COMMUNICATION

Dr A Prakash

Sr Professor, Health Management

National Academy of Indian Railways

Let us play a game

(Chinese Whisper)

Let us read something

Please Read Loudly

I didnt say he borrowed my book.

I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.

Now Read This

I didnt say he borrowed my book.

I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.
I didnt say he borrowed my book.

VERBAL COMMUNICATION
LEVELS

Words - 7%

Paralinguastic 38%

The way something is said.

Accent, Tone & Voice modulation

Body language 55%

What the speaker looks like

Appearance / Dress

Emotions on face

Posture / Gesture / Movement

May Be Writing is Better

Let us frame a question!

Please give me a three digit number

Column 1 2 3
0 Intrgrated Management -------- Options
1. Total ----------- Organisational ------ Flexibility
2. Systematized Monitored --------- Capability
3. Parallel --------- Reciprocal --------- Mobility
4. Functional ----- Digital --------------- Programming
5. Responsive --- Logistical ----------- Concept
6. Optional -------- Transitional -------- Time-phase
7. Synchronised Incremental ------- Projection
8. Compatible ---- Third Generation -- Hardware
9. Balanced ------- Policy ---------------- Contingency

BEWARE!

70% of all communication is

Misunderstood

Misinterpreted

Rejected

Distorted

Not heard

RESULT

17 September 2012 Last updated at 23:02 GMT

Complaints about doctors up 23% in year

By Nick Triggle Health correspondent, BBC News
The rise in complaints by 23% continues a trend
seen in recent years
The number of complaints made to the General
Medical Council about doctors has risen 23% in
the past year, the regulator says.

But the regulator said there was no

evidence to suggest care was getting
worse.
Instead, it claimed the rise was down to
greater expectations and willingness to
complain.

The most complained about topic was the care and

treatment given, followed by communication and
respect for patients, which both saw large rises in the
past year

IMPORTANCE

Perceived ability of a
person

30% is what you

know

70% is how you

communicate it

HENCE
COMMUNICATION IN HEALTH CARE

SHARE OF COMMUNICATION
TYPES
Writing
9%

Speaking
30%

Reading
16%

Listening
45%

TRAINING FOR
COMMUNICATION
Skill

Used

Taught

Listen

Speak

Read

Write

BARRIERS TO COMMUNICATION

Noise

Inappropriate medium

Assumptions / Misconceptions

Emotions

Language differences

Distractions

Poor listening skills

FILTERS

Delete

Distort

Generalize

Depending upon

Values, Beliefs, Past experiences, Prejudices,

Feelings, Environment

TYPES OF LISTENERS
Brain can process 3-4 times the speed of
speech

The non-listener

The marginal listener

The evaluative listener

The active listener

COMMUNICATION STYLES

Different basic personal styles

Different at different times

Different with different persons

Conflicting styles create barriers

Eileen Russo Model

High Assertiveness
Tells

Hides Emotions

Displays Emotion

Low Expression

High Expression
Asks

Low Assertiveness

COMMUNICATION STYLES
SYSTEMATIC

DIRECT

Low Assertiveness +
Low Expression

High Assertiveness +
Low Expression

Low Assertiveness +
High Expression

High Assertiveness +
High Expression

CONSIDERATE

SPIRITED

COMMUNICATION IN MEDICINE
WITH PATIENTS

Symptoms
Counselling
Feed back

AMONG HEALTH
PROFESSIONALS

Superior
Peers
Subordinates

OBJECTIVES

Trust and Satisfaction

Decreased Symptom Severity
Less Adverse Effects
Higher Adherence
Effective Self management Behaviour

TRUST
Trust is to rely on the veracity and integrity of
another individual.

Trust occurs when the patients perceive that

the provider has their best interest in mind.
Trust occurs when the patients perceive that
the same provider is capable & competent to
help him.

EMPATHY

It is not only the ability to understand the

patient's experiences and feelings but also the
capacity to communicate this understanding.
What it must be like to be a patient!
Leads to hope and trust

It is different from Sympathy.

(inclination to think or feel like another)

STEPS TO EMPATHY

Identification

Incorporation

Reverberation

Detachment

BARRIERS TO EMPATHY
PROVIDER BARRIER
Professional hazard; Overexposure; Overwork;
Personal

PATIENT BARRIER
Previous experience; Refusal to disclosure;
Cultural; Psychological

ENVIRONMENTAL BARRIER
Organisational factors

TIPS FOR EMPATHY

Active listening / Empathic listening

Eye contact

Posture

Verbal quality

Verbal message

CONSTRAINTS

Time Shortage

Man Power Shortage

Low Education

Culture & Traditions

Communication under
Transactionactional Analysis

TRANSACTIONAL ANALYSIS

A Psychotherapeutic tool
Developed by Dr Eric Berne
In 1960's

Transaction

STRUCTURAL ANALYSIS

Parent Critical
Nurturing
Adult
Child Natural
Adapted

Ego States

RECIPROCAL / COMPLEMENTARY
TRANSACTIONS

A: "Have you written the report?" (Adult to Adult)

B: "Yes - I'm about to email it to you." (Adult to
Adult)
-----------------------------------------------------------------A: "Would you like to skip this meeting and go
watch a film with me instead?" (Child to Child)
B: "I'd love to - I don't want to work anymore, what
should we go and see?" (Child to Child)
-----------------------------------------------------------------A: "You should have your room tidy by now!"
(Parent to Child)
B: "Will you stop hassling me? I'll do it eventually!"
(Child to Parent).

CROSSED TRANSACTIONS

A: "Have you written that report?" (Adult to Adult)

B: "Will you stop hassling me? I'll do it eventually!"
(Child to Parent)
-----------------------------------------------------------------A: "Is your room tidy yet?" (Parent to Child)
B: "I'm just going to do it, actually." (Adult to Adult)
-----------------------------------------------------------------A: "I can never trust you to do things!" (Parent to
Child)
B: "Why don't you believe anything I say?" (Child
to Parent)

A: "This model is the best but you can not afford

it"
B: "I will take that one"
-----------------------------------------------------------------A: "Would you like to skip this meeting and go
watch a film with me instead?"
B: "I'd love to - I don't want to work anymore, what
should we go and see?"

THREE RULES
So long as transactions remain complementary,
communication can continue indefinitely
When a transaction is crossed, a break in
communication occurs, one or both have to
change their ego states
The behavioural outcome in ulterior transactions
is determined at psychological level and not at
social level

FOR EFFECTIVE
COMMUNICATION
Plan transaction
Respond to transaction
Identify other's dominant / current ego state
Invitation to move to a different ego state

INVITATION TO ADULT
Stating few facts
Asking a question
Asking opinion
Asking a view

INVITATION TO PARENT
(NURTURING)
Asking for help
Asking for advice
Asking for expert opinion
Communicating your fears & worries

INVITATION TO CHILD
(NATURAL)
Being one yourself
Being enthusiastic
Showing funny side of the situation
Showing unconventional way of looking at things
Going yourself to nurturing parent

4 LIFE POSITIONS

"I'm Not OK, You're OK"

"I'm Not OK, You're Not OK"
"I'm OK, You're Not OK"
"I'm OK, You're OK"

7 LIFE POSITIONS

"I'm not-OK, You're OK"

"I'm not-OK, You're not-OK"
"I'm not-OK, But You're Worse"
"I'm not-OK, You're Irrelevant"
"I'm a Bit More OK Than You Are"
"I'm OK, You're OK"
"I'm OK, You're Irrelevant"

Thank You
Examples in TA quoted from the book
Games People Play by Eric Berne