Physician executives and communication

Today's physician executives are deeply concerned about management skills-and rightly so. In our information society, a crucial foundation of management effectiveness is one's ability to communicate, as well as to foster effective communication within a health care organization. Outside of the health care industry, numerous studies have probed the strengths and weaknesses of business executives' managerial communication skills. Why this level of interest? Because, as one expert puts it, "Communication is what managers do. It breathes life into planning, organizing, motivating, and controlling. It is the catalyst for accomplishing meaningful work through the efforts of other individuals and groups. It consumes up to 90 percent of a manager's workday."' In order to compare the views of physician executives with those of their counterparts in business, we undertook a survey through the auspices of the American College of Physician Executives at its National Institute on Health Care Leadership and Management. We collected responses from 185 physician executives, of whom 42 percent were medical directors and associate medical directors, 18 percent were department heads, 18 percent were presidents and vice presidents, and 22 percent were board members, chiefs of staff, and "other." The level of management experience averaged six years. In setting up the survey, we took into account the results of earlier studies that probed the quality of managerial communication outside the health care arena and in which the results are consistent and persuasive. For example, when 1,158 newly promoted chairmen, presidents, and from a variety of organizations were asked to name the courses that best prepare students for business leadership, courses in communication were named most often-even over courses in finance, accounting, business planning, and marketing. And while a 1970 survey of Fortune 500 executives showed that only66 percent believed their communication skills had a major effect on advancement to a top executive position, a 1986 survey found 84 percent claiming a major effect. In an additional response, 94 percent saw that communication skills will have a major effect on the upward mobility of future executives.' Thus the perceived importance of an executive's ability to communicate effectively is growing as inter- and intracorporate competition increases. in order to find out what physician executives think about their own communication effectiveness, we asked for the relative amounts of time spent in specific communication activities, the relative importance of several communication skins, and the problem areas they face communicating within the organization. Physician executives indicated that of the total amount of time spent communicating on the job, 36 percent is spent listening, 30 percent speaking, 19 percent reading, and 15 percent writing. These results are similar to those reported in the business world: 33 percent listening, 26 percent speaking, 19 percent reading, and 23 percent writing. In some studies, business executives report that up to 63 percent of each day is spent listening.4 While listening may well be managers' most important communicative skill, it is rarely their most proficient. Research is quick to point out that the average person listens at only 25 percent efficiency, and big business-Sperry, IBM, Ford, Honeywell, and Bank of America, for example -has incorporated listening into its training programs across the spectrum of employees. Writing may be what physician executives do least, but letters and memos have public, permanent, and far-reaching results. So while writing may be lowest on the time scale, its very nature underscores its importance to managers'professional aspirations as well as to the reputation of the organization as a whole.5 We also asked respondents to rate their level of agreement with four different statements across four basic and six complex communication skills. The basic skills were listening, speaking, reading, and writing; the complex skills were interviewing, leading meetings, diagnosing communication problems, reading nonverbal cues, building one-on-one relationships, and managing conflict. The four statements pertaining to these communication skills were: 1. This skill is important in the day-to-day

performance of my job. 2. This skill was important in achieving a

managerial position. 3. 1 would like to enhance my ability in

this area. 4. 1 would like to enhance my staff's

ability in this area. We then asked respondents to identify areas of their health care organizations in which major communication difficulties surfaced, and to report the communication problems that have the most negative impact on their organizations. Of the basic communication skills, listening" and "speaking" were consistently rated as most important and most in need of enhancement. For example, almost 75 percent agreed that listening and speaking skills were important in achieving a managerial position, while 54 percent agreed that reading and writing skills played an important role. Perhaps writing skills are typically viewed as the lesser medium because they are less immediate and personal. A previous study of presidents, personal directors, training directors, and other corporate officers in 45 corporations found similar results. Speaking skills were perceived to be more important than writing skillS.6 Of the more complex communication skills-those requiring a complex mix of the basic skills-"managing conflict" was rated most important both on the job and in achieving a managerial position (table 1, page 15). Note that several of the complex skills-"reading nonverbal cues," "diagnosing communication problems," and interviewing"-have become significantly more important in actually performing as a physician executive than they were in achieving that position. We also asked for respondents' level of agreement with the statements, "I would

m s area," and "I would like to enhance my staff's abilities in this area." Not swprisingly, speaking skills were rated as higher need areas than were writing skills (table 2, this page). As shown in table 1, physician executives reported their skill in "building one-on-one relationships" as second in importance only to managing conflict" in achieving a managerial position. They also apparently felt confident in their present relational ability rating it least in need of enhancement. But they rated it third in terms of their staffs' need for enhanced skills, indicating a gap between what executives feel they themselves do well, and what they'd like their staffs to do better. When asked, "In which areas do your major communication difficulties lie?" a majority answered "with physicians" and "with administrators" (table 3, this page). Why are "patients" rated so low on the scale of difficult communication areas? Although health care professionals regularly encounter communication problems with clients, the average physician executive deals primarily with his or her own staff and with other administrators and managers. Does this mean that the executive can overlook the problems of practitioner-patient communication? Not at all. On the contrary, the executive must anticipate and seek to prevent at the operational level the sorts of patient-centered communication problems that inevitably hurt the health care organization.' In a recent study of "The Ideal Physician," patients rated highest the physician who is communicative," who cares, takes time, and listens.1 The laws of the marketplace imply, then, that the physician executive must be sensitive to the communication weaknesses permeating the organization and take measures to correct them, whether through wide-scale training and consciousness-raising or through individual counseling. When asked to identify the five communication problems having the most negative impact within their organizations, physician executives consistently identified "lack of clarity ... .. poor feedback," and "poor listening skins"-results similar to the perceptions of Fortune 500 executives (table 4, this page). Of these problem areas, "poor feedback" was noted by 25 percent of the respondents as the single most important problem in their organizations, followed by "poor listening skills" (20 percent) and "lack of clarity" (19 percent). These results for physician executives are interesting in comparison With those of Fortune 500 executives (table 5, this page). Why is poor feedback rated more strongly by physician executives? Is the nature of the health care industry such that useful feedback is not forthcoming? The question bears further study, because the effect of poor feedback can be seriously debilitating-if only in the area of patient care. Why are the managerial communication skills covered in this survey so vital for managers across the board, and particularly for physician executives? Because communication is how things get donecorrectly, efficiently, safely. If new procedures aren't disseminated accurately and quickly in your health care organization, or if those procedures are misunderstood, things won't get done and mistakes win occur. Further, the quality of the communication taking place throughout your organization contributes to your organization's climate," the prevailing mood of the organization. If formal downward messages are continuous, but employees see themselves as little more than social security numbers or personnel files, the organization's climate is most likely a negative one, and constructive communication will be difficult to come by. If, on the other hand, you encourage open communication up, down, and across the control structure, and if your people feel they're listened to thoroughly and productively, the organization's climate is positive. Why is a positive climate so important? Because an organization's climate contributes to its overall personality or culture -the "system of shared values (what is important) and beliefs how things work) that interact with a company's people, organizational structures, and control systems to produce behavioral norms (the way we do things around here)."" In an increasingly competitive health care industry, your organization's culture must be not only technically and fiscally sound, but also inviting and supportive." That culture must be supportive of patients, encouraging them to return to your organization when in need of health care, and it must encourage personal involvement at all staff levels in communicating information for the good of the organization. in a recent issue of Physician Executive, Sandra Gill advises health care organizations to "Make effective communication a top priority."" Effective managerial communication sets the stage for an organizational culture that competes successfully for increasingly limited resources. And it's up to the physician executive to appraise and improve, throughout the organization, those crucial managerial

COPYRIGHT 1989 American College of Physician Executives
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