We can never have too much communication

What are the three foundational elements of successful change?  Communication, communication, communication.

In any continuous improvement culture, there is change, and hopefully a lot of it.  In fact, kaizen, in Japanese means “good change” (change for the better).  On an earlier post, I talked about a few Change Management Secrets and my main focus was the same as today’s post: communication.

When we are trying to drive improvement, we need to communicate three things:

• Communicate that the change is coming
• Communicate while you are performing the change
• Communicate after you are done with the change

And even though it may sound like I am saying we only need to communicate at three distinct moments of the implementation, that is not what I mean.  Communication must be constant and in abundance.  It has always been my belief that you can never over-communicate and I have not found a place where that is more true than in healthcare.

I was recently facilitating improvement events at a hospital and after they had mapped the process and identified opportunities for improvement, the team was ready to carry out some small tests of change.  In these events, I encourage teams to use the P-D-S-A cycle to guide them through the test.  On the day of the proposed change, I asked how everything was going and I got an earful: “The PACU (Post-Anesthesia Care Unit) nurses are not being cooperative.  They are sabotaging the test and it is not working because we need their support for this to work…” you get the idea.  As we all know, there are two sides to every story, so I went to look for the second side of this story.  I visited with the PACU nurse manager and I did not even have to ask about the P-D-S-A.  About two minutes into the conversation, it came up.  What do you think was the other side of the story?  “Surgical services decided to perform this test of change today, but we are not staffed adequately for this.  Two of my nurses called in sick and we had not planned for this.  We are trying to be supportive, but we feel today is not the best day to try this.”  Ahh!!!  There it is!  Communication was virtually nonexistent about this test of change.  And when you realize that they did not communicate appropriately with a critical stakeholder, you are probably not that surprised that the test of change was failing.

Why is it so hard for people to communicate in these instances?  I honestly have not figured this one out yet.  I have a few speculations though:

• The people that are immersed in the change cannot put themselves in the position of those outside of the core team, which are not as familiar with the team’s plans… A sort of “curse of knowledge” so widely discussed in the book “Made to Stick”.  Countermeasure:  We must be very deliberate in trying to understand others’ frame of reference when we are communicating.
• People only communicate in the way they understand and the way they want to be communicated to.  Different people grasp things in different ways.  Countermeasure:  We must be exhaustive in the means and messages we use to communicate change and improvement.
• The people driving the change are on a different phase of the Change Curve than others affected by the change.  This is sort of a variation of the first bullet, but deserves to be treated separately.  The people driving the change are way ahead in the curve than those that are just learning about it.  Countermeasure:  We must realize that different people go through the phases of change (denial, frustration, anger, acceptance, hope, excitement, etc.) at different rates and good communications help close the gap between those ahead of the curve and those just getting started.

I cannot close this post without saying that even when you think you have done a great job communicating, communicate some more and keep people apprised on everything you are planning, everything you are doing and everything you have done.  I guarantee a much greater chance of success for your improvement efforts.

Do you have a good story about communication, or lack thereof, during continuous improvement efforts?