HCA 301 Leadership and Management in Healthcare Setting PDF

HCA 301 Leadership and management in healthcare setting CHAPTER 6 LEADING THROUGH COMMUNICATION Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2023- 20...

HCA 301 Leadership and management in healthcare setting CHAPTER 6 LEADING THROUGH COMMUNICATION Resource: Sullivan, E.J. & Garland, G. (2013), 2nd Edition. Practical Leadership & Management in Healthcare for Nurses and Allied Health Professionals. UK: Pearson HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 1 Learning Outcomes 1. Identify the factors that influence communication. 2. Describe the role of communication in management and leadership 3. Explain directions and approaches of communication 4. Explain what principles must be followed for collaborative communication to take place. 5. Explain situations that can challenge effective communication. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 2 Introduction Communication ◦ A complex, ongoing, dynamic process in which the participants simultaneously create shared meaning in an interaction ◦ Process in which individuals employ symbols (both verbal and nonverbal) to establish and interpret meaning within their environment ◦ The principal goal of communication is to approach, as closely as possible, a common understanding of the message sent and the one received. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 3 Introduction Communication Simple, but not easy Both participants are influenced by; Past conditioning The present situation Each person's purpose in the current communication Each person's attitudes toward self, the topic and each other. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 4 A communication model It is important that participants construct messages as clearly as possible, listen carefully, monitor each other's response and provide feedback HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 5 Communication ◦ The following are other common causes of unclear messages: ◦ ◦ ◦ ◦ ◦ Using inadequate reasoning Using strong, judgmental words Speaking too quickly or too slowly Using unfamiliar words Spending too much time on details Messages become less clear when the recipient: ◦ Is busy or distracted. ◦ Bases understanding on previous unsatisfactory experience with the sender. ◦ Has a biased perception of the meaning of the message or the messenger. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 6 Role of communication in management and leadership ▪Management and leadership are complementary processes ▪People must use both forms of communication to be successful Management Leadership Concerned with planning, organising, coordinating, supervising, staffing and evaluating Concerned with persuasion, energizing, creating connections, empowering others, creating meaning and facilitating learning. Use communication to inform, clarify, direct, develop plans and evaluate outcomes. Use communication to motivate people, create a common vision and goals, and create alignment between different perspectives Communicating policies and procedures, teaching students, delegation and directing the actions of new staff are examples. Is more likely to be needed when people are capable but unwilling. Situational leadership theory identifies directing and supporting as essential leadership actions. E.g when what is needed is clear instruction (direction) that sets standards and guides effective care. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 7 Factors that can affect communication A message is conveyed through words, sounds (such as the tone, volume and speed of speech) and what is seen. Mehrabian (1969) in his classic study of communication found that the total impact of a message is about 7% verbal (words only, 38% vocal (tone of voice, inflection and other sounds) , 55 % non-verbal. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 8 Factors that can affect communication Non-verbal communication is a method of sending a message without using words and can take the form of gestures, facial expressions, body positioning and actions. In person, body language conveys the greatest part of the message, whilst on the phone, the tone of voice is most important. Written communication depends on the choice of words, how sentences are constructed and the clarity of the message. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 9 Factors that can affect communication Body language can affect the meaning of the words spoken. When speaking to someone in person, verbal messages are accompanied by a number of non-verbal messages. Such behaviours include head position, facial expression, eye contact, gestures of the shoulders, arms, hands or fingers, body posture and position, dress and appearance. Non-verbal communication can also take the form of actions. When a verbal message is incongruent with the non-verbal message, the recipient has difficulty interpreting the intended meaning. For example, a manager who states 'Come talk to me any time' but keeps the office door closed sends a conflicting message to the staff. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 10 Factors that can affect communication Vocal sounds — tone, volume and inflection of the voice The way words are spoken should be congruent with the intended message. An insult delivered with a smile and light-hearted tone of voice is more often taken as a joke than an insult. Conversely, praise offered in a deadpan voice lacking enthusiasm can be seen as insincere or as sarcastic. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 11 Factors that can affect communication Words The choice of words can significantly affect the intended message. Using medical jargon with patients can cause them not only to misunderstand but also you are different and perhaps superior. Some words can convey a judgemental view of other people. E.g ‘Not a team player’ Vs 'prefers to work independently' HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 12 Factors that can affect communication Culture Cultural attitudes, beliefs and behaviours all affect communication. A great many problems result from people's lack of understanding of each other's cultural norms. Gestures are a good example of this. Understanding the cultural heritage and learning to interpret cultural messages is essential for the manager to communicate effectively with staff from diverse backgrounds. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 13 Factors that can affect communication Power dynamics A person who feels less powerful in relation to others will tend to communicate from a less confident position. There may be a reluctance to express opinions, offer honest feedback or disagree. Choose an approach that creates safety for each person in the interaction HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 14 Modes of Communication Synchronous ◦ Rapid feedback, multiple cues, natural language, and personal focus ◦ Face-to- face, telephone, voicemail, and video Asynchronous ◦ Slower feedback, fewer cues, less naturally occurring language, and less personal focus ◦ Email, postal mail, discussion board posts Choosing the appropriate mode of communication can be an important leadership and management skill. Written communications (emails, faxes, letters) are an important management tool, in that the information can be stored and referred back to when needed. Verbal communications such as telephone calls, conversations and meetings are more suited to situations needing discussion, sharing of ideas, or developing relationships and understanding. continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 15 Modes of Communication Channels from more synchronous to less synchronous: ◦ ◦ ◦ ◦ ◦ ◦ ◦ In person By phone Voice mail Text Email Postal mail Posting on social media websites, including blogs continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 16 Communication Nonverbal Messages ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Head or facial agreement or disagreement Eye contact Tone Volume Inflection Gestures of the shoulders, arms, hands, or finger Body posture and position Dress and appearance Timing Environment continued on next slide HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 17 Nonverbal gestures Emblems are the nonverbal cues that have a universal meaning within a specific culture. For example, in many cultures, a thumbs up means good job. Illustrators; The automatic nonverbal gestures and cues we use subconsciously to illuminate our word. For example, saying, "It's so great to see you,“ and use big sweeping gestures with arms. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 18 How nonverbal and verbal communication overlap There are six different ways that nonverbal and verbal communication interact in real life. 1. Repeating; A nonverbal behavior reinforces a verbal message. For example, saying, "Nice job," while giving a thumbs up 2. Substituting; When we use a gesture or some other form of nonverbal communication in place of a word For instance, you might give a high-five instead of saying "Wow, that's awesome, congratulations." 3. Turn-taking; Relying on nonverbal communication to signal turn-taking For example, in a group conversation, you might lean in and do an outwardly gesture to signal that maybe they would like to say something. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 19 How nonverbal and verbal communication overlap 4. Complementing; Enhancing a verbal message with nonverbal communication For example, if you're giving your manager your team's epic progress , you might gesture an upward chart signaling growth 5. Emphasizing; To accentuate a verbal message especially in a speech, presentation or meeting. For example, use a strong gesture or change tone of voice, volume, inflection pattern and pitch. 6. Contradicting; This occurs when nonverbals contradict your spoken words. For instance, a friend tells you they are in so much pain but smiling. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 20 How nonverbal and verbal communication overlap Nonverbal leakage You say how you feel with your words other feelings leak out through your nonverbals For example, if we verbally express one thing but our body language, facial expressions and tone of voice are screaming something else entirely, our nonverbals are leaking into our words and altering our message In other words, there's a disconnect between what we're saying and how we're saying it. Research shows that in studies on deception 98% of people expressed nonverbal leakage when they were trying to hide a charged emotion like anger, jealousy, depression, or dishonesty. Micro expressions where an emotion will flash across the person's face happen as fast as 1/15th to 1/25th of a second. The seven universal micro expressions are happiness, surprise, fear, anger, sadness, disgust, and contempt HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 21 Directions of Communication ◦ Downward communication ◦ Manager to staff ◦ Is often directive. ◦ Upward communication ◦ Occurs from staff to management ◦ Often involves reporting pertinent information to facilitate problem solving and decision making HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 22 Directions of Communication Lateral communication ◦ Occurs between individuals or departments at the same hierarchical level ( ward managers, team leaders) Diagonal communication ◦ Involves individuals or departments at different hierarchical levels. Both lateral and diagonal communications involve information sharing, discussion and negotiation. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 23 Directions of Communication Grapevine ◦ An informal channel for communication (Rumors and gossip) ◦ Usually rapid, haphazard and prone to distortion ◦ It is also useful. Sometimes the only way you learn about a pending change is through the grapevine. ◦ No one is accountable for the misinformation relayed. ◦ A slightly altered version of truth Types Single strand Gossip Probability Cluster HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 24 Directions of Communication Communicating with staff ◦ Who report to you, either as members of your team or as healthcare support workers who assist in care the most important part of being a team leader. ◦ Staff rely on the team leader or manager for information to get the job done, feedback on how they are performing and support for their development. ◦ Much of the information is routine, such as notifying staff of changes to policy or upcoming training events. ◦ Team leader or manager are in a more powerful position than staff. Often sensitive to communications from manager. ◦ Apply the principles of effective communication ◦ Good communication is the adhesive that builds and maintains an effective work group. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 25 Directions of Communication Communicating with those above you in the organization ◦ The principles for effective communication important in upward communication. ◦ Clear and concise communication inspire confidence in those to whom you report and enable them to fulfil their responsibilities. ◦ Be organized and prepared to state needs clearly, to explain the rationale for requests, and to suggest benefits for the larger organization. ◦ Be prepared to listen objectively to the other person's assessment of the situation ◦ Understand that the people above you have even more responsibility and pressure than you do. ◦ Getting to know the other individual on a personal and professional level is also important. E.g How does the person respond to stress? HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 26 Directions of Communication Communicating with those above you in the organization – Guidelines ❖Give immediate feedback for things the other person does that support you or your service; feedback, praise and gratitude are often a welcome change. ❖Never let those above you be caught off guard; keep them informed. ❖Always tell the truth. Admit when you are wrong. ❖Try to align your goals with theirs. Show them how your ideas will have a positive impact on their priorities. ❖Inform the successes you achieve. At each meeting be sure to describe progress towards goals, problems solved and important outcomes such as positive patient comments. ❖Be aware of the other person's achievements and acknowledge them. If your manager asks you to do something, do it well and ahead of the deadline if possible. If appropriate, add some of your own suggestions. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 27 Directions of Communication Patients and families – Tips for effective communication ❖Most individuals are unfamiliar with medical jargon. Use simple words that are appropriate to the recipient's level of understanding without speaking down to the patient. ❖As much as possible, maintain privacy. Try to hold your conversations where they cannot be overheard by others ❖Recognise cultural differences in communicating with patients and their families. People in some cultures do not ask questions for fear of imposing on others. ❖Provide information verbally and in writing wherever possible. This will give the person something to remind them of the key points of information. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 28 Approaches to Communication How powerful, comfortable or confident you feel in relation to the other person in the conversation will affect how you approach him or her. There are four styles of approach: Passive Aggressive Passive-aggressive Assertive. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 29 HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 30 Approaches to Communication ◦ A passive approach to communication is where the sender approaches the receiver in a subservient way and communicates through body language, tone of voice and choice of words that there is respect for the receiver but not for self. Situation; Raja , a newly qualified staff member, approach an experienced colleague, Noor. Noor, would you please, when you have time, come and look at Ms.Layla with me. I am worried about her and not sure if I should call someone. I know you are busy, but I really need your help. Please.’ ▪It is likely that the newly qualified staff member would use a pleading tone of voice. Raja has inadvertently communicated weakness and insecurity and, as a strong character, Noor is not likely to respect that kind of approach HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 31 Approaches to Communication An aggressive approach to communication is where the sender has respect for self but not for the receiver. Anger often accompanies aggression, such as anger about being criticised, treated unfairly or put down. The speaker often attributes some negative attribute to the receiver, such as stupidity, incompetence, unfriendliness, rudeness or simply that they are somehow 'less worthy' than the sender. Noor’s response to Raja 'You again. Every time I turn around you want something. You are fully qualified now, not a student, and you should be able to look after your patients without always bothering me. I am tired of doing your job for you.’ Raja clearly sees Noor as a problem and a bother, has little respect for her as a colleague. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 32 Approaches to Communication A passive-aggressive approach is one in which an individual disagrees with the speaker but fails to voice their disagreement or resists an idea through inaction. Instead of voicing a concern about an idea, the passive-aggressive person may simply stay quiet. The sender of the message believes the receiver is in agreement because they have no information to the contrary, but in fact the receiver disagrees. Raja may respond to Noor's aggressive reply with passive-aggressive actions. Raja may simply walk away and, without giving Noor any feedback directly, go to the ward manager to complain about Noor. Raja is hurt and angry and wants to get Noor into trouble.. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 33 Approaches to Communication An assertive approach is reciprocal, one that respects both the sender and the receiver (Dickson, 2004). Being assertive requires personal confidence as well as careful planning. Using an assertive approach to professional situations is normally the best option, Assertive communications build professional relationships and team working from a position of mutual respect. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 34 Approaches to Communication An assertive approach of Raja to Noor Not only conveying respect for herself but also using a common value as a basis for her approach. ‘Noor, I am concerned about Ms Layla. My experience in caring for someone in an unstable position is limited. I trust your judgement and experience and I would like your professional opinion. I want Ms Layla to be safe and to receive the best care possible.’ By phrasing her request in this way, Raja recognises her limitations and makes it clear that she has Ms Layla's safety as a primary concern. Noor is much more likely to respect Raja and to assist her in the situation. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 35 Steps in effective communication ▪Be clear about exactly what you want to happen. Be certain you know exactly what you want from the other individual, within what time frame, and what steps should be followed to do it. ▪Get positive attention. The first step in face-to-face communication is to enable listening. Avoid factors that interfere with effective listening, such as noise and distraction. ▪Give clear, concise information. Use an inoffensive and non-defensive style and tone of voice ▪Verify understanding. Make sure the receiver has understood your specific request for action. ▪Give follow-up communication. Understanding does not guarantee performance HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 36 Situations that challenge effective communication An important study called 'Silence Kills' (VitalSmarts, 2005) was undertaken to discover the types of message that were difficult for managers, nurses and doctors to address with each other. They are: Broken rules Mistakes Lack of support Incompetence Poor teamwork Disrespect Micro-management. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 37 Situations that challenge effective communication The study called 'Silence Kills' (VitalSmarts, 2005) found that less than 10 per cent of people who witnessed these situations felt able to address these issues, and that most of the time, the issues had persisted for more than a year. They are a serious barrier to team working and can have consequences for the patient. Could lead to the undertaking of difficult conversations — conversations that involve risk to one or more of the participants. Difficult conversations are often avoided because of fear of; feeling awkward hurting the other person retaliation making the situation worse personal safety. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 38 Situations that challenge effective communication The intention in holding a difficult conversation is to communicate a sensitive or unwelcome message whilst maintaining or improving the relationship between two people. Dickson (2004) recommends starting with three questions for reflection: 1. What is happening? 2. How do I feel about it? 3. What would I like to be different? HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 39 Situations that challenge effective communication 1. What is happening? To describe and gather evidence about the situation. For example, if you have an employee who has been late a number of times in the past two months, you need to know the exact nature of the lateness. How many times, how late and on what shift are all essential objective facts. Also collect evidence about the impact of the lateness on colleagues and on patient care. If the person dismisses their lateness as unimportant, these two pieces of information, evidence and impact, are the components of effective feedback. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 40 Situations that challenge effective communication 2. How do I feel about it? Identifying your emotional response to a situation is an important step in preparing for a difficult conversation Fear is the most common emotion to get in the way of difficult conversations. If you feel angry about the situation, you may be inclined to become aggressive. This feeling in itself could prevent you from addressing an important issue (worry that you will lose temper) If you feel hurt, you may worry that you will cry (emotions will be seen as unprofessional). HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 41 Situations that challenge effective communication 3. What would I like to be different? State what you want, not what you don't want. For example, if a staff member is rude; 'l want her to stop being rude.' This reply doesn't describe what is wanted. Instead say 'l want her to be polite in all conversations with staff, patients and families.' This sets a positive standard and focus the person on the desired behaviour. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 42 Preparing for a difficult conversation Example of how to use the three questions to prepare for a difficult conversation (table) Consider timing (close to the event occurrence but not when emotions are high) and setting the tone of the conversation before holding the discussion What is happening? How do I feel about it? When Noor has been scheduled for a Saturday shift, she has phoned in sick on the past three occasions and the service has been short handed. This has caused other staff to work harder and to feel angry with Noor. I feel frustrated and I want Noor to come to work on the concerned about how Saturdays she is assigned. the team is feeling about Noor. The discontent could affect how we treat patients HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 What would I like to be different? 43 Opening a difficult conversation The five -step approach Step Example 1. Thank the person for meeting Noor, thanks for agreeing to meet with me today 2. Tell them how you are feeling using the feeling section from your preparation I have been feeling very frustrated lately. 3. Describe the situation from your ‘what is happening ?’ section The past three times you were scheduled to work on a Saturday you have phoned in sick. Because it is difficult to back-fill weekends your colleagues often have to work shorthanded which has led to resentment from your colleagues and puts a strain on patient care 4. Tell them what you want to happen from your preparation I want to be confident that you will be at work on the Saturdays that you are assigned. 5. Invite a response Tell me about those Saturdays so I can better understand the situation HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 44 Opening a difficult conversationresponses Explanations 'l am having some problems at home that make it hard for me to come to work on time.' Reflect back their concern whilst keeping the responsibility for solving the problem with them. 'As I understand it, you are having some problems at home. It remains important for you to be at work on time as it affects both the service we offer and the team. What needs to happen to ensure you can get to work on time? This response keeps the accountability for timekeeping with them and conveys that you believe that they can solve the problem as a responsible adult HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 45 Opening a difficult conversationresponses Deflections It is possible that the person will try to deflect you from the issue at hand by providing an excuse or attacking your credibility. Examples of deflections are 'I've heard it all before.' 'You just don't understand, 'l don't have time, 'I've tried that and it doesn't work. Effective responses to these deflections consist of two parts: acknowledgement and redirections. The first step is to acknowledge the concern using the person's own words, and the second is to bring the situation back to the topic at hand. For example, a staff member reply to your suggestion by saying, 'We tried that and it didn't work', you could respond by saying, 'I know it has been tried before [acknowledgement], but the situation has changed and I think it is a good time to give it a try [redirection]. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 46 Opening a difficult conversationresponses Diatribe The diatribe (or rant) is an explosion of anger typically including indignation or criticism. It is important that the diatribe is halted, and that the person is treated with respect. The following method is suggested. 1.Interrupt the speaker by repeating their name firmly and loudly without anger in your voice. 2.Once they stop speaking, say: 'l want to hear your point of view, and I cannot concentrate on what you are saying when you are speaking like that. Please tell me your concern.' HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 47 Opening a difficult conversationresponses Tears Tears can be a deflection, but more often it is a sign of emotional intensity. It is best to stay in the room, with the person, staying quiet and letting them compose themselves. When the tears stop, say, 'l realise this is difficult. I don't intend to upset you. It is important to talk about [the issue].’ Silence Silence can be an expression of resistance or defiance, or it can be a sign of fear about telling the truth. Remain relaxed, attentive and expect an answer. If the silence persists, say: 'You have been silent for some time now, and I think you have something to say. What is on your mind?' Wait for another reasonable time. Try asking again: What is it you want to say?’ If the silence persists, it may be useful to reschedule the conversation for later in the day, or soon thereafter to resume the conversation. Say, 'l would like to resolve this situation. You seem in need of some time to think. Shall we start again after lunch?' HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 48 Opening a difficult conversationresponses Storming out It is never safe or helpful to hold someone in a meeting if they are determined to leave. If a person announces their intention to leave, you cannot stop them. If possible, tell the person that you will set up another meeting as this is an important issue and it needs to be addressed. If the leaving is very sudden, contact the person within a day or so to set up a continuation. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 49 Effective feedback Feedback is the gift of information, offered in the form of evidence and impact. It offers the objective evidence (what, when, where, how often), the subjective evidence (how people reacted) and why it is important. Feedback is intended to inform and, development of insight into the situation, motivate the person to change. Criticism is a negative judgement on the actions or motives of the other person. Universally, people respond to criticism with defensiveness and that makes criticism an ineffective tool for communicating desired changes. Praise is a positive judgement on the actions or motives of the other person. People respond to praise with pleasure and pride. Sincere praise, carefully structured with specific information, usually causes people to feel good, and can be motivating and can build good relationships. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 50 Example of praise, feedback and criticism Situation Praise Feedback Staff member with a history of lateness has been on time for the past two weeks Good job for getting here on time! You’ve been on time every I knew you could get shift for the past two here on time if you tried weeks. That has made it hard enough. possible for handover to go smoothly and for the night shift to get home on time. A staff member receives special mention in a patient letter Well done! Mr Ali commented that you He liked you, didn’t he? took extra time with him No wonder you spent so explaining his tests and much time with him. that really made him feel less anxious. That was clearly an important part of his care. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 Criticism 51 Ponder points ▪A complex, ongoing, dynamic process in which the participants simultaneously create shared meaning in an interaction. ▪Expert communication skills are essential for a manager/leader to be successful. Gender, cultural background and the organisational culture influence communication and its outcome. ▪Messages can be distorted or misconstrued. Your job is to be as clear as possible and ensure that you have been understood. ▪Communication strategies vary according to the situation and the roles of people involved. ▪Holding difficult conversations (those where emotions run high) are part of a manager/ leader's responsibility in order to address performance, behaviour or competence issues. HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 52 Useful links Verbal and Nonverbal Communication https://www.youtube.com/watch?v=wOhLMEKLTKE 4 Communication Styles - Passive, Aggressive, Assertive & Passive Aggressive https://www.youtube.com/watch?v=IEUjZiO5vmg HCA 301, CHSS, AHD, SEMESTER II-2023- 2024 53