“generating, transmitting, receiving, and interpreting messages.” This definition applies to all communication, whether it is in a factory, between individuals, or in a hospital setting. The hospital in which I work has a problem with the flow of communication. This is common in a tall structure where it is necessary for information to flow downward. Many times, information begins the downward descent not correctly encoded. This leads to misinformation being passed down through the ranks of the hierarchy starting with the Board of Directors, then proceeding to the department heads, then continuing with the department managers, and ultimately stopping with the staff. It is at this point that the “hospital grapevine” is set into motion. This pattern has most recently emerged with the announcement of the restructuring of the hospital. I will discuss how the administration handled the situation, as well as give my recommendations as to how it should have been handled.
The CEO and Board of Directors announced in early l998 that the hospital would be bringing in a group of consultants to “trim the fat” and help the hospital become more competitive and profitable. The consultants arrived and began their examination of every department in the hospital. The group spent about one month interviewing employees, doing time studies, and going over hospital policy and procedures. The staff felt that they had played an integral role in helping the group gather information as well as giving them their opinions’ via the interviewing process. However, when the consulting firm left, management failed to share the information with the staff.
The staff lodged complaints with their respective department managers, who in turn informed the department heads, and then the Board and CEO were notified. The upper management decided to schedule meetings for each individual department to discuss the firm’s findings. However, meeting times and places changed without prior notice, or the meetings were canceled altogether. The meetings that did take place were unorganized and each department was given different information. Eventually, the concept of the meetings were abandoned entirely.
Administration took a different approach to dispersing the information, or a least part of the information, that had been gathered by the consultants. Three plans for the restructuring of the hospital were set out for the staff to view. No formal forum was designed to discuss the impact that each plan would have on the individual departments. In each plan, departments were moved or merged with other departments with no explanation as to how these departments would be governed. Speculation and supposition began to run rampant among the staff.
Rumors of personnel cuts began to circulate through the hospital. Several versions of the same story were being told. One version was that lab personnel would be eliminated and the respiratory staff would be trained to do the lab draws. In another version, respiratory staff would be cut and nursing would be doing the therapy. This rumor caused a great deal of tension between the departments. Each department became defensive for fear of losing their jobs.
Merging of the departments appeared to be eminent because each plan contained integrating of departments in some fashion. Talk of Pediatrics and Intensive Care fusing with the Medical Surgical floor caused many to wonder about the quality of patient care and the perception that the community would have about the hospital. The “grapevine” was picking up where administration left off, filling in the blanks with conjecture and gossip. As Alexander Pope conveyed in The Temple of Fame, “And all who told it added something new, And all who heard it, made enlargements too.” This is exactly what was happening in my hospital.
The problem was intensified by the fact that management did nothing to dispel any of these rumors. Some of the department heads were actually participating in the “grapevine” chain by telling parts of what they heard from upper management. These bits and pieces of information became distorted and blown out of proportion, and because they were coming from middle management, the staff assumed these rumors to be true. Ironically, the “grapevine” is often a good source of information with accuracy around 78-90 percent, according to the Hanna/Wilson text. The informal network, or “grapevine,” is one of the most believed forms of communication that an organization posses with one survey reporting that 57 percent of the respondents thought that the “grapevine” was the “only way to find out what’s really happening.” Obviously, the staff at my hospital felt this way also, but the accuracy was not meeting the standards as described in the Hanna/Wilson text.
I feel that there were many avenues that management could have, and should have, used to keep the staff informed, the most simple of those being simply to report the findings from the consultant firm. A detailed report distributed to the department heads and posted with a sign off sheet would have insured that all members of the staff had access to the information. An all staff meeting, held after everyone had a chance to look at the report, would be necessary to clarify the report and answer any initial questions the employees may have had.
The next step in assuring that the personnel was properly informed would be to poll the staff on which plan they felt worked best for the hospital. It would be important to note that would mean not voting for what was best for specific departments or individuals, but ultimately for what would benefit the hospital as a whole. I think that it would be important to be honest with the employees at this point, if staff cuts are necessary, that information should be given up-front.
Thirdly, a multi-disciplined task group should be formed to help facilitate any retraining necessary in the restructuring process. This group’s main function would be to develop cross-training programs. Cross-training would help cut down on the loss of jobs because employees would be trained to do more than one job, thus making a more efficient and cost-effective worker. The second benefit of this cross-training approach would be assurance to the community that our staff is equipped to handle many different scenarios. The benefits of such a program would make the hospital better capable of competing in an ever advancing market.
Meetings with each department would be necessary to address any unique problems that may arise for that particular group. In these meetings, any discussions relating to job specific changes warrant deliberation. Those departments that are going to move and perhaps take care of a different patient population need to be instructed on any education or training that they would be required to undergo. It would also be important to discuss any fears that may be derived from the changes. Management needs to be sensitive to those fears and reassure staff that proper training will take place before the transition.
Finally, management should learn to use the “grapevine.” Employees value the “grapevine” in such a manner that communication could be enhanced if the informal network were to be channeled and given some structure. Since the hospital is a tall structure, and that probably is not going to change, then simplifying the flow of information could be achieved by streamlining the process by which information is delivered. Instead of scheduling meetings, then not keeping them, a simple memo to the department heads and department managers should suffice. The department managers could then have a department meeting where the information is discussed. This method would create a more relaxed forum where questions could be asked and discussion could take place with a smaller, more intimate group. Management also needs to relay to the employees that their opinions’ are valued and encouraged; this would also stimulate constructive discussions and, ultimately, a smoother transition toward restructuring.
The communication in my hospital is damaged, but is able to be repaired. If the situation were handled in the method outlined above, several positive outcomes would emerge. Most of the suggestions I diagramed are as simple as keeping the employees informed with correct information. When employees feel that they have been kept abreast of important issues, they can then offer their experience and knowledge to almost any situation. Employees that are kept in the dark feel as if the organization does not value them, let alone their thoughts and ideas, it is at times such as this that gossip and innuendo take the place of truth and fact. Erica Jong put it best in her work The Fear of Flying, “Gossip is the opiate of the oppressed.”