Leadership Through Communication

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included Escherichia coli and entero- invasive Klebsiella pneumoniae. Editors: Mary Jane Ferraro. Paul A. Granato. Josephine A. Morello. R.J. Zabransky.
remains to be seen. Establishing such an association is complicated by the long and variable nature of the disease; the complex, interrelated, and incompletely understood pathophysiologic mechanisms involved in the process; the lack of ascertainable markers of intravascular infection with C. pneumoniae; and the difficulties in performing and interpreting experimental studies in humans. As was the case with H. pylori, the final determination of a causalassociation will likely rest on the aggregate evidence derived from multiple types of studies,including cellular and animal modelsand humantreatmenttrials, rather than on any single study or group of studies.In the coming years, the accrual of additional piecesof evidence will shedimportant new light on the question of whether there is an infectious componentto atherosclerotic disease. References 1. Gibbs,R.G.J.,N. Carey, andA.H. Davies. 1998. Chlamydia pneumoniae and vascular disease. Br. J. Surg. 851191-1197. 2. Jackson, L.A. et al. 1997. Isolation of Chlamydia pneumoniae from a carotid endarterectomy specimen. J. Infect. Dis. 176:292-295. 3. Jackson, L.A. et al. 1997. Specificity of detection of Chlamydia pneumoniae in cardiovascular atheroma: evaluation of

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the innocent bystander hypothesis. Am. J. Pathol. 150:1785-1790. Saikku, P et al. 1988. Serologic evidence of an association of a novel chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction. Lancet ii:983-986. Danesh, J., R. Collins, and R. Peto. 1997. Chronic infections and coronary heart disease: Is there a link? Lancet 350:430-436. Ridker, PM. et al. 1999. Prospective study of Chlamydia pneumoniae IgG seropositivity and risks of future myocardial infarction. Circulation 99: 11611164. Moazed, T.C. et al. 1997. Murine models of Chlamydia pneumoniae infection and atherosclerosis. J. Infect. Dis. 175:883-890. Muhlestein, J.B. et al. 1998. Infection with Chlamydia pneumoniae accelerates the development of atherosclerosis and treatment with azithromycin prevents it in a rabbit model. Circulation 97:633636. Libby P 1996. Atheroma: more than mush. Lancet 348(1S):4s-7s. Gaydos, CA. et al. 1996. Replication of Chlamydia pneumoniae in vitro in human macrophages, endothelial cells, and aortic artery smooth muscle cells. Infect. Immun. 64:1614-1620. Fryer, R.H. et al. 1997. Chlamydia species infect human vascular endothelial cells and induce procoagulant activity.

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J. Invest. Med. 45:168-174. Kalayoglu, M.V. and G.I. Byrne. 1998. A Chlamydia pneumonaie component that induces macrophage foam cell formation is chlamydial lipopolysaccharide. Infect. Immun. 66:5067-5072. Kol, A. et al. 1998. Chlamydial heat shock protein 60 localizes in human atheroma and regulates macrophage tumor necrosis factor-alpha and matrix metalloproteinase expression. Circulation 98:300-307. Bachmaier, K. et al. 1999. Chlamydia infections and heart disease linked through antigenic mimicry. Science 283:1335-1339. Meier, C.R. et al. 1999. Antibiotics and risk of subsequent first-time acute myocardial infarction. JAMA 281:427431. Jackson, L.A. et al. 1999. Lack of association between first myocardial infarction and past use of erythromycin, tetracycline, or doxycycline. Emerging Infect. Dis. 5:281-284. Gupta, S. et al. 1997. Elevated Chlamydia pneumoniae antibodies, cardiovascular events, and azithromycin in male survivors of myocardial infarction. Circulation 96:404-407. Gurfinkel, E. et al. 1997. Randomised trial of roxithromycin in non-Q-wave coronary syndromes: ROXIS pilot study. Lancet 350:404-407.

Editorial

Leadership

Through

DonnaWolk, Ph.D., M.H.A., S.M. (AAM) Dept. of Veterinary Science and Microbiology University of Arizona Tucson, AZ 8.5721

As leaders,managers,and clinical microbiologists, we have many roles. We are decision-makers, agents of change, directors, and information sourcesof science and policy. Our effectiveness in each of our roles is determinedby the effectiveness of our communication. Most of us think that becausewe speak,we communicate our intent. Perhapsthis can be true, but it is “Present address: Clinical Microbiology. Hilton 470, Mayo Clinic, 200 First St., S.W., Rochester MN 55905.

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Communication often not the case.Communication is a constant processand occurs in many forms. It can be natural or unnatural, intentional or unintentional, effective or misleading.It is often easierto miscommunicate than to communicate effectively. Everyone communicates, but effective communication

is not nec-

essarily a natural talent. Effective communication is a mind-set and a skill that requirestraining, patience, and practice. Learning to communicateeffectively is a commitment, and a responsibility to ourselves,our peers,and our organization (1). Our individual successand the successof our organization dependson

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our ability to communicate effectively. Studies show that the verbal and nonverbal communication skills of an organization’s managersinfluence profit and effectivenessmore than any other factor! In contrast, the costsof miscommunication are large. They accrue in the form of lost profits, lost productivity, lossof supplies,low employee morale, diminishedjob satisfaction,and high employee turnover (1). As the healthcareworkplace continues to undergo dramatic changes, organizations becomemore complex increasing the need for effective and cross-trainedteamsand improved communication at all levels of an organizaClinical

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tion. Because of recent “down-sizing” and “re-engineering” in healthcare, communication skills are more essential now than ever before. By his own admission, Michael Hammer, co-author of the 1993 best seller, “Re-engineering the Corporation,” recently described a flaw in the re-engineering logic. “I was reflecting my engineering background and was insufficiently appreciative of the human dimension. I’ve learned that’s critical.” In other words, he and other advocates of themassive re-engineering efforts neglected the human factor, the loss of organizational culture, morale, and employee self-esteem. It’s time for us to fix that. We must take the time to learn to communicate not only facts, but also the values and culture of our organization. We must translate and communicate the future direction of the organization to our workgroups, giving examples of how everyone fits into that future. Most importantly, we must communicate our respect and concern for all team members, our trustworthiness, and our commitment to patient care and workplace satisfaction. We cannot assume that these intentions are understood. How easy it is to take time to communicate the impersonal, and leave little time to keep employees mentored, informed, and in tune with the organization’s mission. Yes, information sharing requires time and energy; it sometimes seems like an impossible task. Perhaps overlooking these responsibilities may save time in the short run, but eventually the neglect will erode your Workgroup’s morale, productivity, and effectiveness. Lack of communication produces detrimental effects on career satisfaction and quality of life (l-3). Surprisingly, many scientists do not consider their interpersonal and communication skills to be lacking. As laboratory scientists, we make time for writing procedures, training, teaching, and policy, all worthy venues of communication. However, effective communication of facts does not ensure effective communication of other workplace issues. We would never expect a management trainer, motivational speaker, negotiator, mediator, or administrator to write an effective scientific procedure without training. Likewise, when our job requires us to perform in their capacities, we should not expect that we can perform without training Clinical

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and practice. Seeking help from experts in those areas should not be an embarrassment, it is a logical career step (4).

Classical Management Communication Classical and historical management communication styles have created many problems within our large, modern, reengineered workplaces. Communication within the organizational chart varies from organization to organization, but in general, there is some form of information inertia. Information has a tendency to rest at certain layers within the organization and stay there. The traditional hierarchy to communication allows only certain types of information to get through each organizational level. There are primarily three routes of information flow. First, there is the traditional downward flow involving what to do and how to do it. Downward communication is generally condensed and distorted, controlled by gatekeepers, and flowing along formal lines. Information and orders are slowed or changed on their way to employees who are expected to carry out the directives. Secondly, there is the traditional upward flow. Department heads communicate what has been done in the form of a yearly summary, and what is needed in the form of capital equipment, staffing, and supply lists. Lastly, the one true multidimensional information channel, the grapevine, exists on a large scale in the organizations that hold on to traditional hierarchy. It is often the most available source of information or misinformation and passes the latest news, much to the detriment of the organization (5). Informal communication about work relationships or information other than orders and instructions is inhibited by this communication style. Information, ideas, and solutions from employees rarely reach managers and directors who make decisions because people are fearful and inhibited from speaking. Employees who think independently and creatively are discouraged from speaking up. Disagreement can be a slow form of career suicide. In these organizations, it is not safe to communicate unless you agree with the current accepted opinion (5). Under traditional management, conflict and change is communicated and resolved on the basis of who has author0 1999 Elsevier

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ity to make decisions and give orders. It is not based on mutual discussion and agreement. Status differences inhibit successful conflict resolution. Change is dictated and communicated in a downward fashion. Very little effort is given to motivate employees to internalize the changes occurring in the workplace or to exceed their traditional job requirements. Mentoring is scarce and often self-serving. Leadership is viewed as decision-making and giving orders, the responsibility and privilege of the higher status positions (5).

Another

Way

In modem, effective workplaces, employees are no longer mandated to accommodate traditional authoritarian practices. Communication is not only a matter of giving orders and instruction, but also a matter of building and maintaining friendly supportive relationships. Communication has the added dimensions of motivation, coordination, and adjustment to change. Information about what needs to be done and why is distributed among executives, middle management, supervisors, and employees. Information is shared as needed and flows in and across every organizational level in all directions. Managers are trained to listen as well as speak; communication is interactive. Leadership is viewed and practiced as a commttnieation process to form and maintain relationships and reaffirm the value of employees and intent of the organization. For organizations to function effectively, the entire organization must be committed to a multi-dimensional form of communication. This type of communication is necessary for task coordination, problem solving, sharing information, and conflict resolution (2,3,5,6). Unfortunately, for many healthcare employees, the classical workplace communication hierarchy still exists. The emergencies, “STATS,” and life-ordeath situations of our profession have perpetuated the order-directed, authoritarian communication styles commonly found in healthcare. In some situations, those styles are appropriate; there is certainly no room for discussion in a crisis situation, However, we cannot be content to allow classical management to keep its roots under all corners of our workplaces. Administrators must 0196-4399199

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support, encourage, and enforce the organizations non-emergency-based communication system. Ideally, this system must be dually focused on tasks and on people. For communication to be effective, an organization or team must address issues of trust, influence, and awareness of the usual organizational barriers. Laboratory directors must communicate abstract ideas to middle managers who must translate them into concrete ideas for the workplace. Employees must receive information and purposely and professionally express their agreement or concern. If problems are discussed openly and relevant information is shared, solutions can be created by those involved in the problem. As a result, the organization will experience better problem solving and improved success. If all team members observe and improve their skills, even stressful interactions and conflict can be positive and effective (56). Since an organization’s norms and culture are often communicated through symbols, special language, informal behavior, and communication patterns, formal communication channels are often ineffective. To be an effective communicator in your organization, you must be able to participate in the organization’s dialogue. Organizations are not fixed; they do not have their own identity. An organization is created and changed by its members in an ongoing dialogue of ideas, expectations, and terminology, the elements of the conversation. As members of our organization, we must recognize, understand, and use existing and emerging ideas and terms in our vocabulary. We must be able and willing to participate in changing the dialogue and to assess the applicability of new ideas, critically evaluating them for their immediate and future worth (45).

What

Can One Person Do?

In organizations where classical management has been the norm, it is difficult to be the messenger of the need for change in communication policy. We all know what can happen to the messenger! We can begin in our own workgroup. First, we must understand our own communication style, then teach others to explore their styles. Take the time to list your own strengths and limitations as a communicator. Be honest 150

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with yourself, however painful that may be. In his book “Principle-Centered Leadership,” Steven Covey (2) defines communication as “mutual understanding.” First we must translate what we mean into what we say. Then we must learn to listen so that we understand what others are saying. This requires a deep level of self-awareness and awareness of those around us. Trust, awareness, respect, and rapport lay the groundwork for effective two-way communication C&3,5,6).

Core Communications

Skills

Trust and rapport builds credibility Lack of communication and miscommunication are two of the biggest reasons employees distrust their bosses, their organization, and their co-workers. The bigger the organization, the more likely that miscommunication will occur. Team members often are physically distant, across the city, state, or country from each other. They are sometimes relative strangers. It is more difficult than ever to maintain communication. However, without communication, fear and distrust will creep into an organization and insidiously undermine even the most wellintentioned efforts to merge systems and consolidate resources (57). Trust is one of the most difficult things to earn and one of the easiest to lose. We must take the responsibility to communicate our trustworthiness by words and body language that matches our sincere intent. We cannot assume that it is our right to be trusted; we must earn that right. Marginal efforts are not acceptable. Building rapport in your organization is a career-long commitment. Communicate candidly and honestly. Keep your words congruent with your actions. Admit your mistakes and imperfections. Listen well. Keep your promises. Keep your Workgroup informed of changes in your organization and listen to how those changes will affect your employees, Communicate the organization’s expectations to and within your workgroups, showing examples of how each individual will fit in. Initiate one-on-one, candid conversations with your Workgroup. Maintain your sense of humor, but avoid the use of condescending, sarcastic, or belittling humor. Through good communication and rapport building, net0 1999 Elsevier

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works are established that allow for information to be gathered, problems to be solved, resources to be shared, and change to occur throughout the organization. Networks, built by rapport, move across boundaries and organizational levels. They create effective performance and healthy peer relationships with open, honest, available, positive participation (3,5-7).

Inc.

l

Communicating change Effective workplace changes require continuous communication. Often, the manner of communication is more important than the change itself. Communicating change with honesty, respect, and candor builds organizational commitment. Communicating change by dictate, or by conversation with only a privileged few builds disrespect, mistrust, and contempt in an organization. Communicate changes well in advance. Don’t sugar coat consequences or disregard employees concerns. Explore and listen to both positive and negative aspects of the change. Listen and learn. Allow yourself to experience and show genuine concern for those most impacted by the change. There is never a time when knowing yourself and your communication style is more important. Understanding the strengths and weaknesses of your own style and that of your team members will allow you to use change as an opportunity to build group commitment and enhance problem solving. Change is difficult, so communicate praise before, during, and after the change occurs (7). It is always a danger to ignore the grapevine, but it is especially perilous during times of great change. Roots of misinformation are harbored in the grapevine. Keep yourself in tune with formal and informal channels and do not force employees to rely on the grapevine for their information. Share information with them, even if “the news is that there is no news.” Never communicate an unpopular change via memo or e-mail; share information through group meetings and discussion (1,5X Miscommunication can reach an all time high when many changes occur simultaneously. You can avoid miscommunication by knowing your audience and changing your language to fit each audience. Avoid the use of slang, jargon, and technical terms if possible. If need Clinical

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be, use interpreters, people within the work group who are in tune with the major concerns of the team, and understand the culture and norms. Ask for help from local group leaders who know what information needs to be communicated (1,5,8). Remember, when people are stressed and concerned about how changes will affect them, they may selectively misinterpret key parts of your message. Reinforce your-message by using more than one form of communication. Prepare a written summary and/or use visuals to explain the change. Making direct straightforward statements that are firm and believable is the key to delivering a message that contains unpopular changes. Keep your message short, straight, and simple. Adjust your voice volume so it can be heard by everyone, not too loud or soft (5,7,8). After your message is delivered, listen! Have consideration and understanding for the concerns of the group. Avoid the use of negative or hostile words. Avoid blaming, sarcasm, whining, or pleading; and avoid impatient or condescending tones of voice. Maintain good eye contact, keep your body and head erect, maintain proper body distance, and avoid threatening gestures and nervous fidgeting. Above all else, make sure your facial expressions agree with your words and your intent. Most people take 7 to 20 seconds to judge the meaning of a message. They judge it by what your face conveys to them. When we are stressed and overwhelmed we may not even be aware of how our actions are being received by our audience. Make sure to get feedback about how you and your message are being perceived (7-9). Obviously, you cannot remember to do, think, and act out all of these requirements without some practice and preplanning. Prepare your message and presentation strategies in advance. Remember, even the most nurtured relationships undergo stress during times of great change, but if trust and respect are present, and the foundations of good communication have been placed, most change can occur in an effective and positive manner (1,2,8). Listening Seek first to understand; there are multiple realities and views in your workplace. Employee satisfaction ratings, Clinical

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Workgroup effectiveness, and your own time management will benefit if you commit to developing effective listening skills. In today’s workplace, we simply cannot afford to be poor listeners. Most people listen to only the first 75% of any given message, a circumstance that is a major cause of miscommunication and workplace stress. Listen to all the words so that you can avoid miscommunication. Communication is two-sided. Both sides have the responsibility to get clarification at any time and develop active listening skills by asking questions and paraphrasing to make sure each party understands ( 1,2). Listening skills are not only auditory. Learn to listen between the lines. A good listener receives verbal and nonverbal messages. When you are listening, minimize your own negative behavior and body language. Don’t be critical, interrupt, interrogate, or give advice. Use both verbal and non-verbal skills to communicate your sincerity. Assume a level posture with the person who is speaking. Look straight at the speaker, maintaining a square posture and an open and relaxed body position. Use positive body movements, such as nodding while leaning forward, toward the speaker. Never lean back with your arms behind your head! Be verbally attentive, using phrases like “I see,” or “Please tell me more.” Most importantly, portray your approval by use of positive facial expressions such as smiling, eye contact, and the face of your heart-felt sincerity. If you can’t truly feel sincere, then chances are most people will be able to sense it in your face and body language (5,7,9). Understanding and motivation Whether we like it or not, personal problems do affect job performance for employees. Since it is the behavior of people that enables organizations to meet defined goals, there is a desperate need for honest communication and the ability to comprehend feelings and the opinion of others. That is not to say that you can disregard obligations to patient care or organizational policy in order to please everyone. It simply means each employee has a life. You must be available and prepared to hear employees concerns and issues, both work-related and personal, in order to facilitate their own efforts to resolve their problems effectively. To achieve true loyalty and 0 1999 Elsevier

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motivation, focus on communicating ideas and consequences in a way that ensures understanding and positive reinforcement. You cannot have a positive workplace that is filled with negative feedback. Fear only motivates people for so long; it is a cost disadvantage to any organization (1,2).

Managing

Conflict

Conflict resolution requires a special set of communication skills. For constructive resolution of conflict, don’t avoid or punish those in the conflict. Conflict is natural. It will and should occur in any effective workplace. Conflict requires time, energy, and risk. Direct communication is imperative for effective conflict resolution and mutual agreement. There is no place for e-mail, memos, and third-party “say so.” Your role in conflict is to facilitate and teach, separating people from the problems. Auditory signals are very powerful stimuli, creating links with future behavior; so it is imperative that proper, supportive messages are sent to all those involved in the conflict. You must verbally communicate your focus on the issues that are in the best interest of all parties. You must generate and communicate options, and be absolutely objective in your approach. You must be especially aware of gender and cultural differences during conflict. They create diversity in the non-verbal cues and may lead to misunderstanding and eventual mistrust (1,5,9,10).

The Keys to Success Effective and sincere communication is one of the most sought after skills in the modern workplace. There is synergy in our interactions and that synergy is what gives effective organizations their edge. Communication skills and the ability to read non-verbal messages are among the two most important aspects of our emotional intelligence, a key factor to individual success and popularity. Even more importantly, effective communication is the key to fostering healthy, fulfilling relationships in the workplace and in our personal lives. Mastery of communication skills requires self-reflection, commitment, patience, honesty, understanding, impartiality, responsibility, open-mindedness, and humility. The investment is substantial, but the rewards are countless (2,3,6,11). Let’s begin. 0196.4399/99

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References 1. Huseman, R., J.M. Labiff, and J.M. Penrose, Jr. 1988. Business communication, strategies and skills, 3rd ed., Dryden Press, Orlando, FL. 2. Covey, S.R. 1991. Principle-centered leadership. Simon & Schuster, New York 3. Goleman, D. 1995. Emotional intelligence. Bantam Books, New York. 4. Pryor, F. 1994. Management problems of the technical professional in a leadership role. Ptyor Resources, Inc., Shawnee

Mission, KS. 5. Dues, M. and M. Burgoon. 1998. Applied organizational communication. McGraw-Hill Book Co., New York. 6. Murphy, EC. 1996. Leadership IQ. John Wiley & Sons, Inc., New York. 7. Goamn, C.K. 1991. Managing for commitment, building loyalty within organizations. Crisp Publication, Los Altos, CA. 8. Frank, M.O. 1986. How to get your point across in 30 seconds - or less. Clinical Laboratory Management Association/

“Potpourri” from the Spring 1999 Laboratory of the American Public Health Association spotted fever is the most severetick-borne infection in the U.S., a notifiable diseasethat had a case fatality ratio of almost 40% before the availability of effective antimicrobial therapy. Although serological assays are widely available and used, they are often non-confirmatory in the first ten days of disease.Currently, serological testing only estimatesthe mortality resulting from this illness, as exhibited by positive staining (immunoalkaline phosphatase)of tissue from postmortem diseasecases. . . . Rocky Mountain

doseof measles-mumps-rubella vaccine, putting themat high risk to thesediseases, especially rubella. . . . pertussis, which causesa readily vaccine-preventable disease, is currently identified asthe causeof paroxysmal cough in the U.S. Limited recognition is due to difficulty in defining the diseaseby proper laboratory studiesand failure to considerthe diagnosis. . .. Bordetella

More than 50% of American college studentshave not received a second

Influenza kills more people than does any other viral respiratory diseaseand is largely preventable by immunization. While we wait for a vaccine for HIV,

Editors:

General

Mary JaneFerraro Paul A. Granato JosephineA. Morello R.J. Zabransky 0 1999

Elsevier Science Inc.

ISSN 0196-4399 CMNEEJ 21(18)145-152,

1999

Simon & Schuster, New York. 9. Anderson, P.A. 1999. Non-verbal communication: forms and functions. Mayfield Publishing Co., Mountain View, CA. 10. Samovar, L.A., R. E. Porter, and L.A. Stefani. 1998. Communication between cultures, 3rd ed. Wadsworth Publishing, Co., Belmont, CA. 11. Edelman, J. and Cram, M.B. 1993. The Tao of negotiation. Harper-Collins, New York.

Section Newsletter we have at hand a vaccine for an infection that is responsible

for >60,000

potentially preventable deathsper year. . . . In the U.S. each year, foodborne illness affects six to eight million

persons,

causing9,000 deaths, and costs an estimated $5 billion. Proper food handling (preparation, storage,hand washing) is an easy and recognized preventive measure. For instance, a patient suffered multiple organ failure after consuming

a portion of a hamburger bought at a fast food stand. The “coliform”

invasive Klebsiella

pneumoniae.

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Editorials and letters printed in this newsletter are published for the interest of the readers and do not necessarily reflect the opinions of the editors. Clinical Microbiology Newsletter is abstracted in Tropical Diseases Bulletin, Abstracts Communicable Diseases, EMBASlYExcerpta Medica, and Current AIDS Literature.

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