Team Building and Communication in High-Reliability Health Care

Research in areas of employee communication suggests that successful communication strategies must include a decisive effort to connect management's vision with employees at every level. If the vision of management and the overall vision of the organization are not communicated to employees, there may be a breakdown in the development of goals and employee satisfaction, as employees will feel they have no connection to the ideals and standards of management — and therefore to the work they contribute to the organization. Kleinbeck et al. conclude that the better the communication between leaders and employees, the better the organizational structure and function (Kleinbeck, Quast, Thierry, & Hacker, 1990, p. 136). Without this connection, empowerment is not likely to be present and employee satisfaction will likely suffer (Dew, 1997, p. 6).

Differences in centralized versus decentralized communication strategies can often result in mixed messaging to key constituents, which can have a sustained impact on the reputation of supervisors and collaborators within the organization. Mintzberg (1979) notes that managers individually carry in their heads a rich, dynamic map of their policy domains that they are continually updating. However, these maps are informal and largely undocumented, and are not communicated well to subordinates or colleagues who might be able to use the information to the organization's advantage (Ozen & Ulengin, 2004, p. 6).

Delivery methods and issues of inconsistency can also be measured in terms of overall employee satisfaction. Employee satisfaction and goal attainment often depend on consistency of communication, as perceptions of inconsistency can create unintended results including employee confusion and dissatisfaction:

"If the receiver's integration process results in a perception of consistency, then, happily, the outcome is actualization of the intended communication goal and possible positive affect. If, however, the perception of the receiver is that there is inconsistency, the outcome is goal failure, confusion, and possible undesired negative affect. Positive and negative evaluations often feed back to the firm and may influence subsequent efforts." (Schumann, Dyer, & Petkus, 1996, p. 54)

The value of creating communications perceived as congruent with both the vision of the organization and the agent's view of the processes for achieving it is essential to communication structure, effectiveness, cohesive reliability, and increased competitive advantage.

Each level of an organization requires support from above and below in order to function. A critical aspect of this support is communication. Communication in general determines the standard by which individuals understand the vision of the organization and the vision of each functional team within it. If a communication breakdown occurs, teams will likely be weak, as each unit will be defining and developing activity beyond project development in terms that differ from those of the whole and from each other.

Communication must occur at every level to ensure that all perspectives are seen as essential to the overall process vision, and to ensure that the organization can be defined and developed as a high-reliability organization (HRO). The communication of changing vision is particularly important, as organizations are increasingly involved in transitional cultures that can — and often do — alter the traditional models of vision that employees have been working toward. Dynamic organizations are frequently in a period of functional and idealistic change, which requires reiteration of updated vision from and to every level.

"The advice of corporate communication professionals who enjoy high credibility in their firms is increasingly sought at the highest levels of a firm in decision making about how changes in strategic direction affect stakeholders; what changes in culture are required when a new strategic direction is taken; and what high-level communication plans are needed to implement new strategy, vision, and mission." (Forman, 2005, p. 209)

Vision shifts can in fact be a strategic part of planning for change in a fluctuating and competitive business environment. Yet if that vision is received as incongruent with past visions — or diametrically opposed to employee standards and ideals — there will likely be a breakdown in the process and a loss of employee motivation (van der Heijden & Verbaan, 2005, p. 35). Bielski defines a good manager as one who is able to effectively communicate and demonstrate the vision of the organization: "Right up there with respecting employees, having emotional intelligence or communicating often complex information effectively, good leaders demonstrate the vision, build coalitions, and influence the rank and file in the art of execution" (Bielski, 2005, p. 21).

If such vision communication is lacking, or if the individual has previously been seen as ineffective and therefore lacking credibility, the vision may be lost in the rhetoric of communications and become disconnected from the employee base — no matter how effective the vision is at its source. Jameson discusses the writer-reader relationship in business communications in terms of unintended results:

"Writers achieve an appropriate writer-reader relationship in business prose not by merely switching from their own to the reader's viewpoint but by artfully interweaving multiple rhetorical and linguistic elements. The writer-reader relationship is expressed through the many possible combinations of vision and voice, which originate in the textual identities of the implied writer, the implied reader, and, sometimes, other characters." (Jameson, 2004, p. 227)

Legitimate communication of vision is so essential to the process of aligning employees with a common goal that a missing or unclear common goal will likely fail — or be interpreted and acted upon in unexpected, unintended ways. For example, in health care delivery, if there is a consistent emphasis on cost management with no equal emphasis on high-quality care, individuals in the system may reduce care quality by denying needed services for the sake of cost-cutting. If this occurs, the institution may be deemed an unreliable organization, and where alternatives are available, health care consumers may intentionally seek care elsewhere.

The delivery method for communicating vision and subsidiary information is an essential decision-making strategy for managers, as recognizing the most effective model for the business structure and the message being conveyed is paramount to how the communication is received. Delivery methods have become increasingly dependent on IT structures, which can and often do give rise to what might be called a virtual team (Awadzi Calloway & Awadzi, 2005, p. 28). Over the last twenty years, as other forms of communication have tended to incur considerable cost and consume time that dynamic organizations do not wish to expend, electronic communication has grown dominant. Though many firms still utilize paper office memo-style communications, hard-copy methods may not hold the same weight of convenience as intra-organization email. One example of technology-supported communication in practice is a health care delivery charting system that checks and supports desired care strategies (Pelletier, 2005, pp. 1087–1088).

It is essential, however, that in an environment of easy electronic communication, a new set of ethics must also be addressed, along with the challenge of creating understanding without the personal characteristics of face-to-face meetings. Though email communications will never completely replace face-to-face interaction, they have significantly reduced the time it takes to communicate a message — not always a positive outcome — as well as the cost of messaging. One aspect of the ethics of electronic communications is that people feel an insular autonomy implied by the format, and they often choose to communicate at many times of day and night, sometimes regretting that a message was not made with appropriate forethought. The social dimension of work communications must not be ignored, as the dynamic of email can seriously alter the human element of work (Rooksby, 2002, pp. 2–3).

In the management–employee relationship, depending on the size and structure of the organization, the dynamic of distance may be assumed and even relied upon as a foundation of authority. At the same time, the goal of management may be to connect more personally with individuals to ensure a common vision and understanding, as well as a relationship that demonstrates teamwork and employee empowerment. Management may choose a more personal delivery method — through electronic means, a personal letter, hard-copy memo, or even a face-to-face meeting — for important issues. The method is at the manager's disposal, but the delivery method can shape the message and give it more or less meaning, depending not only on content but also on form.

With any written communication there are challenges regarding content and style. If a manager is to be effective, certain individual characteristics must be conveyed in addition to the core message. Personalization and humor can be challenging to express via written communications, though they are said to be essential to good management (Green & Knippen, 1999, p. 45). If communications all revolve around the written form — and especially the electronic written form — there could be a loss of the personal dimension so essential to appropriate social culture within the workplace. The effective manager balances the necessary characteristics of good leadership that link individuals together in a common vision and action plan, and does so by appropriately choosing delivery methods that reflect the correct level of communication for the message being sent.

Consistency is essential to appropriate communications because it establishes a standard that individual employees recognize as the expression of the common goal, as it revolves around the organizational vision. In the case of inconsistent communication, the message is fractured and the employee may feel that the timeliness of communications does not meet the needs of goal development and implementation for team building. Another form of inconsistency can occur when agents see differing perspectives based on the nature of their particular job set, and when these perspectives are not given appropriate weight in communications. Though it is essential that agents with a narrowed view communicate the needs of their particular local context effectively, communications centered on local needs can potentially undermine central communications — and vice versa (Xuan & Lesser, 2002, pp. 2–3).

Inconsistency is generated between local agents and their subordinates when the goals stated in local or departmental messages do not reflect the broader vision, or the reverse. This can create in the employee a sense of not only a lack of a common goal but a demonstrable breakdown in communication between team managers and those above them. Differing messages can create confusion about goals and job tasks, leaving employees unable to independently determine the next appropriate action and lacking in motivation. As Massey points out, inconsistent communication in crisis management is the most fatal error, and crisis can in fact result from originally inconsistent communication:

"The reason organizations should engage in consistent crisis communication is that 'audiences may challenge the truthfulness of the account' (Ginzel et al., 1993, p. 240) if inconsistent responses are given. As Coombs (1999) states, 'consistency is essential to building the credibility of the response. A consistent message is more believable than an inconsistent one' (p. 117). Furthermore, if the organization provides inconsistent crisis responses, the image of the organization can be tarnished. 'Such behavior can destroy the trust that might have been put in the company.... The ideal is to be able to speak with one voice.'" (Massey, 2001, p. 153)

Not only can the credibility of the entire organization be challenged, but inconsistent communication can also undermine the credibility of the individuals involved. In a crisis state — or even under normal conditions — inconsistent or contradictory communication can seriously damage employee motivation and satisfaction, making individuals feel that management is not capable of defining the needs and responsibilities of any given department or individual.

Conversely, consistent communication can unite team members around a common set of goals and vision, provided that such communication does not become so routine that it is considered perfunctory and ignored. When individuals face moments of indecision and must seek guidance, consistent communication can serve as a reliable guide. However, when everything is running smoothly, overly consistent, monotonous communication may be ignored — even when crucial information is embedded within it (Crossman, 2003, p. 72). It is therefore the manager's responsibility to vary communications just enough that individuals receive all pertinent information, without the problems of monotony or excessive inconsistency. The manager must evaluate information based on its level of importance and create an appropriate method of delivery that reflects its essential nature.

Strategic project management is an essential team-building exercise that employs all aspects of strategic planning and develops through steps that, if applied correctly, seem concrete to those involved, creating both short-term and long-term decision-making and action (Grundy & Brown, 2004). Strategic project management also employs collaboration and teamwork as essential elements. Through it, teams can complete concrete tasks best suited to each member's abilities and perspectives, then cultivate completed works through dimensions previously opaque to many parts of the organization. Consistency is developed through a balance between the team and its leader, as well as through the ability of individual team members to fulfill project-based tasks in ways that effectively meet the needs of all involved. Essentially, strategic project management has become a new and essential component of many HROs.

According to Hatton and Raymond, businesses that work are those that most effectively bring together all the information needed to successfully complete tasks, in a manner reflective of both the tasks being done and the structure of the business. Hatton and Raymond rely on primary sources and seminal theories in business research: