Module 4

Module 4


In Module 3, we discussed the importance of admitting mistakes and taking ownership of our actions. We also addressed how to properly address conflict and we wrapped up the lesson by providing insight into handling naysayers and know-it-alls.

In this module, Module 4, we will cover three sections: formal and informal communication, informational roles, and communication vehicles.

Section 1: Formal and Informal Communication

Healthcare, perhaps more than any other field, relies heavily on communication. Imagine for a moment if there were no communication in a hospital. Patients, visitors, and even staff would wander aimlessly trying to determine what to do or where to go. Thankfully, we do have communication.

In the health service organization, there are two distinct forms of communication: formal and informal. Formal communication is that which is sanctioned by the organization itself. On the other hand, informal communication is everything outside of formal channels. The following table summarizes the key differences between formal and informal communication.

Attribute Formal Communication Informal Communication
Time Occurs in specified silos. Each silo may take time to read, interpret, and then send responses as needed. Slow and tedious. Extremely fast. Although many organizations have policies that try to limit and restrict cell phones, easy access to text and social messaging have increased the speed of the informal communication chain.
Direction Most formal communication occurs from the top-down. An example would be a supervisor giving a message to the manager and the manager gives the message to the individual employee. Mostly top-down. However, in the healthcare organization, it is necessary to have horizontal communication. An example would be multiple nurses working together to coordinate care for a patient. No directions or boundaries with informal communication. Most informal communication occurs through a randomized grapevine (see Did You Know)
Control Easier to control than informal communication. The organization controls the output, message, timing as well as the channel. No restraints. Difficult if not impossible to control.
Channel Email, bulletin, text, face to face, meeting Face to face, social media, text messages.
Security Vulnerable to an extent. Secured channels are mostly used. No security.
Focus Both internally and externally based. Most healthcare organizations have formal processes and procedures for addressing both internal and external stakeholders. Mostly internally based due to the comfort level between sender and receiver. Many informal messages may be in direct violation of company policy.
Language Developed with the end receiver in mind. May be technically based and use specific jargon known throughout the organization. Common based – not technical.
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One of the biggest problems with the informal communication chain is the inability to verify information as being factual. This is due to rumors. To fully understand why rumors are often so far from the truth, we must understand a critical component of human psychology, the gestalt.

In 1890, a German philosophy known as Gestaltqualitat, which postulates that the whole is greater than the summation of the components, became popular among psychologists and is still relevant today. When applied to the process of thinking it explains why our brain does not like incompleteness.

Our brain prefers the gestalt or the whole picture. In fact, our brain will subconsciously insert missing components to establish completeness. Imagine then that you are in the break room at work and someone tells you something important but there are a few holes in the narrative. Near the end of the story, someone else comes in and is interested in the information.

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The original storyteller leaves and you begin telling the newcomer the story from the top. However, when you come to the areas with holes, your brain subconsciously ties loose ends together that may or may not be relevant or even true. As such, the person hears just a slightly different story than what you were given. Now, imagine this happening a dozen times. Not only do rumors spread fast, but they change from person to person.

Section 2: Informational Roles

In healthcare, information comes at us in staggering amounts. There is so much information that it would literally be overwhelming if we tried to process it all. In 1990, Henry Mintzberg organized the main roles of management into three separate and distinct categories. In no particular order, they are interpersonal roles, decisional roles, and informational roles.

In a separate course, we will delve into all managerial roles, but for this course we will only focus on informational roles. While Mintzberg categorized the processing of information as truly a managerial task, it could be effectively argued that everyone in healthcare is a processor of information. Therefore, we will discuss informational roles from a broad, yet encompassing perspective.

Informational roles consist of monitor, disseminator, and spokesperson.


In the role of monitor, an employee gathers information from a variety of sources. Such sources may include but are not limited to employees, reports, medical equipment, etc. Once the information is gathered, the employee must filter the information into a logical array and then determine if they are going to act as a result.


In this role, the employee takes the information gleaned in the monitor stage and determines whether to disburse to others. In healthcare, there are distinct rules and regulations that often dictate what can and cannot be distributed. The most well-known piece of legislation is HIPAA.


In this final role, the employee may have to support their position to internal or external stakeholders. As a spokesperson, the employee disseminates their information to others.

Section 3: Communication Vehicles

Imagine that you own your own home health agency. A major regulatory change is set to go into effect in two weeks. You send a company email, post the news in the company newsletter, and mention the upcoming change in the weekly meeting. A month later, you are shocked to find a key employee has not changed their routine and is not in compliance with the new regulation. There was certainly a break down in communication, and this time, it is more than likely related to the communication vehicles used to communicate the change.

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Communication vehicles are simply the means used to convey messages to employees and stakeholders. Such vehicles include but are not limited to:

  • Handbooks – The employee handbook is mostly a collection of standard policies and procedures. These are normally static in nature and may remain unchanged for long periods of time. It is a good organizational practice to review the handbook quarterly.
  • Newsletters – Organizational newsletters are historically used to convey news related to products, services, and its employees. Newsletters may be intended for internal and external use. Some organizations use their newsletters to help bolster marketing efforts.
  • Emails – Emails are the most common form of communication vehicle for the organization. Size is the number one factor to determine if the message will be sent via email or through another route.
  • Text messages – Many organizations use text messaging systems for emergency management or for information that requires an immediate response.
  • Meetings – There are two different types of meeting structures that organizations often employ. They are face to face or virtual. With more and more healthcare entities expanding their demographic footprint, virtual meetings are on the rise.
  • Phone calls – While email is the number one form of communication for the organization as a whole, phone calls are utilized more frequently for one-to-one based discussions. From consultations to referrals and scheduling, healthcare is heavily dependent on the telephone.
  • Social media – Many healthcare entities have an online presence with social media. Larger organizations have a social media designee who is responsible for updating information and responding to individuals as needed.
  • Messaging apps – Similar to text messages, some organizations have switched to messaging apps like Slack to share information with employees.

Communication Vehicle Summary

There are many communication vehicles available for an organization to share information with interested parties. Normally, there are three main factors that determine which vehicle to use and when. They are timing, size, and security.

Information that requires employees to act within a certain timeframe will normally use multiple vehicles. Let’s return to our example of the regulatory change within the home health agency. Due to the urgency of our need to communicate this change with all employees, we would more than likely use a multitude of communication vehicles. An initial email would more than likely be followed up by phone calls and perhaps even text messages to ensure that everyone received the information.

As mentioned above, size dictates what communication vehicle to use. If you are working in a solo practice, odds are that there are just a few employees and it would not be difficult to reach all of them face to face in a rather short period of time. For our current discussion, size refers to both the number of sites and the number of employees.

An organization that has three facilities and only 40 employees, but they are geographically disbursed may need to use email as their main communication vehicle. Conversely, a single urban hospital may have several thousand employees, and touching each one face to face may be nearly impossible.

To conclude our discussion on communication vehicles, read the following key highlights from a recent survey on employee communication.

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Key Findings of Employee Communication (December, 2019)

  • Nearly two-thirds (60.8%) of employees regularly ignore work-related emails. Respondents reported that they ignore emails because they believe them to be irrelevant.
  • Almost half (47.7%) said receiving fewer emails at work would improve their job satisfaction.
  • Approximately 30% of employees state that they never check email outside of working hours.
  • It takes the average employee 38 hours to reply to an email.
  • Only 12% of employees send read receipts when requested.
  • A full 91% of employees respond to text messages sent.
  • The average response time to a text message is 10 minutes.
  • Most employees, 82%, state that they would rather receive a text as opposed to an email.