Copyright 2007 by American Society of Clinical Oncology.

Developing Effective Communication Skills

A practicing oncologist likely uses just about every medium to communicate.
They talk on the phone, send e-mail messages, converse one-on-one, participate in
meetings, and give verbal and written orders. And they communicate with many
audiencespatients and their families, referring physicians, and office staff.
But are you communicating effectively? How do you handle differing or
challenging perspectives? Are you hesitant to disagree with others, especially those in
authority? Do you find meetings are a waste of time? What impression does your
communication style make on the members of your group?

Be an Active Listener
The starting place for effective communication is effective listening. Active
listening is listening with all of one's senses, says physician communication expert
Kenneth H. Cohn, MD, MBA, FACS. It's listening with one's eyes as well as one's
years. Only 8% of communication is related to contentthe rest pertains to body
language and tone of voice. A practicing surgeon as well as a consultant, Cohn is the
author of Better Communication for Better Care and Collaborate for Success!
Cohn suggests creating a setting in which listening can be accommodating.
For example, don't have a conversation when one person is standing and one person
is sittingmake sure your eyes are at the same level. Eliminate physical barriers,
such as a desk, between you and the other party. Acknowledge the speaker with your
own body language: lean forward slightly and maintain eye contact. Avoid crossing
your arms, which conveys a guarded stance and may suggest arrogance, dislike, or
disagreement.
When someone is speaking, put a premium on being present. Take a deep
breath (or drink some water to keep from speaking) and create a mental and
emotional connection between you and the speaker. This is not a time for
multitasking, but to devote all the time to that one person, Cohn advises. If you are
thinking about the next thing you have to do or, worse, the next thing you plan to say,
you aren't actively listening.

Suspending judgment is also part of active listening, according to Cohn.

Encourage the speaker to fully express herself or himselffree of interruption,
criticism, or direction. Show your interest by inviting the speaker to say more with
expressions such as Can you tell me more about it? or I'd like to hear about that.
Finally, reflect back to the speaker your understanding of what has been said,
and invite elaboration and clarification. Responding is an integral part of active
listening and is especially important in situations involving conflict.
In active listening, through both words and nonverbal behavior, you convey
these messages to the speaker:

I understand your problem

I know how you feel about it

I am interested in what you are saying

I am not judging you

Communication Is a Process
Effective communication requires paying attention to an entire process, not
just the content of the message. When you are the messenger in this process, you
should consider potential barriers at several stages that can keep your intended
audience from receiving your message.
Be aware of how your own attitudes, emotions, knowledge, and credibility
with the receiver might impede or alter whether and how your message is received.
Be aware of your own body language when speaking. Consider the attitudes and
knowledge of your intended audience as well. Diversity in age, sex, and ethnicity or
race adds to the communication challenges, as do different training backgrounds.
Individuals from different cultures may assign very different meanings to
facial expressions, use of space, and, especially, gestures. For example, in some Asian
cultures women learn that it is disrespectful to look people in the eye and so they tend

to have downcast eyes during a conversation. But in the United States, this body
language could be misinterpreted as a lack of interest or a lack of attention.
Choose the right medium for the message you want to communicate. E-mail
or phone call? Personal visit? Group discussion at a meeting? Notes in the margin or
a typed review? Sometimes more than one medium is appropriate, such as when you
give the patient written material to reinforce what you have said, or when you followup a telephone conversation with an e-mail beginning, As we discussed.
For one-on-one communication, the setting and timing can be critical to
communicating effectively. Is a chat in the corridor OK, or should this be a closeddoor discussion? In your office or over lunch? Consider the mindset and milieu of the
communication receiver. Defer giving complex information on someone's first day
back from vacation or if you are aware of situations that may be anxiety-producing
for that individual. Similarly, when calling someone on the phone, ask initially if this
is a convenient time to talk. Offer to set a specific time to call back later.
Finally, organize content of the message you want to communicate. Make sure
the information you are trying to convey is not too complex or lengthy for either the
medium you are using or the audience. Use language appropriate for the audience.
With patients, avoid medical jargon.

Be Attuned to Body Language- Your Own and Others

Many nonverbal cues such as laughing, gasping, shoulder shrugging, and
scowling have meanings that are well understood in our culture. But the meaning of
some of these other more subtle behaviors may not be as well known.1

Hand movements. Our hands are our most expressive body parts, conveying even
more than our faces. In a conversation, moving your hand behind your head usually
reflects negative thoughts, feelings, and moods. It may be a sign of uncertainty,
conflict, disagreement, frustration, anger, or dislike. Leaning back and clasping both
hands behind the neck is often a sign of dominance.

Blank face. Though theoretically expressionless, a blank face sends a strong do not
disturb message and is a subtle sign to others to keep a distance. Moreover, many
faces have naturally down turned lips and creases of frown lines, making an
otherwise blank face appear angry or disapproving.

Smiling. Although a smile may show happiness, it is subject to conscious control. In

the United States and other societies, for example, we are taught to smile whether or
not we actually feel happy, such as in giving a courteous greeting.

Tilting the head back. Lifting the chin and looking down the nose are used
throughout the world as nonverbal signs of superiority, arrogance, and disdain.

Parting the lips. Suddenly parting one's lips signals mild surprise, uncertainty, or
unvoiced disagreement.
Lip compression. Pressing the lips together into a thin line may signal the onset of
anger, dislike, grief, sadness, or uncertainty.

Build a Team Culture

In oncology, as in most medical practices, much of the work is done by teams.
Communication within a team calls for clarifying goals, structuring responsibilities,
and giving and receiving credible feedback.
Physicians in general are at a disadvantage because we haven't been trained
in team communication, says Cohn. He points out that when he was in business
school, as much as 30% to 50% of a grade came from team projects. But how much
of my grade in medical school was from team projects? Zero.

The lack of systematic education about how teams work is the biggest hurdle
for physicians in building a team culture, according to Cohn. We've learned team
behaviors from our clinical mentors, who also had no formal team training. The styles
we learn most in residency training are command and control and the pace setting
approach, in which the leader doesn't specify what the expectations are, but just
expects people to follow his or her example.
Cohn says that both of those styles limit team cohesion. Recognizing one's
lack of training is the first step [in overcoming the hurdle], then understanding that
one can learn these skills. Listening, showing sincere empathy, and being willing to
experiment with new leadership styles, such as coaching and developing a shared
vision for the future are key.
Stated goals and team values. An effective team is one in which everyone works
toward a common goal. This goal should be clearly articulated. In patient care, of
course, the goal is the best patient outcomes. But a team approach is also highly
effective in reaching other goals in a physician practice, such as decreasing patient
waiting times, recruiting patients for a clinical trial, or developing a community
education program. Every member of the team must be committed to the team's goal
and objectives.
Effective teams have explicit and appropriate norms, such as when meetings will be
held and keeping information confidential. Keep in mind that it takes time for teams
to mature and develop a climate of trust and mutual respect. Groups do not progress
from forming to performing without going through a storming phase in which team
members negotiate assumptions and expectations for behavior.2

Clear individual expectations. All the team members must be clear about what is
expected of them individually and accept their responsibility for achieving the goal.
They should also understand the roles of others. Some expectations may relate to
their regular job duties; others may be one-time assignments specific to the team goal.
Leadership of the team may rotate on the basis of expertise.
Members must have resources available to accomplish their tasks, including time,
education and equipment needed to reach the goal. Openly discuss what is required to
get the job done and find solutions together as a team.

Empowerment. Everyone on the team should be empowered to work toward the goal
in his or her own job, in addition to contributing ideas for the team as a whole.
Physicians' instinct and training have geared them to solve problems and give orders
so they often try to have all the answers. But in an effective team, each team
member feels ownership in the outcome and has a sense of shared accountability.
Cohn notes, You get a tremendous amount of energy and buy-in when you ask
What do you think?
Team members must trust each other with important tasks. This requires accepting
others for who they are, being creative, and taking prudent risks. Invite team
members to indicate areas in which they would like to take initiative. Empower them
by giving them the freedom to exercise their own discretion.
Feedback. Providing feedback on performance is a basic tenet of motivation. For
some goals, daily or weekly results are wanted, while for others, such as a report of
the number of medical records converted to a new system or the average patient
waiting times, a monthly report might be appropriate. Decide together as a team what
outcomes should be reported and how often.

Positive reinforcement. Team members should encourage one another. Take the lead
and set an example by encouraging others when they are down and praising them
when they do well.
Thank individuals for their contributions, both one on one and with the team as a
whole. Celebrate milestones as a way to sustain team communication and cohesion.

Effective E-mail
E-mail has numerous features that make it a wonderful tool for
communicating with a team: it is immediate; it is automatically time-stamped; and
filing and organizing are easy. (E-mail with patients is a more complex topic and is
not addressed herein.)

The e-mail subject line is an especially useful feature that is typically

underused. Make it your best friend. Use it like a newspaper headline, to draw the
reader in and convey your main point or alert the reader to a deadline. In the
examples given below, the person receiving an e-mail headed HCC is likely to
scroll past itplanning to read it on the weekend. The more helpful subject line alerts
the reader to be prepared to discuss the topic at an upcoming meeting:

Vague Subject Line : HCC

More Helpful Subject Line : HCC Plan to discuss the SHARP trial this
FridayYour comments due December 5 on attached new policies

As with all written communication, the most important aspect to consider is

the audience. Consider the knowledge and biases of the person/people you are emailing. Where will the reader be when he or she receives your message? How
important is your message to the reader?
The purpose of writing is to engage the reader. You want the reader to do
something, to know something, or to feel something. Write it in a way that helps the
reader. Put the most important informationthe purpose of the emailin the first
paragraph.
Except among friends who know you well, stay away from sarcasm in e-mail
messages. The receiver does not have the benefit of your tone of voice and body
language to help interpret your communication. When delivering comments that are
even slightly critical, it's better to communicate in person or in a phone call than to do
so in an e-mail. Something you wrote with good intentions and an open mind or even
with humor can be interpreted as nitpicky, negative, and destructive, and can be
forwarded to others.
Because we use e-mail for its speed, it's easy to get in the habit of dashing off
a message and hitting the send button. We count on the automatic spell-check (and
you should have it turned on as your default option) to catch your errors. But spelling
typos are the least of the problems in communicating effectively.
Take the time to read through your message. Is it clear? Is it organized? Is it
concise? See if there is anything that could be misinterpreted or raises unanswered

questions. The very speed with which we dash off e-mail messages makes e-mail the
place in which we are most likely to communicate poorly.
Finally, don't forget to supply appropriate contact information, including
phone numbers or alternative e-mail addresses, for responses or questions.

Conclusion
Conflict is inevitable in times of rapid change. Effective communication helps
one avoid conflict and minimize its adverse consequences when it does occur. The
next issue of Strategies for Career Success will cover conflict management.

References
Givens DB The Nonverbal Dictionary of Gestures, Signs, & Body
Language Cues. http://members.aol.com/nonverbal2/diction1.htm.
2. Cohn KH, Peetz ME (2003) Contemporary Surg, Surgeon frustration:
Contemporary
problems,
practical
solutions. www.healthcarecollaboration.com, 59, pp 7685.
1.

June 13, 2016

Critical Elements of Effective

Communication
Organizations cannot function without effective communication, and the

actions of every team member verbal, nonverbal, written, or electronic will

influence opinions and affect the teams overall goals. It is imperative that when
crafting and delivering a message, you are: utilizing the proper communication
channel, aware of your own communication style, and crafting your message so that
it is clear and being received as you intended. In order to address these critical
elements of effective communication, you must merge your learned interpersonal
skills with knowledge and proper use of technology tools that organizations have
come to rely on.

Proper Communication Channel

Let us first examine what it means to utilize the proper communication
channel, as this point is where technology and conflict can often intersect. The
evolution of communication technologies continue to make organizations run more
efficiently, giving even the smallest businesses a global presence and a direct link to
their customers. While organizations should be quick to embrace these tools, they
should do so with caution. Overreliance on communication technology can
undermine the ability to effectively connect with employees and potential business
partners, and managers who become too dependent on these tools may instead create
a chasm of distance between themselves and the parties being addressed.
Modern businesses may use more than one tool to communicate with
employees and customers. Specialized platforms such as Slack allow companies to
separate employees into project groups in order to work together, social media
management platforms such as Hootsuiteallow managers to assign tasks and
employees to interact virtually with an audience, and email remains a reliable way to
send messages and other communications throughout an organization. For a manager
or employee delivering a message through one of these technologies, there is always
the risk of message failure. One must be mindful of everything from timing to
channel richness (Baack, 2012) when sending the message.
Electronic communication can also fail the sender when the tone of the
message isnt conveyed as intended. We exist in a world in which millions of people
communicate via social media in 140 characters or less, and it can be extremely
challenging to express thoughts and intentions in such a confined space. As Becker,
Boswell, and Butts (2015) argued, Whether intentional or not, electronic
communication is capable of delivering an emotionally charged tone (as cited by
Barsade & Gibson, 2007, and Walther, 1996). If a person sending a message isnt
mindful of capital letters, punctuation, or verbiage, the recipient may react negatively
to what was intended as a polite request or interaction. Moreover, individual
differences such as age, personality, gender, and exclusive language (Baack, 2012)
may be amplified when electronic communication isnt properly received. One need
only look to the current news cycle for an example of a social media fail in which a
person sending a message found that it wasnt conveyed as intended (Reyes, 2016).
When this scenario happens within an organization, it has the potential to create
conflict between the messenger and the receiver.

Organizations that do business on a global scale electronically or face-toface can ill afford to have their messages ignored or misinterpreted because of such
differences. Consider a potential business relationship between a Chinese company
and an American company. According to Pan Fan and Zhang Zigang (2004), If
American managers want to do business with Chinese managers, they should give
their Chinese partners enough time to know themselves and develop a personal
relationship with them. Americans would need to take great care to learn more
about the Chinese culture prior to beginning the relationship, and the company could
employ cultural assimilators to avoid any lapses in manners as well as explain how
to show friendliness and respect in a host country (Baack, 2012). From an
organizational perspective, effectively communicating your intentions may require
extensive knowledge of that countrys laws and everything from employee wage rate
to currency exchange rates (Davis, Latham, and Sadeghinejad, 2015).

Communication Style
Just as you must be cautious when choosing the proper communication
channel, you must be constantly aware of your own communication style. If youve
ever come across someone with no self-awareness, you know how the lack of
internal filter can undermine the ability to communicate. Self-awareness
encompasses more than just the words coming out of your mouth, but also your body
language. Nonverbal communication plays an important role in your communication
style. Picture a manager trying to explain a new initiative to his/her employees. The
words on paper may be inspiring talk of winning over new customers with a new
product and becoming the most successful company in the field. But if the message
is delivered with the manager seated behind a desk, eyes gazing out the window as
he/she speaks thats not going to inspire many people. Now picture the manager
standing in front of the room, looking his/her employees in the eyes and emphatically
describing how this inventive new product is going to be a game-changer for the
organization the message is likely to be received much more positively by the
group.
Being aware of your communication style will also allow you to maintain
composure in a business setting, and not risk your emotions getting the better of you,
which can occur at all levels of an organization. Anger, sadness, envy or jealousy,

and romantic attitudes can threaten to disrupt communication from sender to receiver
and vice versa (Baack, 2012). Losing control of your emotions in a conversation can
result in the other person simply putting up a mental wall and blocking out
everything you have to say because they are taken aback by the way you are saying
it. Many of us have worked in high stress environments. The lack of self-monitoring
among co-workers can lead to conflicts on a daily basis. For this reason, selfawareness and keeping your emotions in check is critical, especially if you want to
grow into a management role (Timmins, 2011).
Becoming a manager does not mean youve made it and can stop
evaluating your communication skills. Exactly the opposite, you must now increase
your self-awareness and reevaluate (Davis and Rosenblatt, 2009) everything from
your verbal and nonverbal communication technique to your listening abilities. Let
us examine the latter, as your ability to listen and provide feedback will constantly be
tested as a manager, often in one-on-one interactions with employees. Being prepared
to actively listen and take notes will immediately remove some of the potential
barriers to a successful interaction. When an employee engaging with a manager can
see that the latter is focused solely on him/her, they feel relaxed and are much more
likely to transmit and receive messages as intended. A manager supervising more
than one employee will also want to take an individualistic approach to
communication. As no two employees are alike, the manager may find what
motivates one person does nothing for the other (Pauley and Pauley, 2009).
Failure to control your emotions as a manager may have a destructive
influence on employees. As Davis and Rosenblatt (2009) stated, Managers are in a
position of power in relation to those whom they supervise, so theres always a risk
of intimidating others. A manager must maintain composure and be aware of
nonverbal actions finger pointing, crossed arms, and frustrated looks are all
examples of nonverbal cues that could create tension among employees.
Managers who are directly involved in conflict resolution must remain selfaware, even if their instincts are telling them to side with one employee over another.
Once a manager has established the persons involved in the conflict and issues at
hand, he/she must work to find what Baack (2012) termed the bargaining zone in
which the conflicting parties can reach a resolution. If both sides feel the decision is
satisfactory, the manager will have achieved a win-win solution (Baack, 2012). The
role of a manager in conflict resolution is to act as a moderator and problem-solver,
so it is imperative that he/she remains self-aware and does not show favor to either

party. Doing so would risk damaging the outcome and losing favor with one or more
employees.

Craft Your Message

A manager can self-monitor his/her communication techniques and be
mindful to use the proper communication channel, but unless the message is clear it
will not be received as intended. If a CEO were to send a company memo letting
everyone know the marketing team is doing a good job but sales needs to step it
up, that would lead to a lot of questions from both teams. What exactly was
marketing doing that was effective? In which area does sales need to improve? The
clarity of your communication is just as important as the message itself. This
precision applies to everything from verbal to written communication, and also
presentations in which managers are speaking to employees or C-level executives.
Developing an effective communication style takes time and practice. It is
something that is learned over time and through failure sometimes many failures. It
is never perfect and must be adjusted depending on the person with whom you are
communicating and the method by which you are transmitting or receiving a
message. But ensuring that youve addressed the critical elements learning the
proper channels, self-monitoring your methods, and communicating in a clear
manner will greatly enhance your chances of success in any role.
Written by Jason R. Latham, Content Manager for Bridgepoint Education.

References
Baack, D. (2012). Management Communication San Diego, CA: Bridgepoint
Education
Becker, W.J., Boswell, W.R., & Butts, M.M. (2015). Hot Buttons and Time
Sinks: The Effects of Electronic Communication During Nonwork Time on

Emotions and Work-Nonwork Conflict. Academy of Management Journal,

58(3), 763-788.
Davis, B., Latham, J., & Sadeghinejad, A. (2015). Why Business Students
Need to Embrace Global Diversity. Forward Thinking. Retrieved
from http://forwardthinking.ashford.edu/business-students-need-embraceglobal-diversity/
Davis, M., & Rosenblatt, C. (2009). Effective Communication Techniques
for Nurse Managers. Nursing Management. 40(6). 52-54 3p.
Pan Fan, K., & Zhang Zigang, K. (2004). Cross-cultural Challenges When
Doing Business in China. Singapore Management Review, 26(1), 81-90.
Pauley, J.A., & Pauley, J.F. (2009). Communication: the key to effective
leadership. Milwaukee, Wisconsin : ASQ Quality Press, 2009.
Reyes, M. (2016). What Underpaid Millennials Can Learn From the Yelp
Girls
Mistake.
The
New
York
Post.
Retrieved
fromhttp://nypost.com/2016/03/07/what-underpaid-millennials-can-learnfrom-the-yelp-girls-mistake/
Timmins, F. (2011). Managers Duty to Maintain Good Workplace
Communications Skills. Nursing Management UK. 18(3), 30-34 5p.

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