Communication: The #1 Secret to Operational Success In MSK

How To Engage Staff Through Clear Communication

Photo by Jason Rosewell on Unsplash

In the realm of musculoskeletal care, particularly within physical therapy, the importance of technical skills and clinical knowledge is well understood. However, the role of effective communication often remains underappreciated from the standpoint of operational success, even when recognized for its importance in the patient-clinician relationship. 

Communication isn’t just important for clinicians interacting with patients. It is a vital skill that significantly impacts business, management, and operations in physical therapy, leading to improved outcomes, enhanced team dynamics, and streamlined operational efficiency.

If someone asked me what is the number 1 skill of a great manager in the MSK space, my answer would not be clinical skills, data analysis, or fiscal operations. By far the most important skill for operational success is communication…both in the written and verbal form. Therefore, this post will focus on communication from the standpoint of managing staff.

Not As Simple As It Appears

In the business world, we know how changing the words and the headline of an advertisement can double, triple, or even “10x” the response that you get. And I’ve personally witnessed how changing an advertisement to hire a physical therapist can get many, many more times the responses. As managers and leaders, it is our job to coach, coordinate, counsel, evaluate, and supervise through the process of communication. 

Communication seems simple enough as we're naturally wired to do it but my experience has been that while it appears simple on the surface, it is actually very challenging to accurately get a message from one human to another with a high degree of fidelity and consistency. And when communication isn't achieved- misunderstanding, misalignment, confusion, friction, inefficiency, and conflict are the result. 

The Importance Of Communication

Clear communication isn’t typically taught in physical therapy or other clinical schools and professions, but it is universally recognized for its role in engagement and adherence.

Simply put, effective communication helps build rapport between management and staff. When staff feel heard and understood, they are more likely to trust management and adhere to organizational goals and strategic objectives.

Clear explanations about organizational policies, operations, and expected outcomes gives staff the knowledge and motivation to actively participate in the success process, improving adherence to policies and initiatives.

Open-ended questions and active listening enables managers to engage staff effectively. It also helps identify barriers, misconceptions, or other challenges. Addressing these issues early can enhance organizational effectiveness.

Clear communication enhances interdisciplinary collaboration, allowing clinicians to effectively coordinate care with other healthcare professionals. It ensures that all team members are on the same page, sharing insights and expertise, which can lead to innovative solutions, improved patient care, and positive cash flow for the clinic.

So with all the positive benefits of effective communication, how can managers and clinicians do it better?

Principle #1: Assume Responsibility Of The Communication

Let’s first start with the definition of communication. For our purposes, we will define it as something that happens when we transmit messages to another person using words, voice tone, gestures, and other means to share knowledge, feelings or methods in order to achieve an outcome, build a relationship, or spread an idea. 

So the communication begins when you send the message, but where most managers screw up is that they assume it ends when the other person receives the message. In reality, the communication does not end when the other person receives the message, but when the receiver provides you feedback indicating that they understand the message, its level of importance, and what must be done with it. 

Thus, the meaning of a communication is the response that you get, not the message that you send.

So the implication here is that communication is an exchange, not just a delivery of thought processes by a sender. All parties must participate actively in order to complete the information exchange.

And one important principle for effective communication is that the responsibility of communication belongs to the communicator. Every manager should take responsibility for communication, making sure that the communication lands and that it is understood. 

In other words, if someone on the team “doesn’t get it”, the mindset is that the manager is the one responsible for communicating the message in a different way, perhaps “on a different channel” so that the message is received and understood by the staff member. It is not the staff member’s responsibility to “figure it out”. Taking ownership over the communication forces the manager to alter their communication until it lands. 

Principle #2: Four Channels

Human beings process information and communicate in one of four different channels. These channels are visual, auditory, kinesthetic, and conceptual. Visual processors are (you guessed it) visually-oriented. They'll often say things like, “I see what you're saying” or “let me show you something" 

Auditory processors are tuned to the words and the sounds that are coming in and they'll often say things like “I hear you” or “that rings a bell”. They can listen to and learn from audiobooks or from conversations very well. 

Kinesthetic communicators, refers to kinesthesia or body awareness. These are experiential learners. They learn by doing things. 

And conceptual types operate in the abstract space. These people really need to understand the “why” and the logic behind why something works in order to implement it.

Managers need to listen closely to understand their staff so they can start communicating with them on their “channel”. For example, a visual learner may need to see someone doing something so they can repeat it. A kinesthetic type may need the manager to be there while they are actually performing the task to confirm they are doing it correctly. 

Generally speaking, the more channels you can communicate on, the richer the communication will be, and the greater the chance that it will “land”. 

Principle #3: Clarity Is Key

Before you can send the message, and before the message can be received, it must exist in the first place. And most messages are general, nonspecific, unconscious, uninteresting, and they never make an impact either on ourselves or on others. 

It is very important to define any terms, ideas, concepts, or components. The more you refine and clarify your definitions, the better your ability to create messages that are more effectively sent and received, and the better you become at understanding, communicating, and getting results.

Our definitions in our minds are squishy, ambiguous, and undefined enough that we can go through our entire work day without really having to be awake and take conscious and intentional control. The more you define your terms, ask yourself what you mean, and test it against reality, the more it challenges you to become conscious of what you're saying.

So it's important to first get clear about what you're communicating and then use the best means to actually communicate it. And clarifying is key. If you don't understand the essence of what you're trying to communicate, it's going to be difficult to communicate it. 

So when you're starting with an idea, thought, or message that you'd like to communicate, it's important to stop and boil it down to the most basic idea (the key part of your idea or thought) and then to communicate it. It's important that you challenge yourself to be more and more specific and to really define what you want. 

Instead of saying something general like, "I want my staff to answer the phone in a professional and empathetic manner”, you say “I want them to answer the phone by saying ‘Good morning, XYZ Physical Therapy, this is Paul speaking, How may I help you?’

Specificity, concreteness, having a definite descriptive clear language around what you want, what you want to create, and what you want to communicate, is key. 

Principle #4: The Need To Be Right 

When interacting with another person, it's important to remember that we human beings have a really important need to be “right”. We have a high need and a drive to see ourselves as being good and having positive intentions. So when interacting with another person, it's important to make sure and acknowledge their goodness and their positive intentions. This operates as a connection and commonality, but it also allows the other person to let their guard down and realize that this is someone who “gets them”.
 

Now we screw this up oftentimes, largely because we're not aware that people need to be right and they need to be seen as having positive intentions. We often forget that there is a human there, and instead we focus on the ideas or the message on its own. 

The idea of “right” and “wrong” or “good” and “bad” are value judgments. They're just decisions that we make about whether or not we think the other person is correct or incorrect. And we do this in all kinds of ways. We have very subtle ways of approving or disapproving of other people, of hinting that they're wrong, bad, or that their intentions aren't good. And what you will find is if you take all the preconceived notions off and you start interviewing people with an open mind,  everyone thinks that they're right and that they have positive intentions.  

So if you want to communicate well with others- find commonality and eliminate the stance of “you’re wrong”, “you’re bad” or “you don't have good intentions”. 

And to do this, you have to let go of your own need to be right and your own need to be seen as having good intentions because these operate as blocks. And when you let go of this, you don't grasp onto ideas and positions as much. You become more flexible. Metaphorically speaking, you become the water and not the rock, and you can “flow more easily”. You can alter your communication and your behavior better. And you also get rid of what is called sub-communication or subliminal communication of disapproval, which really closes people off. 

So when you're interacting with another person, you want to communicate with them, treat them like they're a good person, and like they have good intentions. And if they say something to demonstrate that they're incorrect or that they don't have good intentions, instead of making them wrong and bad, help them see how a different intention or a different perspective would serve them better (and do it without judgment). Because as soon as you start bringing the judgment in, that's when other people close up. 

Remember people need to be right….or at least feel that they are right. It's important when someone expresses a belief in these moments to treat that belief tenderly and to not attack them or make them wrong for it. 

You can bend someone's belief a little bit, but you can't break it. So don't argue with beliefs because all it's going to do is break the relationship. A much better route is to get into their model of reality, into their world, ask them more, seek to understand until you get it, and then help them take steps so that they can transcend to a different idea or concept. 

If the other person says or does something that doesn’t match your model of the world or your values system, instead of arguing with them, validate their position. This is known as a “steelman” and it is important especially when there's tension or conflict. This relaxes the other person, it brings their guard down, and this is especially true if someone is criticizing you.

Principle #5: Signing Off  On The Message

When communicating with a staff member, if you're sending a message, it's important to get “sign-off” and ask them what they understood. In other words- to get their feedback. 

So once you send your message, ask them for some feedback. And then once they provide you with feedback, clarify it until their sign-off is satisfactory. And you'll notice that most of the time you'll have to go back for two or three rounds of clarification before you will be satisfied that the sign-off really works. 

This is especially important to do when you’re giving your staff specific instructions that you need them to implement. In fact, I used to do this all the time with patients if I gave them any home instructions. I’d tell them everything they needed to know, and then I’d finish off by saying something like “Ok Ms. Smith, I’ll see you next week, but before you go, tell me what you’re going to do at home?”. Compliance is substantially increased when someone can verbalize to you exactly what you want them to do and why you want them to do it.

To conclude, effective communication is the cornerstone of operational success in musculoskeletal care and physical therapy. By assuming responsibility for clear communication, understanding and utilizing different channels, prioritizing clarity, acknowledging the inherent need to be right, and ensuring message sign-off, managers can foster a more cohesive, efficient, and motivated team. This not only improves internal dynamics but also enhances patient care and clinic operations. 

In essence, mastering the art of communication equips leaders with the tools to navigate and resolve challenges, align their teams towards common goals, and ultimately drive the success of their practice. As we continue to emphasize and refine these communication principles, we pave the way for a more effective and harmonious work environment, leading to better outcomes for both staff and patients.