How a leader communicates directly influences operational success—it is through others that leaders succeed or fail. Equally important to what is presented is how information is presented.
The leader’s body language sends messages that are loud and clear. Simple things like eye contact, smiling, listening, and responding set the stage for engaging staff and residents in meaningful conversations.
Leaders provide the team with direction, support, instruction, mediation, supervision, and appreciation—all of which require effective communication skills. In addition, leaders are charged with inspiring and motivating staff through the articulation of the vision and mission.

No Man Is An Island

Some leaders do not have a systems view and protect the performance of their turf zones, operating as if they were separate, unconnected entities. They may withhold information without considering the harm this can cause. According to a Leading in Context blog by Linda Fisher Thornton titled “Case Study: Is Withholding Information From Other Leaders Unethical?” behaviors generally considered to be unethical include dishonesty, withholding information needed by others, and distortion of facts.

Courtesy, manners, and the Golden Rule—“treat others the way you want to be treated”—are effective communication strategies that are often underestimated. These simple approaches go a long way in establishing relationships with other people. The importance of friendliness in building relationships with staff members, peers, and residents is explored by Ferdinand Fournies, internationally known business consultant.

“Friendliness doesn’t mean being your employee’s best friend, forgiving bad performance, inviting them to your home, lending them money, or letting them do what they want to do,” he said. “Friendliness means doing the little things you might think of as politeness and respect.”

These little things, according to a seminar at the 2013 American Association of Nurse Assessment Coordination annual conference, include:
■ Saying “please” and “thank you;”
■ Looking at people’s faces when they are speaking and showing a pleasant face;
■ Greeting people with good morning or a good afternoon before talking about their work;
■ Apologizing when late or having to interrupt a meeting;
■ Controlling emotional outbursts (because one doesn’t have the right to speak loudly or otherwise abuse one’s employees);
■ Not making sarcastic comments; and
■ Showing interest or getting to know people on a personal level.

These simple communication strategies help build respectful relationships with staff and can be incorporated into a code of conduct to encourage courteous and respectful behavior.

Repetition: The Mother Of Learning

Other important aspects of communication are repetition and inclusion. Adult learners must hear a message frequently for it to take hold. This is a concept recognized in advertising, which uses frequent, repetitive commercials.

The leader’s message could be a change in policy, instruction in principles of resident-directed care, or an explanation of organizational directives.

Providing clear direction to achieve desired outcomes requires skill. Think about the steps needed to complete any “simple” task. When broken into detailed steps, the simple task is no longer simple. Consider directions given to a new employee during orientation. Is the communication clear and concise? Are steps left out for brevity? Are questions asked to clarify that instructions were understood, or is it merely assumed? Errors in sending and receiving information can result in errors in care delivery.

Strategies To Implement

Fortunately, there are strategies that can be used to improve the ability to communicate direction and instruction. According to Eleanor Sullivan and Phillip Decker’s 2005 book, “Effective Leadership and Management in Nursing:”

■ Know the context of the instruction. Be sure to communicate exactly what is wanted done, by whom, within what time frame, and what steps should be followed to do it. Be clear about what information a person needs to carry out the instructions, what the outcome will be if the instruction is carried out, and how that outcome can or will be evaluated. Then proper instruction can be given.

■ Get positive attention. Avoid factors that interfere with effective listening. Inform the person that instruction will be given to get positive attention. Highlighting the background, giving a justification, or indicating the importance of the instructions also may be appropriate.

■ Give clear, concise instructions. Use an inoffensive and nondefensive style and tone of voice. Be precise, and give all the information receivers need to carry out what is expected. Follow a step-by-step procedure if several actions are needed.

■ Verify through feedback. Make sure the receiver has understood the specific request for action. Ask for a repeat of the instructions.

■ Give follow-up communication. Understanding does not guarantee performance. Follow up to determine the outcome of the instruction, and give feedback to the receiver.

Learning Circles Aid Problem Solving

Leaders are in a position to develop and use strategies for communication that promote teamwork and participative problem solving. Learning circles have become increasingly popular as a tool for leading discussions related to facility practice. They are built on the idea that every team member has something to contribute and something to learn.

In some facilities, learning circles are used to solicit input about organizational changes, such as the implementation of resident-directed care. In others, teams are trained and empowered to conduct learning circles for problem solving and conflict resolution.

A learning circle differs from a meeting in that all participants are encouraged to speak, listen, and participate in finding solutions. Participants observe, interpret, and experience their own feelings about an issue and are asked to consider the perspectives of others. A group leader, who may or may not have leadership authority, facilitates the process.

According to LaVrene Norton’s Journal of Social Work in Long-Term Care article titled, “The Power of Circles: Using a Familiar Technique to Promote Culture Change,” a learning circle generally follows these guidelines:
■ The number of participants is 10 to 15 or fewer;
■ Participants sit in a circle so that everyone is visible;
■ The facilitator poses the issue for discussion, gives encouragement, and keeps responses flowing in an orderly fashion;
■ A volunteer within the circle responds with thoughts on the topic;
■ The person to the right or the left of the first respondent then voices his or her thoughts and so on until everyone has had a chance to speak;
■ Participants are encouraged to speak but can choose to pass;
■ The facilitator ensures that each person has an uninterrupted set amount of time to speak and reminds participants of ground rules, such as no cross talk, analysis, or interruptions. After everyone has had a chance to speak, the facilitator goes back to anyone who passed and offers another opportunity to respond; and
■ Once everyone has had a chance to speak, the floor is opened to discussion.
Learning circles are a simple but powerful way to gain staff participation in problem solving and decision making. Other benefits include increased trust, collaboration, confidence among team members, and improved communication skills for all involved.

Communication Travels Multiple Paths

Communication in any facility must travel from the top down, from the bottom up, and back and forth across the various departments and levels of accountability and responsibility.

A valuable exercise to determine whether communication pathways are working well involves asking the following questions:
1. Do any of the facility’s communication pathways need improvement?
2. What are the barriers to communication in the identified pathways?
3. Are any aspects of operations hindered by communication problems?
4. What are three things that can be done to improve communication?

Time invested to establish effective communication strategies can result in benefits to all and supports success for both the leader and the organization.
Betty Frandsen, RN

Betty Frandsen, MHA, NHA, RN, CDONA/LTC, C-NE-MT, is a curriculum development specialist for the American Association of Nurse Assessment Coordination. She can be reached at (800) 768-1880.