Module 1

Introduction

To effectively learn about the many facets of communication, we must first arrive at a definition. Merriam-Webster defines communication as a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior. At first glance, this definition appears to be very straightforward, however, when we step back and evaluate communication as a process, we can truly begin to appreciate just how complex communication can be.

This module consists of four sections:

1. History of Communication
2. Models of Communication
3. Nonverbal vs Verbal Communication
4. Basic Communication Skills

Section 1: History of Communication

It is hard to envision what interactions among the first humans resembled. Think about the following scenario for a moment to set the tone for this discussion. Imagine it is the year 12,000 BC and you have just feasted on some delicious fruit. With a full stomach, you decide to explore your surroundings. After walking for some time, you come upon a group of three fellow humans. You have never seen them before. Come to think of it, it has been years since you have seen another human. Do you wave? Oh wait – they wouldn’t know what that is. Truth be told, you don’t know what that is. So, you don’t wave.

How would you greet them? How would you convey to them that you were not a threat? Would you throw your arms up in the air for a sign of peace or would they assume you were trying to attack them? For our discussion here, let us assume that they are not hostile. You quickly realize that they are hungry. How would you explain to them where the tree was? Would you act it out? Grunt and yell “ooga booga” until they understood you? Odds are – you would probably point to the general area from whence you came and draw a picture or two as to where the tree could be found.

Pictures were the essence of human communication for thousands and thousands of years. Pictures in caves are referred to as pictographs and pictures etched in rocks are known as petroglyphs. Pictographs are paintings that have survived the elements and are normally found in caves or beneath under-hangs. Petroglyphs are etched or carved into stone and can be found all over the world.

Wherever they are located, pictographs and petroglyphs were used to tell stories or convey information to either a current generation or to future generations to come.

Eventually, over time, pictographs and petroglyphs were minimized to represent the smallest and most basic of shapes. These word signs or word concepts were then adapted over time by the Sumerians into a generalized form of writing known as cuneiform (circa 3500 BC). Cuneiform was widely adopted and served as the basis for most forms of written communication for nearly 3000 years. Cuneiform was eventually replaced by alphabetic script somewhere around 100 BC.

Before we get too carried away though, think about the sheer amount of time that writing in such a fashion must have taken. It wasn’t as if we jotted our random thoughts or blogged about life in a cave. Information that was written down was of utmost importance. Such documents or artifacts were to be treated with respect and protected. As such, our first known libraries were created to house and protect these documents which mostly consisted of clay or stone tablets.

Although papyrus was used in Ancient Egypt for writing and recording events, papyrus did not have the staying power as clay tablets, and papyrus was therefore used to mostly document the mundane. The major switch from writing on clay tablets to human-made material came with the invention of paper.

Historical records indicated that the Chinese invented paper by beating hemp into a pulp and then placing it in forms to dry. Materials such as bamboo fibers and mulberry bark helped stabilize and make the paper more durable. Oddly, it wasn’t until about 500 years after the invention of paper that it made its debut as the preferred means of transcribing documents. Initially, paper was used to pack and protect more valuable items during shipping.

Eventually, the world fell in love with using paper for written communication and paper mills began to spread across Europe. By the 12^th century AD, paper was made and used worldwide.

Oral communication seems to have followed a similar development process as that of written communication. Word signs and word concepts eventually associated various sounds and phonetics which then enabled humans to communicate without the aid of written images.

History suggests that through time, vowels entered the phonetic language and may have been introduced by the early Greeks. As communication improved, the ability to share knowledge improved as well.

Section 2: Models of Communication

In this section, we will examine the various communication models. Models are basic frameworks from which we can analyze the constructs of both personal and professional communication.

While there are numerous models, we will focus on four: 1) linear, 2) interactive, 3) transactional, and 4) contemporary.

Linear Model of Communication

The linear model of communication is the most basic of the four and has been around for thousands of years. Aristotle proposed the fundamental groundwork for this model circa 300 BC however, it was mostly predicated on the notion of speaker and audience. In the linear model, the basic concept suggests that there is a Sender who gives a message to a Receiver. It is a one-way model.

Example: a professor lectures to a student(s).

Its simplicity is also its greatest weakness. In this model, a person gives a message to another. However, what is not clear is if the message was received. The message may have been lost in translation, but the sender remains blissfully unaware of any communication breakdowns.

Interactive Model of Communication

The next model is the interactive model. The interactive model adds the element of feedback. In our original model, the speaker or sender sent a message to the receiver. This model adds the feedback loop. The speaker sends a message, and the receiver can then state that they have received the message or even ask for clarification.

This model also includes the idea of noise. Communication that takes place in a church would be very much different than communication that takes place at a hockey game. Noise often requires that the sender pause or otherwise ensure that the message is being received. It is a two-way communication model.

Example: a professor lectures to students who in turn ask questions and further understanding.

Transactional Model of Communication

The third model is the transactional model of communication. It builds upon the interactive model yet adds the basis of context. To explain this, imagine the first conversation you had with a good friend. Meeting them for the first time, the conversation and communication were probably much different than what it is now. Context also includes the idea of social norms, customs, and idioms. In the United States, asking questions of a supervisor or questioning a teacher is commonplace. In other countries, such practice is considered extremely rude and rarely happens.

Idioms include phrases such as “beat a dead horse” or “dead tired” and would be confusing to others not from the US or other areas that use such terms.

Example: a professor gives a lecture to a class that has been meeting for 8 weeks. Students are known by name and have become familiar with the professor’s use of idioms.

Contemporary Model of Communication

The final model is the contemporary model of communication. This model expands on the previous three yet adds the dimension of medium. It recognizes that communication is not a one-time process and can take place across a variety of mediums. While we will address these mediums later in this course, some examples of mediums may include telephone, email, text, social messaging, or other forms of electronic messaging.

Example: a professor gives a lecture. Later in the evening, a student has a question about a subject covered. The student sends an email asking for clarification.

Section 3: Verbal vs Nonverbal Communication

 It is estimated that healthcare employees spend 85% of their day communicating in one form or another. It is second only to sales and marketing in overall time dedicated to conveying a message. Communication, as you are beginning to understand, is extremely complex. In this section, we will review the differences between verbal and nonverbal communication.

We will start our discussion with nonverbal as it is far more common than verbal. Dr. Albert Mehrabian, the author of Silent Messages, found that only 7% of our communication is word-based. Through several studies, it was determined that vocal elements such as pitch, tone, and word choice accounted for 38% and the remaining 55% were nonverbal (e.g. posture, hand gestures, etc.).

Nonverbal communication includes:

• Facial expressions - are we showing emotions or lack of interest?
• Hand gestures - what do our hands do as we talk? Do we gesture more when we are excited or upset?
• Eye contact - do our eyes wander or do we maintain eye contact? How do we feel when someone stares a little too much?
• Appearance – uniforms – name tags
• Distance –
  • Intimate distance – 0 to 18 inches
  • Personal distance – 18 inches to 4 feet
  • Social and work distance – 4 feet to 12 feet
  • Public distance 12 or more feet
• Hygiene – grooming
  • Tie or no tie
• Posture - are we alert? Do we have our legs or arms crossed in a symbol of closure?
• Nodding of the head - are we truly listening or are we giving false signs of listening?
• Environment – where you choose to talk is as important as what you say. Especially in a supervisory role.

Verbal communication includes:

• Word choice - semantics
• Knowing the audience - at what level do we speak? Do we speak at or to our audience?
• Pauses - mostly these are used for effect or for allowing opportunities for questions or feedback.
• Speed of speech - do we speak faster when we are excited? Slower when we are angry?
• Volume - similar to the speed of speech. When we are excited or angry, our volume normally increases.
• Pitch - have you overheard someone speaking to a baby or a child?

Section 4: Basic Communication Skills

The final section of this module discusses 10 communication skills that are effective within the workplace. Many of these skills transfer to personal situations as well.

1. Active listening. Listening is an art that takes time to develop. How many times have you thought that you had someone's attention only for them to ask you to start over? Active listening requires that the receiver pay attention to not only verbal and nonverbal cues but to word choice, pitch, and tone. The truly active listener is "seen" to be listening. Their face, body language, eyes, and posture all indicate that they are engaged and processing with intent.
2. Clarity. In healthcare, clarity is extremely important. Many medical terms and even medications sound a lot alike. Take for instance Celexa and Celebrex or Amicar and Omacar. Speaking with clarity and focused intent helps avoid unnecessary errors.
3. Respect. Healthcare, or the need for health services, brings everyone together regardless of background. As such, people with different beliefs who may not normally associate with one another are brought together in proximity. Although we may not agree with a person, we respect their right to have a different opinion.
4. Medium. A little later in this course, we will explore the various mediums available for communication (e.g., email, text, etc.). A basic communication skill is to best determine what form of communication is most appropriate for the given situation. Imagine being given a terminal diagnosis via text message or receiving an email that you have been laid off. How you say it is as important as what you say.
5. Confidence. If you second guess yourself others will be second-guessing you. In healthcare, trust is of the utmost importance. As such, it is critical that when we communicate, we do so with confidence. Communicating with confidence has a calming effect on those to whom you are speaking.
6. Being Present. Imagine yourself laying on a beautiful beach in Hawaii instead of reading this on your computer. It is easy to daydream and studies have shown that it is wonderful for your mental health. However, when we are communicating with others it is important to be present. There is a huge difference between being no where and being now here. A shift of the letter w is like the shift in attention needed to be present.
7. Self-Awareness. This is very similar to active listening with the added caveat of understanding the environment and social context. In healthcare, it is important to be cognizant of the entire situation where our communication is taking place. Are there others within earshot? Do the privacy concerns of HIPAA pertain? We constantly need to be assessing our environment as we communicate. Skilled communicators are adept at maintaining effective communication while constantly filtering noises in the background.
8. Empathy. Communicating with empathy lets the receiver know that we care about them and their feelings. Without empathy, trust is lost and our ability to deliver our message effectively is compromised.
9. Open Questions. Open-ended questions are those that are not easily answered with a simple yes or no. By asking open-ended questions, we encourage others to share their feelings and/or their experiences. We build trust and can move relationships forward.
10. Compromise. Too often, supervisors view communication as a win or lose exchange. Healthcare is not about knowing which hill to die on rather it is knowing that we need to give to receive.