LEADERSHIP

Engaging in Assertive Communication—Why It’s Vital for Health Care Leaders
Being able to communicate with colleagues and staff clearly and effectively is a key component of leadership, particularly in the health care space, which has faced unprecedented challenges in recent years partly due to the COVID-19 pandemic. 

Indeed, communication problems have become more acute since the start of the pandemic, as selected care services transition to telemedicine and some staff adopt remote or hybrid (a mix of in-office and at-home) work schedules. 

Although most leaders would describe themselves as effective communicators, many are lacking in the fundamental qualities and skills needed to get their message across in ways that allow all parties in a dialogue to feel valued, according to M.J. Clark, vice president at Integrated Leadership Systems in Columbus, Ohio. 

In fact, effective communication starts with effective listening, she says. This was a key theme of the session titled “Assertive Communication for Health Care Leaders,” part of the SHSMD Connections conference in September, which also included SHSMD board member Terri Flood, MHA, vice president of business development at Wayne HealthCare in Greenville, Ohio. The full session from the Connections conference is available here, and an episode of the SHSMD podcast on the same subject can be found here. 

“What I’ve found in coaching is that the more I coach people up the [leadership] food chain, the worse their listening skills become,” Ms. Clark explains. “I think as we get busier, we think, ‘I’m going to be really direct. I’m just going to say what I’m going to say and they better get it,’ but that doesn’t always work.” 

Common Communication Challenges
During the session, audience members offered their own communication challenges. Those cited included:

• Engaging with multiple stakeholders in large health systems, particularly if they’re spread out among several facilities and/or working remotely.
• Establishing “virtual meeting etiquette” for staff working from home.
• Training providers offering telehealth in virtual communication skills. 

These and other communication problems can be addressed through planning and practice, according to Ms. Flood. 

For example, the ideal setting for effective communication is face-to-face and, if that’s not possible, speaking by phone or videoconferencing can suffice. “We tend to hide behind technology, and rely on email,” Ms. Clark says. “People don’t use the phone enough.” 

Verbal communication, either in person or by phone/web, reduces the risk for someone misinterpreting the message or taking offense, she adds. 

Meanwhile, creating standards for virtual meetings, including telehealth, can also prevent mishaps, such as staff not wearing proper attire or appearing to be distracted while others are speaking. Establishing what’s expected of staff, including providers, during virtual meetings—by addressing issues such as what to wear, when to turn cameras on or off and when to speak—is crucial, according to Ms. Clark and Ms. Flood. These standards should be established as part of a formal policy, which should be reinforced with training, they say. 

Given the increased reliance on virtual communication, both for business and clinical staff, training sessions should be considered as well, the speakers add. 

The Importance of Effective Listening 
Effective listening should be a key component of communication standards and training. This involves ensuring that all parties in a conversation feel heard, according to Ms. Clark. 

The hallmarks of effective listening are: 

• Making eye contact with speakers.
• Mirroring and/or validating the speaker’s emotions by acknowledging and accepting them.
• Responding in ways that suggest to speakers that you’re engaged with what they’re saying.
• Not thinking about what you’re going to say next but, instead, focusing on listening,
• Asking questions (without interrupting).
• Observing nonverbal communication, including hand gestures and facial expressions. 

As the emphasis on listening suggests, assertive communication, as Ms. Clark and Ms. Flood define it, isn’t merely about being direct or aggressive in communication with colleagues. The goal should be, ‘I want to win and I want you to win, too,” Ms. Clark explains. 

Remember, she adds, communication is a loop, meaning it involves more than just saying what’s on our minds. We need to make sure people understand what we say, and that starts with making an effort to understand them as well. 

Achieving that often means understanding not only what is being said but the emotions (e.g., frustration or anger) behind the message. In general, human behavior is dependent on a person’s emotional state at the time (see the table below). Passive-aggressive behavior, for example, typically comes from a place of low self-confidence; the primary motivation of someone exhibiting this behavior is “approval-seeking,” according to the speakers. 

Similarly, aggressive behavior often stems from low self-confidence and a need to control others, they say. 

Conversely, a person exhibiting assertive behavior is confident and wants to connect with others, hence the importance of effective listening. 

How To Be Assertive
Beyond effective listening, Ms. Clark and Ms. Flood offer three keys to assertive communication. 

The first step is to present your perspective in a fact-based fashion. For example, if a colleague is exhibiting behavior that is troubling, it is best not to start with how the behavior makes you feel. As opposed to saying, “When you ‘x,’ I feel like,” try something like, “I’ve noticed you have been doing ‘x.’ Have you considered the effect of that on the team?” 

Next, you can begin to describe how the behavior makes you feel, personally, but rather than a detailed rundown of your emotions, synthesize your thoughts and feelings into one word, Ms. Clark and Ms. Flood advise. This can help you reframe negative thoughts and manage your emotions during communication. Instead of saying, “When you ‘x,’ I feel like you’re disrespecting me,” try, “I feel disrespected.” 

Finally, ask for what you want to be different in the person’s behavior using skillful language that states your thoughts clearly and in a way that isn’t argumentative. Try saying something like, “I would ask this” or “I would prefer this.” 

These steps may not come naturally to many, which is why Ms. Clark and Ms. Flood recommend that you practice these techniques at home, in your personal life, with family and friends, before implementing them at work. 

Ms. Flood sums up their take-home message as follows: “Write down your communication goals and practice them regularly,” she advises. “Listen effectively to others so you will be heard as well. Know that emotions and behaviors come from our thoughts, [so] take charge of how you think and reframe negative thoughts to better manage your emotions. Finally, use skillful sentences that don’t elicit arguments for better conversation outcomes.”