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How one hospital’s program has improved communication and coworker relationships

Maintaining solid communication among coworkers is essential to any work environment. But when that line of communication breaks down and conflict ensues, confronting the discord is an important step in upholding positive relationships and avoiding paying grim costs.

“There are all kinds of potential consequences from ineffective communication patterns,” says Catherine Witsberger, MSN, RN-BC, nurse educator at the University of Pittsburgh Medical Center (UPMC). “And the cost of not doing anything is quickly escalated.”

As a means to improving communication at UPMC, Witsberger has been working with various nursing units and offering unit-based sessions. The mandatory classes consist of two, four-hour-long sessions and have been effective at improving personal and group relationships within the hospital.

Can we talk? Why communication is important

If effective coworker communication is lacking at your facility, the results could be more drastic than you think.

A recent study in the Journal of the American College of Surgeons noted that disruptive worker behavior, which has a negative effect on communication, has been linked to adverse patient outcomes, including mortality. Despite these (and other) findings, communication continues to be a major problem in the nursing environment. Year after year, communication is the root cause of more than 60% of the sentinel events reported to The Joint Commission (formerly JCAHO).

“There are also satisfaction issues related to coworker relationships,” says Witsberger. “Bullying, lateral hostility, and coworker conflict can erode job satisfaction and morale.”

Once the lines of communication are open and employees feel empowered to change ineffective patterns, facilities can reap the benefits, she says.

The steps taken at UPMC

In the fall of 2006, Witsberger began working with one of the hospital’s nursing units to help it improve its communication skills. Each staff member, at every level, was required to take part in the sessions.

Most staff members said that physician-nurse communication was most lacking, says Schebeeka Croft, RN, who took part in the program.

“We were able to take our concerns to the doctors after the session to get them to understand where we were coming from,” says Croft. The physicians were receptive to the nurses’ concerns, and relationships were strengthened as a result, she says.

The first session contained discussion about the principles of positive coworker relationships, as developed by Wendy Leebov in her book Working Together for Professionals in Health Care. The principles are:

  • Respect differences
  • Think positively
  • Acknowledge each other
  • Listen
  • Appreciate each other
  • Pitch in and help out
  • Live up to expectations
  • Respect each other’s time and priorities
  • Admit mistakes
  • Get a life!

    Additionally, during the first session, participants discussed communication styles and how coworkers tended to interact with each other. Two main questions that participants pondered were:

    1. How honest is the communication?

    2. How considerate is the communication?

    When the second session got under way, participants focused on the importance of building a common mission.

    “We talked about team-building,” says Croft. “[Witsberger] helped us focus on what we liked, how our group worked together, and what we wanted to improve.”

    The second session also helped staff members learn how to resolve conflicts.

    The different areas of communication (including within the delegation process, among levels of the healthcare team, and with patients) were also analyzed.

    “It allowed us to understand where everyone was coming from,” says Croft. “We saw how to make other people’s jobs easier and took the time for understanding. I thought it was great because it brought us together.”

    See the sample agenda on this page to help structure your own sessions.

    Tips for kicking off your own program

    When looking into starting a similar program at your facility, Witsberger recommends observing issues at the departmental level.

    “You can speak to conflict and communication breakdown housewide, but I think an organization is wise to look at it within a department,” she says. “It’s sort of like how you would imagine family therapy would be more effective if it dealt with the members of a specific family.” So if a particular department is showing signs of poor communication—such as high turnover or patient complaints—then intervention might be needed.

    Educators may face a hurdle in receiving financial support from higher-ups; programs of this type often have a high man-hour cost. The best strategy, says Witsberger, is to make a case for the cost of not doing something.

    “Organizations don’t always perceive that educational efforts like this are worth the money, but I think educators need to help managers understand that many problems may have a behavioral component,” she says. “It’s rarely a one-dimensional issue or one person. There’s always room for improvement related to helping people develop their communication skills.”

    The main challenge, she adds, is convincing people that there is potential for better communication and relationships. “Education is one of those skill sets that without which you can’t be very successful. And most of us do not have sufficient education to prepare us to work and communicate with our colleagues and other members of the healthcare team.”

    Once you’ve gotten the support you need and are able to kick off your program, begin with some simple ground rules. Be honest and respectful and maintain confidentiality. “There’s likely not going to be much growth if people aren’t honest,” says Witsberger.

    During the program sessions, try role-playing and small group work to keep things interactive.

    “I don’t think this is an education topic that lends itself to solid lecture,” says Witsberger. “I think there needs to be experiential learning.”

    To demonstrate an issue regarding delegation, for example, assign a nurse to role-play the nursing -assistant’s part and vice versa. They will then experience a little bit about what the other role might be encountering in the workplace.

    UPMC has received positive feedback from participants regarding its program. Relationships, whether they were nurse-nurse or nurse-physician, were improved as a result of the sessions, says Croft.

    “I thought it was great because it brought us together, and I would definitely recommend it,” she says. “People complained behind each other’s backs, but nothing was getting resolved. But we got to sit down and have the opportunity to talk.”


    Leebov, W. Working Together for Professionals in Health Care. Authors Choice Press: 2003.

    Rosenstein, A., and O’Danial, M. (2006). “Impact and implications of disruptive behavior in the perioperative area,” Journal of the American College of Surgeons 203(1): 96–105.

    The Joint Commission (2007). Sentinel event statistics, December 31, 2006. Retrieved September 4, 2007 from

    Sample agenda for communication sessions

    First session

  • Ground rules
  • Communication perceptions
  • Conflict cycle
  • Principles of positive coworker relationships
  • Individual and group assessment
  • Communication styles
  • Homework

    Second session

  • Building a common mission
  • Conflict resolution strategies
  • How to recover from conflict
  • Communication in the delegation process
  • Communication among levels of the healthcare team
  • Communication with patients
  • Strengthening the T-E-A-M!