like: "Nobody told me," "I was never called," or "I wasn't given a copy."


You can miss out through no fault of your own if important information that starts with others is not brought to your attention. Those who regularly miss out on important information, however, are those who are merely passive participants in communications processes. Passive communicators sit back and wait for the world to come to them. If the world communicated with them inadequately or not at all, passive communicators blame the rest of the world-perhaps department manager, organization, spouse, family, or the ever-blameful "them," for not providing the needed information.


Although many people are passive communicators, passive communication is not among the legitimate communication processes required of the sender or receiver of a message. The 4 basic communication processes that involve language are reading, writing, speaking, and listening. (We also communicate in ways that are nonverbal or behavioral, but here we are considering just language-based processes.)


From both physiological and intellectual viewpoints, one can readily identify the major areas in which our interpersonal communication shortcomings are most evident. Problems can be found in all 4 processes, but the major weaknesses of the communication process are due to the unclear nature of just one of the processes.


Reading, writing, and speaking are all active processes. To read or write or speak, you must consciously put your mind "in gear" regarding the message while performing certain physical acts. Reading, writing, and speaking all involve physical and mental activity together: You cannot read without focusing your eyes and perhaps turning pages. You cannot write without manipulating pen, pencil, or keyboard. You cannot speak without performing a unique collection of physical activities that give you a voice.


Thus, the greatest potential for communication failure lies in listening. For greater understanding of listening weaknesses, however, we need to look beyond that simple statement and consider why it is so. Listening should be an active process because true listening requires concentration and effort. In fact, listening is an active process intellectually. Physiologically, however, listening-or what we more appropriately call "hearing"-is passive. This is the fundamental difference between listening and the other 3 processes: you cannot read, write, or speak without active deliberate, physical participation, but as long as your ears are exposed to sound waves created by spoken language, your auditory mechanisms will automatically convert those waves into words.


The major weakness in our verbal communication processes lies in the physiologically passive nature of hearing. Again, we cannot send via writing or speaking without active participation; we cannot receive via reading without active participation; however, because of the passive way in which our bodies deal with auditory input, we can "receive" without active participation.


Problems are encountered regularly with reading, writing, and speaking, many because of insufficient mental activity invested in the processes. It is possible to read carelessly with flawed comprehension and minimal retention, to write without clarity, and to speak and say little or nothing that can be clearly understood. To be appropriately and constructively applied, all of the language-based communication processes must be intellectually active processes. Success in applying these processes depends on how well the requisite mental activities are performed. Because reading, writing, and speaking are active physiologically, they cannot be accessed without deliberate action; listening, however, is intellectually passive, so no physical action is required to access the process.


Many communication problems result from a combination of 2 principal factors: the tendency to behave on the implicit assumption that we are better communicators than we really are and the tendency to hear without listening actively. Overcoming the first hurdle of this double barrier requires us to recognize that we are not as good at communicating as we think we are and that we need to take active steps to compensate for this weakness. Overcoming major communication barriers means, in effect, that we need to become active communicators, constantly reaching out, avoiding the temptation to simply sit back and let messages come to us.


Receiving information that might otherwise be missed involves "tuning in" as completely as possible to the environment. Waiting for a memo or a question is a passive posture, but most effective communication is active. Much of an individual's success in communication depends on tuning in and reaching out. Tuning in requires developing sensitivity to the total communication environment, using active listening skills to become aware of the need to reach out for information. Reaching out requires taking the initiative to offer information, make suggestions, request information, and ask questions that seek clarification and greater understanding.


Much misunderstanding can be avoided by simply utilizing feedback in every interpersonal exchange to ensure that the message sent is identical to the message received. When you send a message to another party and there is no confirming feedback, the loop remains open, and there is a chance of misunderstanding. We are especially at risk when simple messages are involved because we behave as though confirming feedback is not needed. Depending on which side of a message we happen to be on at the moment-sending or receiving-we are frequently trapped by 1 or 2 assumptions implicit in our behavior. We deliver the message and simply assume the other party knows what we are talking about-after all, we know what we are talking about-or we believe that we understand the message just received without attempting to verify that understanding.


This issue of The Health Care Manager (30:2, April-June 2011) offers the following articles for the reader's consideration.


* "Health Care Transitions and the Aging Population: A Framework for Measuring the Value of Rapid Rehabilitation" reports on a study undertaken to establish a means of measuring the value of "rapid rehabilitation" and identify means of quantifying effective outcomes and efficient processes as health care services are delivered to the gaining population.


* "Electronic Health Record Project Initiation and Early Planning in a Community Health enter" applies 2 specific project management principles, initiation and early planning, to the implementation of the electronic health record in a community health center.


* "The Ethical Leadership Challenge: Creating a Culture of Patient- and Family-Centered Care in the Hospital Setting" addresses the challenge to health care organization leadership to create a culture of patient and family-centered care as a means of improving quality, safety, patient satisfaction, and public trust.


* "Sustainability and the Health Care Manager: Part I" examines the concept of sustainability, provides a broader definition of "going green," and uses a puzzle metaphor to explain the components of sustainability and provide a checklist for the achievement of sustainability goals.


* "Layoffs at Hospitals: A Challenge for Health Care Managers" examines the recent upward trend in hospital layoffs and suggests steps that managers can take to ensure that layoffs are addressed in a professional manner that maintains the trust and respect of the workforce.


* Case in Health Care Management: "Hang On[horizontal ellipsis] I'll Call You Within Minutes" asks the reader to consider what he/she might do when unable to secure even a few minutes of a superior's time to address an important matter that might lie at least partially beyond the individual manager's authority.


* "The Laboratory Workforce Shortage: A Managerial Perspective" addresses current problems encountered in recruiting and retaining types of laboratory personnel, identifies the different kinds of positions that are key for different types of laboratories, and suggests how staffing challenges may be overcome.


* "Depression Care Management: Impact of Implementation on Health System Costs" reports on a study undertaken to examine the mental health care costs associated with implementation of a collaborative care model for the treatment of depression in primary care.


* "Demand Study for Advanced Dental Hygiene Educational Degrees, Part II: Assessing Educational Demand" continues the review begun in issue 30:1 (January-March 2011) of a study undertaken to add to the present body of knowledge by addressing the changing needs of the population and the associated demand for additional formal education for dental hygienists.


* "A Comparative Analysis of Factors That Hinder Primary Care Physicians' and Specialist Physicians' Ability to Provide High-Quality Care" reports on a study that examined conditions and circumstances that hinder physicians' ability to provide quality care, including the effects of insurance company rejections and patient noncompliance with treatment recommendation.


* "Fall Prevention Conceptual Framework" reviews the consequences of falls by hospital patients and suggests that initial fall risk assessment is critical in the planning of individualized care and potential intervention when indicated.


* "Addressing Problems of Employee Performance" examines the 2 major categories of such problems, motivational difficulties and skill deficiencies; describes how problems of performance differ from problems of conduct; and sets forth a number of steps the manager can take to address performance problems.