2.
2 Effective Communication
Teamwork, Safety, and Just Culture
Effective Communication Skills
What is a Just Culture?
A Just Culture is predicated on the belief that conscientious professionals do not intentionally
commit errors. Yet, all professional environments, including healthcare, are made up of
fallible humans who make mistakes. We can only learn from those mistakes if we can openly
discuss them and learn from them. To discuss mistakes and learn from them openly, there
must be a culture of mutual trust and respect built on open communication, teamwork, and
inter-collaborative practice. The following videos provide an excellent introduction to the
concept of Just Culture.
Interprofessional teams function best within a just culture. Just Cultures create an
environment in which mistakes are discussed openly and corrected from a system level rather
than a punitive, individual level. The purpose of correcting errors at the system level is to
promote safety and improve quality for everyone, not just the person who made the mistake
closest to the patient. For example, let us consider the number of errors that were committed
in the Vaught/Vanderbilt cased study before the final one that led to the patient’s death, using
a process called root-cause analysis. Root Cause Analysis is exactly what it sounds like. It is
seeking the source of the variance in quality and creating continuous quality improvement to
eliminate the cause. The Institute for Healthcare improvement has many different tools and
techniques for completing Root Cause Analysis that you can explore at https://www.ihi.org/
Just cultures share very similar values to interprofessional teams and interprofessional teams
thrive best in a just culture. So, what skills are necessary to build a well-functioning just
culture? People actively seeking to build a just culture and promote interprofessional teams
need strong communication skills, empathy, and emotional intelligence. This week, we will
explore these three skills, then apply them to the Vaught/Vanderbilt case study in an activity
designed to challenge us to think about our own work environments and how we can act as
change agents to promote both just culture and interprofessional teamwork.
Just Culture Resources
Expand each section to view the Just Culture resources.
Video: Annie's Story
Video: A Just Culture Guide
Video: What If Healthcare Embraces Just Culture
PDF: Just Culture Guide
Read Just Culture Guide.
Vaught/Vanderbilt Unfolding Case Study
In the Vaught/Vanderbilt Unfolding Case Study, we want you to focus on where
communication and teamwork failed and where they worked. For example, think about:
1. Ms. Vaught’s communication of her mistake to the hospital
2. The hospital’s communication with the family
3. The hospital’s written communication with the death certificate and, ultimately CMS
4. The Nursing Admin’s communication of the mistake to the TBON
5. TBON’s communication with Ms. Vaught
6. The whistleblower’s communication with outside agencies
7. CMS’ communication with everyone
8. The ADA’s communication with Ms. Vaught, press and the hospital
9. TBONs backtracking of previous decisions
10. The Press
11. There are many others that you can probably identify
Next, think about the team dynamics and interprofessional groups. Where did the teams
work? Where did they break down? Where did Just Culture fail, and where did it work?
Where could acts of incivility have occurred and an unsafe environment have been created
for both patients and professionals?
Think about how these worked to create the system failure that set up Ms. Vaught’s mistake.
Select "Next" below to proceed to the next page.
Communication and Teamwork
Photo by Brooke Cagle on Unsplash
Communication and teamwork are complicated and multifaceted concepts. Both require
empathy, emotional intelligence, and an ability to have difficult conversations.
Most of us were first exposed to the essential elements of effective communication in our
Fundamentals of Nursing class during our first semester of nursing school. We were taught
the definitions of communication concepts but not necessarily the “how” of good
communication. It is one thing to be told to “use open-ended questions” and a whole other
thing to learn how to work them into everyday conversation. It is also a “next level” skill to
be able to read non-verbal communication. These skills take conscious practice in a real-
world setting to develop.
What are essential skills necessary for good communication? One can peruse any nursing text
from prelicensure to doctoral education that discusses communication and find a similar list
as the one provided below.
Essential Elements of effective communication include:
1. Listening
2. Non-verbal communication
3. Clarity and concision
4. Friendliness or tone
5. Confidence
6. Empathy
7. Open-mindedness
8. Respect
9. Feedback
10. Context – picking the right form of communication.
Many of these concepts are interlocking. For example, one cannot communicate respectfully
without being open-minded. One must be willing to receive feedback to effectively provide
feedback. One must understand the difference between empathy and sympathy to speak with
emotional intelligence and have the confidence to correctly interpret non-verbal cues.
For a message to be concise and clear, it must be placed in relevant context. Our tone of
voice is a clue to our non-verbal communication. Studies tell us that in face-to-face
communication, about 55% of the message is conveyed through nonverbal cues. Another
38% is conveyed through vocalizations—tone, and the remaining 7% of the message is
conveyed through spoken words (University of Texas Permian Basin, 2024).
If we need empathy to interpret nonverbal, what is empathy, and how can we develop
empathic skills?
Empathy
What is empathy and how does it differ from sympathy? How does empathy help us build
emotional intelligence?
Watch this video to learn more about empathy.
Before we can seek to develop our empathic skills and improve our ability to communicate,
and function within an interprofessional team and promote just culture, we must understand
what empathy is. Empathy is understanding someone else’s perspective. It is placing yourself
in their shoes and trying to see life from their eyes and feel it from their heart, whereas
sympathy is bad for someone but not entering their emotional world. The concept of
empathy is embedded in the very word “patient”. The Latin root word for “patient” is
“patientem”, which means the suffering one (Online Etymology Dictionary, 2021/2024).
When we call our patients “patient” we are making a verbal contract with them to enter their
suffering, or to practice empathy in. our interactions with them. To truly practice empathy
with our patients we must carry over to all stakeholders involved in their care. When our
practice of empathy carries over to all members of the healthcare team, it will actively
promote a just culture. How can we express empathy? Empathy is understanding someone
else’s perspective. It is placing yourself in their shoes and trying to see life from their eyes
and feel it from their heart. Sympathy is feeling bad for someone.
How can we express empathy?
1. Listen
2. Ask for elaboration
3. Paraphrase
4. Verbalize
5. Validate
Learning to be empathic helps us to become more aware of our own and others’
emotions. This awareness opens the door to better emotional intelligence.
Emotional Intelligence
Effective communication begins with emotional intelligence. Emotional Intelligence is an
understanding of our emotions in relation to what we know about ourselves (self-awareness
and social awareness) and what we do in response to those emotions (self-regulation and
relationship management).
We live in a Western culture that has valued logic over emotion for centuries. In Western
culture, emotions are considered weak, something to avoid. Many think that emotions cloud
judgment and cause rash decision-making while logic allows rational thought to prevail and
guarantee good decisions. However, God gave us emotions for a purpose. Psalms 4:4a
(KJV, 1611/2017) says to “be angry and sin not.” If God thinks it is possible for us to be
angry without sinning, then there must be a way for us to understand our emotions
proactively rather than reactively and use them to help us make better decisions. There must
be a way that we can experience emotions without being paralyzed by them, being reactive to
them, divorcing them completely, or allowing them to cloud our judgment. There must be a
way we can use them to tune in to the people around us, inform our decision making and be
proactive in our choices. This is emotional intelligence. As we go through this section of
this week’s content, listen closely to what the speaker Ramona Hacker has said about how to
develop emotional intelligence.
Emotional Intelligence Resources
Expand each section to view the Emotional Intelligence resources.
Website: Emotional Intelligence in the Workplace
Read Emotional Intelligence in the Workplace: What is it, And How Can it Help?
Video: 6 Steps to Improve Your Emotional Intelligence
According to Ramona Hacker, Emotional Intelligence requires three skills:
1. Emotional awareness or empathy,
2. The ability to harness emotions an apply them to thinking and problem solving, and,
3. The ability to manage the emotions of self and others.
According to Hacker, there are 6 steps to improving our emotional intelligence:
1. Acknowledge our emotions as something valuable. God created emotions for a
purpose. They are like the physical symptoms in a body. Emotions are given to us by
God to help us take a mental and spiritual temperature of our emotional health.
2. Differentiating and Analyzing emotions. When experiencing emotions take their
temperature to see what these feelings are telling us about our current situation. In his
book The Gift of Fear, former FBI agent Gavin de Becker, describes fear as a survival
signal. He states that if we listen to the emotion of fear when it arises, it can save our
lives.
3. Accept and appreciate emotions. Emotions are neither good nor bad. They gain their
meaning through societal definitions.
4. Reflect on your emotions and their origins. Often, knowing why we feel the way we
do will often help us handle our emotions.
5. Handle your emotions. Each person will have their own way of handling their
emotions.
6. Handle the emotions of others. Under doing and awareness are the keys to helping
others handle their emotions.
Once we have developed some skill with EI, we are ready to take on the task of effective
communication, especially in those situations that require difficult conversations.
How to Have Difficult Conversations
Several years ago, IWU had a speaker who discussed how to have difficult
conversations. One of the most significant things she said was that we must speak truth with
grace. If all we speak is truth, people will not hear our message. If all we speak is grace, then
we never get to the tough messages that must be addressed. There must be a balance of truth
and grace. The Apostle Paul calls it speaking truth in love “Instead, speaking the truth in
love, we will grow to become in every respect the mature body of him who is the head, that
is, Christ (NIV< 1978/2017, Ephesians 4:14-15).”
Watch this video to learn more about how to have difficult conversations.
References
De Becker, G. (1997/2010). The Gift of fear. Donadio & Ashworth.
Hacker, R., (ND). 6 steps to improve your emotional intelligence. TEdxTalks. Retrieved
from: https://www.youtube.com/watch?v=D6_J7FfgWVc
McGuiness, C., (2020). 10 important elements of communication in 2020. LinkedIn.
Retrieved from: https://www.linkedin.com/pulse/10-important-elements-effective-
communication-2020-mc-guinness/
MedStar Health. (2014, March 19). Annie's story: How a system's approach can change
safety culture [Video]. YouTube. https://www.youtube.com/watch?v=zeldVu-3DpM
New International Version: Holy Bible. (2011). BibleGateway.com.
https://www.biblegateway.com/versions/New-International-Version-NIV-Bible/ (Original
work published 1978)
NHS Improvement. (n.d.) A just culture guide: Supporting consistent, constructive, and fair
evaluation of the actions of staff involved in patient safety incidents. NHS England.
improvement.nhs.uk
NHS Improvement. (2018, March 15). A just culture guide [Video].
YouTube. https://www.youtube.com/watch?v=zje765OEggs
Robbins, M. (2021, May 15). How to have difficult conversations [Video].
YouTube. https://www.youtube.com/watch?v=GeZU5JgomiE
Salerno, N. (n.d.) Emotional intelligence in the workplace: What is it, and how can it
help? Indeed for Employers. https://au.indeed.com/lead/emotional-intelligence-in-the-
workplace-what-is-it-and-how-can-it-help?
gad_source=2&gclid=EAIaIQobChMI3Jmy@45zxgwMVvEZ_AB2IugSHEAAYASAAEgI8
V_D_BwE&aceid=&gclsrc=aw.ds
Steinborn, M. (2021, September 10). Psychologist on how to be more empathic | Empathetic
[Video]. YouTube. https://www.youtube.com/watch?v=SIuwJ7kb3EA
TEDx Talks. (2018, February 21). 6 Steps to improve your emotional intelligence | Ramona
Hacker | TEDxTUM [Video]. YouTube. https://www.youtube.com/watch?v=D6_J7FfgWVc
TEDx Talks. (2020, September 14). What if healthcare embraces just culture? | Jean-Pierre
Kahlmann | TEDxWassenaar [Video]. Youtube. https://www.youtube.com/watch?
v=tHdsxY1PU4Q
