This long term care facility had no communication.
This long term care facility had very poor to no communication. There were four stations. One was lock down Alzheimer unit. One was acute care (ready to leave hospital but not well enough to go home). The other two were regular nursing home type stations. The DON never sent out memos regarding anything. The only way that I (being the weekend RN Supervisor) could contact my LPN’s who were in charge of each station was by texting them or by walking to find them. Assignments were not posted, so I didn’t know who was responsible for what. All I knew was which LPN had which station. I only knew this because it never changed. The CNAs had their own special computers to do their charting. It was the LPNs responsibility to make certain they charted. I didn’t know how to check. The main charting was still done by hand. Only certain LPNs could get into the computer to retrieve labs, etc.
Management was not communicating with other departments or with the staff. There was no open door. If someone wanted to talk to the DON, they had to track her down or text her. It looks unprofessional for nurses to be on their cell phones while working, even though they are using them for work. Families and residents have no way of knowing what their nurse is doing on her cell phone.
Command structures and related organizational policies are open efforts to incorporate and make instructions, directions, commands, and orders routine so that actions may be coordinated and superordinate goals may be completed, and completed proficiently. Many “face-threatening” problems arise in the office, such as supervisors’ should give instructions to subordinates (Mayfield et al., 1998; Salter, 1995) or subordinates’ should refuse to conform with commands that are improper, unprofitable, or unethical (Kassing, 2006). It is believed that subordinates’ capability to scan for internal insufficiencies and external dangers and then relay that information to supervisors, who more than likely have more authority to endorse and coordinate functionally adaptive modifications, is a cornerstone of structural sustainability and origination (Morrison & Milliken, 2000). In fact, administration and communication scholars have made similar points by theorizing about the importance of dialogue and discussion among group members in developing logistic cultures of learning (Bisel et.al 2012).
Supervisors must maintain their credibility in front of subordinates in order to produce an image of authority and avoid appearing weak (Gronn, 1983). However, supervisors do not have to be especially concerned about affronting the public self-image of their subordinates (Campbell et al., 2007; Lim & Bowers, 1991) precisely because of the hierarchical relationship described here. From subordinates’ perspectives, they must maintain their credibility in front of their supervisors in order to survive—and thrive—in the workplace (Yukl, 2006). To look foolish or untrustworthy in front of a supervisor is to run the risk of inciting negative evaluations, which could have negative effects on job security and advancement (Bisel et. Al 2012). In order for there to be job satisfaction, there must be open communication among staff, especially from the supervisor to the staff. It is a continuum triangle that never stops.
Michael Wyatt was hired as the Vice President of the company in the 80’s. The communication was horrible and no one in the company never knew what was going on with the company because of the President not using Downward communication. Those outside the company gave employees of the company information about the company.
Hyatt left and later came back in 1998 as the Chairman and CEO, a decision was being made to make the company private. To help with the communication problem, he developed a written detailed communication plan and strategy that helped to make it a smooth transition. Also, the communication plan helped to ensure that information was given accurate to everyone involved in certain processes such as change in management.
This plan will help to alleviate a lot of stress that the staff was having. All of the staff concerns would be addressed and positive results would follow. Although there would be some debates and disagreements, a compromise would be made. Doing Wyatt’s plan would help avoid excellent staff getting frustrated and resigning.
“Motivation may be described as the drive, impetus, or initiative that causes an individual to direct his or her behavior toward satisfaction of some personal need, using “need” in the broader sense of the word to describe something one pursues because its attainment represents fulfillments of a sort”( Liebler & McConnell, p. 352). “Psychologist Abraham Maslow first introduced his concept of a hierarchy of needs in his 1943 paper "A Theory of Human Motivation" and his subsequent book Motivation and Personality” (Cherry, 2009). These needs are listed in order of importance to the individual starting with the foundation of physiologic needs such as eating, drinking, having shelter and rest. The next level is a need for safety followed by the need to be loved and belong, followed by the need to have self esteem in oneself and well as others. The final need is that of self actualization which comes when a person feels that they are achieving their goals and have a good perception of them themselves. Applying this theory to our scenario looks as follows. Physiological needs include a clean environment with adequate lighting, ventilation method of communications which flows into the next need for safety. This need involves their employment that when accomplished satisfactorily will lead to monetary compensation and financial security. Love and belonging needs are addressed by administration providing an interest in their employees. This also demonstrated by peer to peer relationships amongst the staff, working together towards a common goal. The self esteem need is addressed in that management encourages employees to perform well and acknowledges that result. Self actualization needs can be encouraged by supporting staff to identify areas that may require improvement and assist in finding solutions.
After everyone has agreed on a vision set on how communication should flow, a definite start date will be set. The proper communication will begin. The director of nursing will meet with the assistant director of nursing and the RN supervisor to discuss the current situation, standing orders, any new laws or regulations, and what is happening in the organization. The assistant director of nursing and the RN supervisor will pass the necessary information down to the charge RNs and charge LPNs. The RNs and LPNs will then pass it down to their CNAs and other ancillary staff as needed. The CNAs, LPNs, RNs, ancillary staff can bring any questions, concerns, suggestions, or problems to the RN supervisor, assistant director of nursing or the director of nursing as needed.
A committee will be chosen to observe the behavior, attitudes, and actions of all staff to determine if communication has started. The committee will also review charts, randomly, to see if the communication has been carried out and properly documented. They will keep a log on the progress and report it at the next meeting.
Promoting communication to improve patient care
October 15, 2012
The Problem: Introduction
• Extremely Poor Communication within the
• Main route of communication was word of
• No memos ever sent
• RN supervisor had to send text messages to
her charge LPNs to get or give information
• Management met daily—failed to see the
importance of keeping the staff updated
Root of the Problem
•No communication flowing up or
down the chain
•Problems lies within management
Who is Responsible?
• Director of nursing (Primarily)
• Communication should flow
• Need to bring concerns to
The director of nursing is responsible for the flow of
communication during each phase in the downward flow of
communication, employees of the business receive
information to help them do their jobs.Also, at each phase,
the information become less nonfigurative, more specific,
and more thorough (Abbott, 2000).
• Thomas Nelson Publishing
• Christian Publishing Company
• Michael Wyatt - Vice President in
• Promoted to Chairman and CEO in
• Intercommunication was “terrible”.
• Outsiders knew more than insiders.
• Realized that you can never over
• Developed a detailed communication
• Prepared a written communications
• Prepared a timeline
Can Process Be Applied?
• The process as used by Michael
Hyatt can definitely be applied to
this health care facility.
• Director of nursing should develop
a written communication plan
• Engage the employees and ask for
their input or concerns
Maslow’s Hierarchy of Needs
• Physiological Needs
• Safety Needs
• Love and Belonging Needs
• Esteem Needs
• Self Actualization Needs
Steps to get the employees engaged in the
work and how to receive buy-in for quality
• Meet with staff to address problem
• Encourage discussion for possible
solutions and establish a vision
• Determine a plan
• Identify roles
• Determine implementation date
• Set next meeting date
How will this reduce errors and increase the
quality of work?
• Previous management styles lacked
• An organizational change in culture will
increase communication which will in turn
• Proper communication increases job
satisfaction which decreases errors and
Evaluate the plan: how will it work when
• Vision set
• Set up how plan will be implemented
with audit tool
• Set start date
• Set weekly meeting time to review
• Re-evaluate plan each week
• Progress implementation to all areas
What are the benchmarks for this plan and
how will they be measured?
• Communication committee will set benchmarks
based on current identified problematic areas
• Will observe communication among staff; when seen
following communication plan, will have reached the first
• Develop committee to review 5 random charts per week to
ascertain whether communication has improved
• Audit tool will monitor compliance of implemented
policies and progress to reach goals
Proper communication is a absolute necessity in managing a health care
organization. If the director of nursing doesn’t communicate new rules,
orders, information, etc…the staff will simply not know. The information is
useless unless it travels and reaches every person in which it is intended.
If the CNA fails to communicate to her LPN charge nurse that her patient
vomited, how else is the LPN to know? If the patient continues to vomit
after medicating and is becoming dehydrated, he must tell the RN
supervisor so that the problem can be addressed aggressively and she
will be alert to his hydration issues.
Every employee is an important part of the team. The team members
(employees) must communicate with each other in order to provide patient
care and to discuss any problems, concerns, or questions.
Communication is a non ending process that must be constantly
monitored and maintained in order for the healthcare organization to care
for it’s patients, keep it’s employees happy, and to grow and prosper.
Abbott, R. (2000). Organizational Communication Flow. Retrieved from
Bisel, R. S., Messersmith, A. S., & Kelley, K. M. (2012). Supervisor-
Subordinate Communication: Hierarchical Mum Effect Meets
Organizational Learning. Journal Of Business Communication, 49(2),
Cherry, K. (2009). Psychology:Hierarchy of Needs. Retrieved October 11
Hyatt, M. (2007). Michael Hyatt Intentional Leadership: How to improve
communications inside your company. Retrieved from
Liebler, J. G., & McConnell, C. R. (2008). Management Principles for
Health Professionals (5 ed.). Sudbury, MA: Jones and Bartlett.