importance of good communication in case study

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Quality communication can improve patient-centred health outcomes among older patients: a rapid review

Samer h. sharkiya.

Faculty of Graduate Studies, Arab American University, 13 Zababdeh, P.O Box 240, Jenin, Palestine

Associated Data

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.

Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like “effective communication,“ “elderly,“ and “well-being.“ Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool.

The search strategy yielded seven studies. Five studies were qualitative (two phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, and one was an experimental study. The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes.

Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-023-09869-8.

Introduction

Excellent communication is critical for all health professionals [ 1 , 2 ]. It affects the quality of healthcare output, impacts the patient’s health and satisfaction, and benefits both patients and providers [ 3 ]. Communication is a critical clinical competence because it establishes trust between providers and patients, creating a therapeutic relationship [ 4 ]. Physician-patient communication plays several functions, including making decisions, exchanging information, improving the physician-patient relationship, managing the patient’s doubts, addressing emotions, and enhancing self-management [ 5 ]. Features of effective or quality communication include involving patients in decisions, allowing patients to speak without interruptions, encouraging a patient to ask questions and answering the questions, using a language that the patient understands, paying attention to the patient and discussing the next steps [ 5 ]. This communication also includes listening, developing a good interpersonal relationship, and making patient-centred management plans.

The quality of patient-physician communication influences various patient-centred outcomes [ 6 ]. In this review, patient-centred outcomes refer to all the outcomes that contribute to the recovery or indicate the recovery of patients, as well as suggest positive experiences with the care process. For instance, effective communication is associated with enhanced patient satisfaction, regulating emotions, and increasing compliance, leading to improved health and better outcomes [ 7 , 8 ]. According to [ 9 ], quality communication enhances patients’ trust in their providers, making patients more satisfied with the treatment. A trusting provider-patient relationship causes individuals to believe they receive better care [ 10 ]. For instance, [ 11 ] report that effective provider-patient communication improves social, somatic, and psychological health. During communication, the provider may enhance positive motivations and involve the individual in treatment decisions. Communication helps patients to acknowledge their illnesses, the associated risks, and the advantages of consistent treatment [ 5 ]. note that mutual communication between providers and patients stimulates or strengthens patients’ perception of control over their health, the knowledge to discern symptoms and self-care and identify changes in their condition. Effective communication leads to improved perceived quality of health care [ 12 ]. report that physician-patient communication influences the perceived quality of healthcare services. All these outcomes that suggest or contribute to patient’s positive experiences or imply a positive recovery journey, such as shorter hospital stays, are considered patient-centred outcomes.

This rapid review aims to review studies that have previously investigated the influence of quality communication on patient-centred outcomes among older adults, such as psychological well-being, quality of health care, emotional well-being, cognitive well-being, individualised care, health status, patient satisfaction, and quality of life. The specific objectives include (a) exploring the strategies used to ensure quality and effective communication with older patients in various healthcare settings, (b) exploring the patient-centred health outcomes reported by previous studies investigating quality communication between providers and older patients, and (c) to link quality communication strategies with older patients to patient-centred health outcomes among older patients.

The primary rationale for conducting this rapid review is that although many studies have examined the relationship between quality communication and various patient-centred outcomes, few studies have used older patients as their participants. It is a significant research gap because older adults have unique communication needs, which, if not considered, their communication with healthcare providers could be ineffective [ 13 ]. For example, older adults experience age-related changes in cognition, perception, and sensation, which can interfere with the communication process [ 14 ]. As a result, more research is needed to the specific quality communication strategies that could improve patient-centred outcomes among older adults. To my knowledge, no systematic review has focused on this topic. Therefore, this is the first rapid review to explore quality communication and its impact on patient-centred health outcomes among older patients in various healthcare settings.

This rapid review’s findings could inform practitioners of the quality communication strategies they can use to improve patient-reported outcomes. Besides, the rapid review evaluates the quality of studies investigating this matter and makes informed recommendations for future research to advance knowledge on this subject.

This rapid review was conducted in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 15 ]. The main difference between a systematic review and a rapid review is that the former strictly conforms to the PRISMA protocol, whereas the latter can miss a few elements of a typical systematic review. A rapid review was suitable because a single reviewer was involved in the study selection process, whereas at least two independent reviewers are recommended in typical systematic reviews [ 16 ].

Eligibility criteria

Table  1 below summarises the inclusion and exclusion criteria used to guide study selection in this rapid review. Also, justification is provided for each inclusion/exclusion criteria. The inclusion/exclusion criteria were drafted based on the target population, the intervention, the outcomes, year of publication, article language, and geographical location. This approach corresponds with the PICO (P – population, I – intervention, C – comparison, and O – outcomes) framework [ 17 ].

Inclusion and exclusion criteria

Information sources

Four academic databases were searched: PubMed, Scopus, CINAHL, and PsycINFO. These databases were used as sources of information because they publish studies in healthcare sciences on a wide range of topics, including communication and the health outcomes of various interventions. Additionally, Google Scholar was searched to supplement the databases because it indexes academic journal articles in all disciplines, including healthcare. Combining Google Scholar with these databases has been recommended for an optimal search strategy [ 18 ].

Search strategy

Various search terms related to the critical variables of this rapid review, namely quality communication, patient-centred health outcomes, and older patients, were combined using Boolean connectors (AND & OR). Regarding quality communication, some of the keywords that were used include “quality communication,“ “effective communication,“ “doctor-patient communication,“ and “patient-centred communication.“ The keywords that were used for patient-centred outcomes included “well-being,“ “patient satisfaction,“ “quality of care,“ “health status,“ and “quality of life.“ The search terms related to older patients included “nursing home residents,“ “older,“ and “elderly.“ Additionally, since most older patients are institutionalised, search terms like “nursing homes” and “assisted living facilities” were used in the search strategy. Table  2 below presents a sample search strategy executed on PubMed between September 2022 and July 2023. As shown in Table  2 , Mesh terms were used alongside regular keywords. Truncations on the three keywords, namely elderly, nursing homes, and geriatric were used to allow more of their variations to be captured in the search. The use of Mesh terms was only performed on PubMed – Mesh terms are only supported on PubMed and MEDLINE. The rest of the sources of information were searched using the search terms without specifying whether they are Mesh terms or not.

Study selection process

One reviewer (the author) was involved in screening the studies. The reviewer screened each record at least twice for confirmation purposes. Afterwards, an automation tool called ASReview which relies on machine learning to screen textual data was used as a second confirmation [ 19 ]. Research has shown that combining a machine learning tool and a single reviewer can significantly reduce the risk of missing relevant records [ 20 ]. This decision was reached based on previous research that has also demonstrated the good sensitivity of ASReview as a study selection tool in systematic reviews [ 19 ]. The software was trained on the eligibility criteria and the broader context of this study before it was used to screen the studies and confirm the reviewer’s decision. Therefore, if a record were retrieved, the author would screen for its eligibility the first time and confirm it the second time. For the third time confirmation, ASReview was employed. In case of disagreement between the author’s first and second attempts, a third attempt could be made to resolve it. In case of disagreement between the author’s first/second/third attempts and ASReview, a fourth attempt was made to resolve it.

Data collection process

One reviewer (the author) extracted data from the qualifying records. The reviewer could collect data from a given study in the first round, record them, and confirm them in the second round. In case of disagreement between the first and second rounds, the author would extract data from the record for the third time to resolve it. The data points on which data extraction was based include the country where the study was conducted, the study’s research design (if reported), the population and setting of the study, the characteristics of the intervention (communication), and outcomes. Also, the author remained keen to identify ways the studies defined quality or effective communication in the context of older patient care. Regarding the characteristics of the intervention, some of the data sought included the type of communication (e.g., verbal or non-verbal) and the specific communicative strategies, such as touch and active listening.

Regarding outcomes, ‘patient-centred outcomes’ was used as an umbrella term for several variables that relate to the patient’s subjective well-being. Such variables include perceptions of quality of care, quality of life, symptom management, physical health, mental health, health literacy, patient satisfaction, individualised care, and overall well-being, including social processes, self-actualisation, self-esteem, life satisfaction, and psychosocial well-being. If studies reported on the acceptance and usability of communicative strategies, it was also included as a patient-centred outcome because the patient accepts a specific intervention and acknowledges its usability.

Study quality assessment

The study quality assessment in this rapid review entailed the risk of bias and certainty assessments. Risk of bias assessment formed an essential aspect of certainty assessment. The risk of bias in qualitative studies was evaluated using the Critical Appraisal Skills Program (CASP) Qualitative Checklist [ 21 ]; the Cochrane Risk of Bias (RoB) tool was used for randomised studies [ 22 ]; and Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) was used for cross-sectional observational studies [ 23 ]. The Grading for Recommendations, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for all study designs [ 24 ]. The risk of bias in each study design and its corresponding assessment tool was calculated as a percentage of the total points possible. For example, the CASP Qualitative Checklist has ten items; each awarded one point. If a study scored seven out of 10 possible points, its risk of bias would be rated as 70%. The GRADE Tool has five domains, namely risk of bias, inconsistency, indirectness, imprecision, and publication bias. The first domain, risk of bias, was populated using the findings of risk of bias assessment using the stated tools. The overall quality of a study was based upon all five domains of the GRADE Tool.

Synthesis methods

Both qualitative and quantitative studies were included in this review. The studies were highly heterogeneous in their research designs hence statistical methods like a meta-analysis synthesis were impossible [ 25 ]. Besides, the studies also had substantial heterogeneity in the study settings (some were conducted in primary care settings, but a majority were conducted in long-term care facilities/nursing homes) and outcomes. The studies measured different outcomes under the umbrella variable of patient-centred outcomes. As such, a narrative synthesis approach was considered the most suitable [ 26 ]. The narrative synthesis guidance by [ 27 ] was used. The first step based on the guidelines should be developing a theoretical model of how the interventions work, why, and for whom.

This rapid review’s explanation of how effective or quality communication leads to improved patient-centred outcomes in the introduction section formed the theoretical basis, that is, effective communication facilitates informational exchange between the patient and provider, leading to better decision-making, which positively influences patient outcomes The second step of a narrative synthesis entails organising findings from the included studies to describe patterns across the studies based on the direction of the effect size or effects [ 27 ]. The third step is to explore the relationship in the data by identifying the reasons for the direction of effects or effect size. This rapid review’s reasons were based on the theoretical notions outlined above in this paragraph. The final step is to provide insights into the generalizability of the findings to other populations, which, in the process, further research gaps can be outlined. The results are stated below.

Study selection

After running the search strategy, 40 articles were identified from PubMed, 13 from Google Scholar (records identified from websites (Fig.  1 )), 24 from Scopus, 18 from CINHAL, and 10 from PsycINFO based on the relevance of the titles. It was discovered that 26 were duplicated records between databases and Google Scholar, which reduced the number of identified records to 79. Further, the automation tool (ASReview) marked five records as ineligible based on their title considering the inclusion and exclusion criteria. These articles were excluded because the author confirmed in the fourth round that they were ineligible. After realising they did not focus on older adults, the author excluded three more records. Therefore, 71 records were screened using their abstracts with the help of ASReview (64 records from databases and 7 records from Google Scholar), whereby 44 were excluded (40 records from databases and 4 records from Google Scholar) for various reasons, such as being expert opinions and professional development based on field experiences (e.g., [ 28 ]) and did not have a methodology. The remaining 27 records (24 records from databases and 3 records from Google Scholar) were sought for retrieval, whereby one was excluded because its full text was inaccessible. The remaining 26 articles (23 records from databases and 3 records from Google Scholar) were assessed for eligibility with the help of ASReview, whereby eight records were excluded because they did not report their methodologies (e.g., [ 29 ]), another eight were secondary studies (e.g., [ 30 ]), and three were non-peer-reviewed preprints. Therefore, seven studies met the eligibility criteria for this rapid review.

PRISMA Flowchart summarising the study selection process

Study characteristics

Out of the seven studies, one was an experimental study [ 31 ], one was a cross-sectional observational study [ 32 ], and five were qualitative studies [ 33 – 37 ]. As shown in Table  3 , most of the studies (n = 4) were conducted in the United States. The following countries produced one study each: Australia, Cameroon, the Netherlands, and Hungary. Although all the studies utilised a sample of older patients, the characteristics of the patients differed from one study to another. The studies ranged from primary care settings [ 36 ] and adult medical wards [ 37 ] to long-term care facilities like nursing homes. Apart from [ 36 ], the rest of the studies investigated various non-verbal communication strategies with older adults and their impact on various types of patient-centred outcomes, ranging from health-related outcomes (e.g., smoking cessation) to patient-reported outcomes, such as patient satisfaction, self-esteem, and life satisfaction. These outcomes are within the broader umbrella category of patient-centred m outcomes.

Characteristics of included studies

Further, the studies used different types of communicative strategies that can be used to enhance or promote patient-centred outcomes. In this rapid review, they were categorised into seven, namely (a) touching, (b) smiling, (c) gaze, head nod, and eyebrow movement, (d) active listening, (e) close physical distance, and (f) use of visual aids, and (g) telephone communication. Table  4 summarises the various ways in which each study described its interventions.

Description of interventions used in studies

Quality assessment findings

All seven studies were of high quality based on the GRADE Tool-based Assessment. However, [ 31 ] conducted an experimental study, but they did not provide any details indicating whether there was concealment in participant allocation and blinding of participants and outcome assessors. Therefore, it has a high likelihood of risk of bias. However, they scored excellently in the other domains of the GRADE Tool. All five qualitative studies and the cross-sectional observational study also scored excellently in the domains of the GRADE Tool, apart from the imprecision domain where they could not be scored because none of them reported effect sizes (Table  5 ).

Quality assessment using the GRADE Tool

Results of individual studies

[ 31 ] was the only experimental study used in this rapid review investigating the effect of comfort touch on older patients’ perceptions of well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility. The authors did not report the effect sizes but indicated that comforting touch had a statistically significant effect on each of the five variables. In summary, the authors suggested that comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on the various patient-centred outcomes reported in their study. For each variable, the authors used three groups, the first and second control groups and the third experimental group. After delivering the intervention, they investigated whether the scores of these variables changed between three-time points in each of the three groups. The first time point was the baseline data collected before intervention was initiated; the second was two weeks after baseline data; and the third was four weeks after baseline data. The authors found that in each of the five variables, the scores remained almost the same in the three-time points for the two control groups, but there were significant improvements in the experimental group (the one that received the intervention). For example, the self-esteem variable was measured using Rosenberg’s Self-Esteem Scale, with the highest attainable score of 40. In the first control group, the score remained 27.00, 27.27, and 27.13 for Time 1 (baseline), Time 2 (after two weeks), and Time 3 (after four weeks), respectively. The same trend was observed in the second control group. However, in the experimental group, the score improved from 29.17 at baseline to 36.00 at Time 2 and 37.47 at Time 3. These findings suggest that comfort touch was highly effective in improving self-esteem among older patients. The same significant improvements were evident for all the other variables (p.184).

While all the other studies focused on nonverbal communication cues, [ 36 ] focused on telephone communication. They aimed to investigate the effect of a tailored intervention on health behaviour change in older adults delivered through telephone communication. Therefore, the primary rationale for selecting this study for review is that it used a specific communicative strategy (telephone) to deliver the intervention, which is the primary purpose of effective communication in most healthcare settings. The older patients used as participants in this study lived with COPD. The nurses trained to administer the intervention made regular phone calls over 12 months. The intervention was delivered to 90 participants. Of these, 65 were invited for interviews at the end of 12 months. One of the most important outcomes relevant to this rapid review is that the participants reported “being listened to by a caring health professional.“ It means that regular telephone communication improved the patient’s perceptions of the quality of care. Other critical patient-centred outcomes that improved due to this intervention include many participants quitting smoking and increased awareness of COPD effects.

[ 34 ] also conducted a qualitative study but needed to specify the specific research design, which was generally non-experimental. The authors used formative evaluation and a participatory approach to develop a communicative intervention for older adults with limited health literacy. In other words, apart from literature reviews, the authors involved the target population in developing a curated story to improve their health literacy. They developed photo and video-based stories by incorporating narrative and social learning theories. The most important finding of this study was that the authors found the developed communicative strategy appealing and understandable. Such observations imply that the participants’ health literacy also likely improved even though the authors did not evaluate it.

Further, using a sample of 155 older patients, [ 32 ] investigated the relationship between the communication characteristics between nursing practitioners and the older patients and patients’ proximal outcomes, namely patient satisfaction and intention to adhere to the NPs’ recommendations, and patients’ long-term outcomes (presenting problems and physical and mental health). The proximal outcomes (satisfaction and intention to adhere) were measured after visits, whereas the long-term outcomes (presenting problems, mental health, and physical health) were measured at four weeks. The communication and relationship components observed include various non-verbal communication strategies: smile, gaze, touch, eyebrow movement, head nod, and handshakes. The authors recorded videos during patient-provider interactions. These communicative strategies were measured using the Roter Interaction Analysis System (independent variable).

In contrast, the other outcomes (dependent variables) outlined above were each measured separately with a validated tool or single-item instruments [ 32 ]. For example, presenting problems were measured with a single-item instrument, whereas the physical and mental health changes at four weeks were measured using the SF-12 Version 2 Health Survey. The authors found that verbal and nonverbal communication strategies focused on providing patients with biomedical and psychosocial information and positive talk characterised by receptivity and trust were associated with better patient outcomes, such as significant improvements in mental and physical health at four weeks. Although the study did not report effect sizes, the findings agree that effective and quality communication can improve patient-centred outcomes like patient satisfaction.

[ 35 ] conducted a qualitative study with focus groups (eight focus groups with a range of three to nine participants) of 15 older adults in a nursing home. The study used an ethnographic qualitative design. The nonverbal communication strategies observed in this study included active listening (including verbal responses) and touching. The authors found that the characteristics of the communication strategies that make communication quality and effective include mutual respect, equity, and addressing conflict. The patients perceived that their nursing aides gave them better-individualised care if their relationship and communication were characterised by mutual respect. Portraying mutual respect includes showing the patients that they are being listened to and heard, which can include calling them by their names and showing signs of active listening. Some residents (older patients) complained that some nursing aides had favouritism, whereby they liked some patients and not others. When such a perception emerges, the patients could perceive the treatment as unjust, compromising individualised care quality. Also, nursing aides must equip themselves with communicative strategies to address conflict rather than avoid it. For example, knowing about the patient’s history can help nursing aides understand their behaviour in the facility, improving prospects of providing better personalised or individualised care.

[ 33 ] also conducted a qualitative study utilising a sample of 17 older adults in nursing homes and assisted living facilities in the United States. They aimed to identify the types and examples of nurse-aide-initiated communication with long-term care residents during mealtime assistance in the context of the residents’ responses. Using a naturalistic approach, the researchers observed communicative interactions between the nurse aides and the residents during mealtime assistance. Videos were recorded and transcribed and analysed using the grounded theory approach. They found that apart from emotional support, nonverbal communication strategies were used by nurse aides to address the residents, initiate and maintain personal conversations, and check-in. Although the authors did not provide statistical proof that these communication strategies improved well-being, their findings can inform future studies.

Finally, [ 37 ] conducted a qualitative, grounded theory study to develop a model for effective non-verbal communication between nurses and older patients. The authors conducted overt observations of patient-nurse interactions using a sample of eight older patients. They found that the nature of nonverbal communication to be employed depends on the context or environment, and certain external factors influence it. The factors influencing nonverbal communication include the nurses’ intrinsic factors, positive views of older adults, awareness of nonverbal communication, and possession of nonverbal communication skills. Patient factors that can also influence the effectiveness of nonverbal communication include positive moods, financial situations, and non-critical medical conditions. The model developed also emphasised that non-verbal communication, if carried out correctly considering context and environment, can lead to positive outcomes, such as increased adherence to providers’ recommendations, improved quality of care, and shorter hospital stays.

Results of syntheses

Four themes emerged from the narrative synthesis: nonverbal communication, verbal communication, communication strategies, and patient-centred outcomes. Table  6 summarises the subthemes that emerged under each theme. They are discussed below.

Nonverbal communication

Nonverbal communication was a critical theme that emerged in several studies. Five out of the seven studies investigated the effectiveness of touch on various patient-centred outcomes [ 31 ]. found that nonverbal communication strategies such as comfort touch, characterised by a handshake or a pat on the shoulders, forearm, or hand, had a statistically significant positive impact on patient-centred outcomes, such as well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility [ 31 ]. implemented comfort touch exclusively without combining it with other nonverbal communication strategies. It means that comfort touch on its own can be effective in improving various patient-centred outcomes. As such, it can be hypothesised that if comfort touch is combined with other nonverbal communication strategies, such as active listening, eye gazing, smiling, maintaining a close distance, eyebrow movement, and nodding/shaking of the head can lead to even better results regarding patient-centred outcomes [ 32 , 33 , 35 , 37 ]. [ 35 ] identified active listening and touching as important nonverbal communication strategies that make communication quality and effective [ 33 ]. found that nurse-aide-initiated communication during mealtime assistance using nonverbal communication strategies, such as emotional support, smiling, laughing, touching, eye gazing, shaking hands, head nodding, leaning forward, and a soft tone were crucial in addressing the residents, initiating (and maintaining) personal conversations, and checking in. Finally, [ 37 ] developed a model that emphasised the importance of effective nonverbal communication in forming effective therapeutic relationships, promoting patient satisfaction, and improving the quality of care. An exhaustive list of the nonverbal communication approaches is shown in Table  6 .

In general, most studies, especially the qualitative ones, supported the utilisation of multiple non-verbal communication strategies in a single communicative episode. The studies also implied that it is the responsibility of healthcare providers to initiate and maintain effective nonverbal communication cues, such as those detailed in Table  6 . Additionally, it is important to note that it is only one study [ 31 ] that investigated the effectiveness of comfort touch on patient-centred outcomes. Therefore, the notion implied in qualitative studies that combining various nonverbal strategies could lead to a better improvement in patient-centred outcomes is subject to further empirical investigation. It was noted that there is a lack of empirical studies investigating how the combination of various non-verbal communication techniques or strategies can influence patient-centred outcomes, such as patient satisfaction and perceptions of quality of care.

Verbal communication

Four out of the seven studies implied that verbal communication improved patient-centred outcomes [ 32 , 34 – 36 ]. Effective and quality verbal communication was found to impact patient satisfaction positively [ 32 ], increased awareness of COPD effects [ 36 ], improved health literacy [ 34 ], presented problems [ 32 ], and mental and physical health [ 32 ]. It is worth noting that [ 32 ] used a cross-sectional survey approach and used regression analyses to investigate the relationship between communication and various patient-centred outcomes, such as patient satisfaction and mental and physical health. Also, it is important noting that the authors combined both verbal (e.g., more positive talk, greater trust, and receptivity) and non-verbal (e.g., smile, gazing, eyebrow movements, and interpersonal touches) in their study. Therefore, it can be a bit challenging to directly conclude that effective verbal communication alone without non-verbal communication is effective on its own in improving patient-centred outcomes. Similarly, [ 34 ] combined both narrative-based and picture-based communication strategies to give patients education about health literacy. Therefore, it can be challenging to know whether narratives comprising of verbal communication (and often non-verbal communication) can improve patient-centred outcomes on their own. The rest of the studies were qualitative [ 35 , 36 ], which means that their findings generally reflected the subjective experiences or opinions of their participants. Therefore, it can be said that although all the four studies supported verbal communication can effectively improve patient-centred outcomes, there is a need for future research to experimentally test its effectiveness without being combined with non-verbal communication strategies.

Moreover, two of the four studies implied that some conditions must be met for verbal communication to be effective [ 32 , 35 ]. some communication strategies, such as higher lifestyle discussion and rapport-building rates, were perceived as patronising and associated with poor outcomes [ 32 ]. Instead, the authors found that communication strategies like seeking and giving biomedical and psychosocial information were more effective in improving patient outcomes [ 32 ]. It implies that healthcare providers should be attentive and intentional of the topics they discuss with patients. Further, in their qualitative study, [ 35 ] found that effective verbal communication also requires mutual respect, equity, and addressing conflict. Indeed, it appears that certain communication strategies like lifestyle discussions can undermine the process of establishing trust, which is why they were associated with adverse patient outcomes. Also, unlike nonverbal communication, the studies that highlighted the effect of verbal communication on patient-centred outcomes did not provide rich descriptions of the specific verbal communication strategies that can be used in a face-to-face healthcare setting. The described strategies like using phone calls to regularly communicate with the patient without having to visit a healthcare facility and things to ensure when communicating with the older patient, such as mutual respect and avoiding too many discussions on lifestyle do not offer rich insights into the specific nature of the verbal communication strategies.

Communication strategies

In 3.5.2 above, it was shown that the sample of participants that [ 32 ] used in their study did not prefer discussions related with healthy lifestyles, which compromised patient-centred outcomes. Therefore, it was also important to determine the best approaches to formulate communication strategies that work. Two out of the seven studies implied how communication strategies can be formulated [ 34 , 36 ] [ 36 ]. found that a tailored intervention delivered through telephone communication improved patient perceptions of the quality of care. In this regard, the authors first identified the needs of the patients to guide the development of the tailored intervention, from which they might have obtained insights into the patients’ communication preferences [ 34 ]. found a participatory approach to developing a curated story that improves health literacy appealing and understandable. The findings emphasised the need for participatory approaches when developing communication interventions for patients with varied health and social needs. Although the studies did not compare or contrast the effectiveness of participatory-based communication strategies and non-participatory-based communication strategies, their findings provide useful insights into the significance of involving patients when developing them. From their findings, it can be anticipated that a participatory approach is more likely to yield better patient-centred outcomes than non-participatory-based communication strategies.

Patient-centred outcomes

All studies reviewed highlighted patient-centred outcomes as the goal of effective communication in older patients. Patient-centred outcomes included well-being, self-esteem, health status, social processes, life satisfaction, self-actualisation, and self-responsibility (Butt, 2001), as well as patient satisfaction [ 32 , 36 ], increased awareness of COPD effects [ 36 ], and improved health literacy [ 34 ]. Others included presenting problems, mental health, and physical health [ 32 ], as well as adherence to providers’ recommendations, improved quality of care, and shorter hospital stays [ 37 ]. All seven studies indicated that the various verbal and nonverbal communication approaches could improve these patient-centred outcomes. The consistency observed between the experimental study by [ 31 ], the qualitative studies, and other quantitative study designs implies the need to pay greater attention to verbal and non-verbal communication strategies used by healthcare professionals as they can directly influence numerous patient-centred outcomes. This consistency further implies that effective communication is the anchor of high-quality care, and its absence will always compromise patient-centred outcomes, such as satisfaction and health outcomes.

Discussion and conclusion

Discussion of findings.

In agreement with various studies and reviews conducted in younger populations [ 1 – 3 ], all the seven studies selected in this rapid review supported that effective communication is a cornerstone of improved patient-centred outcomes. Like [ 5 , 11 , 12 ], the studies reviewed in this rapid review also supported the idea that effective communication with older adults involves the combination of verbal and nonverbal communication cues. However, this rapid review went a step ahead to identify the specific conditions that must be present for effective verbal and nonverbal communication to take place, such as perceptions of equity, mutual respect, and addressing conflict instead of avoiding it. The qualitative studies used in this rapid review also offered rich descriptions of how providers use nonverbal communication strategies.

However, the main shortcoming of the seven studies reviewed is that none aimed to define or describe what constitutes effective communication with older adults, apart from [ 37 ], who described a model of nonverbal communication with older adults. The study was qualitative and only formed a theoretical basis of how effective nonverbal communication with older adults could be shaped. The theory developed needs to be tested in an experimental setting so that its effect size in improving patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and emotional and cognitive well-being, can be documented unbiasedly and validly. Therefore, as much as the reviewed studies agreed with younger populations regarding the positive effect of effective and quality communication on patient-centred outcomes [ 9 , 10 ], the methodological rigour of studies with older patients needs to be improved.

Although the individual studies reviewed in this rapid review had low risk of bias apart from [ 31 ], the screening was based on the judgment of the individual research designs. Otherwise, if the assessment had been done from the perspective of the focus of this rapid review, the risk of bias in studies could have been high in predicting the influence of effective communication on patient-centred outcomes. First, apart from [ 31 ], none of the studies used a random sample. The qualitative studies used purposively obtained samples, which means the risk of bias from an interventional perspective was high. However, the studies provided in-depth insights into the characteristics and features of verbal and non-verbal communication strategies that can be used to form and maintain provider-patient relationships.

Recommendations for practice and future research

The main recommendation for practice is that nurses and providers serving older patients must be aware of their verbal and non-verbal communication strategies. Besides, they should engage in continuous professional development to enhance their verbal and non-verbal communication skills. Combining a wide range of nonverbal communication, such as touching the patient on the shoulder or arm or even handshaking can help create strong bonds and relationships, which are key in an effective therapeutic relationship. The qualitative studies reviewed showed that nurses and other providers combine a wide range of nonverbal communication in a single interaction instance, such as eye gazing, nodding, touching, and eyebrow movement. Although studies on verbal communication were rare in this rapid review, some lessons learned from the few studies included (e.g., [ 36 ]) is that using telephones to communicate with older patients regularly is potentially effective in improving patient-centred outcomes like better self-management. The information shared by the nurse should be tailored to serve the specific health needs of older patients. For example, for COPD patients, a nurse can make regular calls to old patients to educate them about the importance of quitting smoking and alcohol to improve their health condition and better self-management. However, as [ 32 ] indicated, the nurse should be cautious about how to present the information to the client and be able to detect patronising discussions quickly. For example, the sample of adults used by [ 32 ] found that many lifestyle and rapport-building discussions with the nurse were patronising in ways that may be detrimental to patient-centred outcomes. Some of the strategies providers can employ to ensure that communication is not perceived as patronising by older patients include ensuring mutual respect (e.g., active listening as a sign of mutual respect), creating perceptions of equity rather than favouritism when communicating with multiple patients at a time, and solving conflicts rather than avoiding them, which entails extra efforts, such as understanding the patient’s behaviour in the past and present. Overall, although studies have not provided specific estimates of the effect sizes of effective communication on patient-centred outcomes among older adults, there is a general trend and consensus in studies that effective communication, nonverbal and verbal, is the cornerstone of high-quality healthcare.

Further, future research needs to address various gaps identified in this study. The first gap is that although [ 37 ] tried to develop a model of nonverbal communication with older adults, their study had some drawbacks that limited the comprehensiveness of the model. First, the authors used a sample of only eight older adults in two medical wards in Cameroon. Besides the small sample, the study was conducted in medical wards, which means its findings may not be generalisable to long-term care settings like nursing homes. More older adults who encounter healthcare professionals are admitted in long-term care facilities, calling for developing a more robust communication strategy. Second, [ 37 ] only focused on nonverbal communication, thereby providing limited practical applicability of the model since verbal and nonverbal communication co-exists in a single interactional instance. Therefore, there is a need to develop a model that provides a complete picture into what effective communication is like with older adults.

After developing a valid, reliable, and generalisable model for effective communication with older adults in various healthcare settings, future research should also focus on investigating the impact of such a model on patient-centred outcomes, such as quality of care, quality of life, patient satisfaction, and physical and mental health. More particularly, the developed model can be used to derive communication interventions, which can be applied and tested in various healthcare settings with older adults. That way, research on this subject matter will mature as more and more studies test the effectiveness of such a communication model in various settings and countries. All that is known in the literature is that effective verbal and nonverbal communication can help promote patient-centred outcomes among older adults.

Limitations

Although this rapid review was conducted rigorously by adhering to the PRISMA guidelines, the use of a single reviewer in the study selection process can undermine the quality of the review. When a single reviewer is involved, the probability of missing out relevant studies increases immensely. However, this limitation was mitigated in this review by using an automation tool in the study selection process. In was assumed that combining the automation tool with one independent reviewer could significantly reduce the probability of missing relevant studies.

Another possible limitation is that few studies have been conducted between 2000 and 2023 investigating the effect of effective communication on various patient-centred outcomes. Although the literature recognises the importance of effective communication, and there is a unanimous agreement between studies of various research designs that it is the cornerstone of quality of care, more studies need to be conducted examining how various communication strategies influence patient outcomes, both subjective and objective. For example, [ 31 ] investigated the effect of comfort touch. Other studies using empirical means (e.g., experiments) can also test the other strategies identified, such as eye gazing, head nodding, eyebrow movement, et cetera. In this way, a more specific and structured approach to communication in healthcare settings can be developed using the evidence base.

Moreover, I initially intended to review studies published within the past five years (2018–2023) but later learned there were insufficient studies meeting the eligibility criteria. Consequently, I adjusted the publication date to the past ten years (2013–2023). I also learned insufficient studies published within that period. Consequently, I chose the period of 2000–2023, which yielded seven studies. Thus, some of the studies included may not capture contemporary realities in healthcare settings, raising the need for more empirical studies on this topic.

This rapid review selected seven studies whose narrative synthesis demonstrated that effective verbal and non-verbal communication could improve patient-centred outcomes. However, the studies were mostly qualitative, and hence they only provided rich descriptions of how nurses and older patients communicate in various clinical settings. It is only one study (Butts, 2001) that was experimental. Still, its risk of bias was high since patients were not concealed to allocation, and participants and outcome assessors were not blinded. Future research needs to focus on deriving a valid, reliable, and generalisable communication model with older adults using a larger and more representative sample size of older patients. Such a model should encompass both verbal and nonverbal communication. After developing a robust model, the next phase of future studies is to derive interventions based on the model and then, through experimental research, test their effectiveness. In that way, a standard approach to communicating effectively and in quality will be achieved, which is yet to be achieved in the current studies.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Acknowledgements

I thank my wife and children for their patience and the great opportunity to devote a lot of time to doing the article in the best possible way.

Authors’ contributions

I am the primary and sole author of this article. My contribution to this article is a full contribution.

Data Availability

Declarations.

The authors declare no competing interests.

‘Not applicable’ for that section. The article is a rapid review type.

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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How Great Leaders Communicate

• Carmine Gallo

Four strategies to motivate and inspire your team.

Transformational leaders are exceptional communicators. In this piece, the author outlines four communication strategies to help motivate and inspire your team: 1) Use short words to talk about hard things. 2) Choose sticky metaphors to reinforce key concepts. 3) Humanize data to create value. 4). Make mission your mantra to align teams.

In the age of knowledge, ideas are the foundation of success in almost every field. You can have the greatest idea in the world, but if you can’t persuade anyone else to follow your vision, your influence and impact will be greatly diminished. And that’s why communication is no longer considered a “soft skill” among the world’s top business leaders. Leaders who reach the top do not simply pay lip service to the importance of effective communication. Instead, they study the art in all its forms — writing, speaking, presenting — and constantly strive to improve on those skills.

• Carmine Gallo is a Harvard University instructor, keynote speaker, and author of 10 books translated into 40 languages. Gallo is the author of The Bezos Blueprint: Communication Secrets of the World’s Greatest Salesman  (St. Martin’s Press).

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Present or publish your research or creative activity, effective communication: case study, three types of communication.

Communicating with your audience is more than giving a handful of information, it is the use of clear language that is factual and logical to depict to the audience that the message is essential to their lives and their future.

The biggest communication problem is we do not listen to understand. We listen to reply.

Here is a video depicting why it is important to tailor to your audience's needs

Communicating to a Diverse Demographic Audience

This video depicts the importance of communication to different demographic audience members. Making sure that your presentation is understood by all individuals is a valuable communication tool

Remember that no matter the audience, everyone should understand and enjoy the information you are presenting.

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• 16 Feb 2024
• Research & Ideas

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Why Communication Matters

We communicate to create, maintain, and change relationships and selves..

Posted July 15, 2021 | Reviewed by Vanessa Lancaster

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• How we communicate helps relationships get off on the right foot, navigate problems, and change over time.
• In communication, we develop, create, maintain, and alter our relationships.
• We communicate to work our way through family changes and challenges in verbal and non-verbal ways.

I remember seeing a poster on my junior high classroom wall: “Communication is the Beginning of Understanding.” This spoke to me at the time. Yet, like so many people, I had never really thought much about communication. I would have described communication as sending and receiving messages.

Communication Is More Than Sending and Receiving Messages

In reality, communication is often about transmitting information. We send and receive messages with people in our lives. Daily, much of our communication consists of coordinating schedules, “What time are you getting home for dinner?” and negotiating whose turn it is to do the dishes, pay the bills, or take dinner to a friend who is ill. We send messages like, “It is your turn to let the dog out” and receive messages like, “Don’t forget to get dog food at the store” (if you have not guessed, a lot of the messages in my house are about the dog).

We might also blame problems on communication, talking about “communication breakdowns” or on a “lack of communication.” If we think about communication in these ways, we have missed so much that is important about communication. We have neglected how and why communication matters.

Communication Matters to Creating and Changing Relationships

We become aware of how Communication Matters when

• We confront issues with work-life balance.
• We experience positive events like the birth of a baby or winning an award.
• We have a friend does who does not do or say what we expect.
• We have disagreements over religious beliefs or political values.

Both positive and challenging events affect, reflect, and change our identity and the identity of our personal and family relationships. What do I mean by this? How did these relationships come into being? Well, think about the last time you started a new friendship or had a new member join your family. Through what you and the other person said and did, what we’d call verbal and nonverbal communication , these relationships took shape.

Sometimes relationships develop easily and clearly. They are healthy and pleasant. Other times, relationships develop in stress and storm and may be healthy or not. How we communicate helps relationships get off on the right foot, navigate problems, and change over time.

What is important to understand is that relationships are talked into (and out of) being. In communication, we develop, create, maintain, and alter our relationships. As we communicate, we become and change who we are. Think about how you have grown and changed as you communicate at home, at work, with friends, and in your community.

Communication Matters to Relationship and Family Identity

As we communicate, we co-create relationships and our own identity. As you think about your close relationships and your family, you can likely recall important events, both positive and negative, that impacted how you understand your relationship and yourself as a person.

Consider this example: one of my college students described a childhood family ritual of going out on the front lawn on Christmas Eve. The family sang Christmas carols and threw carrots on the roof for Santa’s reindeers. The family still does this annual carrot-throwing ritual in adulthood. You can picture them bringing their sometimes confused new partners and spouses out in the snow to throw carrots onto the roof and sing.

Why does this family still throw carrots and sing? Through this seemingly silly ritual, the family celebrates who they are as a family and the togetherness that is important to them. The family creates space for new people to join the family. Through their words and actions, members of the family teach their new partners how to be family members through carrot throwing and other vital experiences.

I am sure you can point to experiences that have been central to creating your relationships and your identity.

Communication Matters as We Face Change and Challenges

We also communicate to work our way through family changes and challenges. Family members or others may have different expectations of what our family and personal identity or should be. This is especially true when a family does not fit dominant cultural models, such as single-parent families, multi-ethnic families, stepfamilies, LGBTQ families, or adoptive families.

For me, becoming a stepfamily was highly challenging. We became a stepfamily when I was 12 years old. My mother had recently died, and my Dad surprised us, kids, introducing us to the woman he wanted to marry. We no longer matched the other families in the neighborhood where we’d lived most of our lives. We certainly did not feel like a family overnight.

It took my stepfamily several years to create an understanding of what it meant to be a family. As we interacted, and with many mistakes and some successes, we slowly came to understand what we needed and expected from each other to be a family.

For all of us, relationship and family identity is constantly developing and changing. In my case, I remember my stepmom reminding me to wear a jacket when going out in the evening, even into my 40s, and giving me advice about my health. At some point, our roles changed, and now, as she moves toward her 80s, more often than not, I am in the role of asking about her health and helping her with significant decisions. What it means to be a mother or daughter and what we expect of each other and ourselves change as we interact.

Communication Matters . Whether we are negotiating whose turn it is to feed the dog, how to become a parent, how to interact with a difficult co-worker, or how to celebrate with a friend who won a major award, it is in communication that we learn what to do and say. This is what I will write about in this blog as I reflect on what I have learned as a professor and researcher of interpersonal and family communication. I invite you to go on this journey with me. I hope to give you insights into your communication.

Communication Matters. Communication is the Beginning of Understanding . It is an exciting and ever-changing journey.

Baxter, L. A. (2004). Relationships as dialogues. Personal Relationships, 11 , 1-22. doi: 10.1111/j.1475-6811.2004.00068.x

Braithwaite, D. O., Foster, E. A., & Bergen, K. M. (2018). Social construction theory: Communication co-creating families. In D. O. Braithwaite, E. A. Suter, & K. Floyd. (Eds.). Engaging theories in family communication: Multiple perspectives (2nd ed., pp. 267-278). Routledge.

Braithwaite, D. O., Waldron, V. R., Allen, J., Bergquist, G., Marsh, J., Oliver, B., Storck, K., Swords, N., & Tschampl-Diesing, C. (2018). “Feeling warmth and close to her”: Communication and resilience reflected in turning points in positive adult stepchild-stepparent relationships. Journal of Family Communication, 18 , 92-109. doi: 10.1080/15267431.2017.1415902

Dawn O. Braithwaite, Ph.D., a professor of communication at the University of Nebraska-Lincoln, studies families and close relationships, especially step- and chosen families.

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Effective Communication in the Workplace

Source: https://pixabay.com/vectors/social-media-connections-networking-3846597/ is in the Public Domain at Pixabay.com. Retrieved 07.05.2022.

Effective workplace communication helps maintain the quality of working relationships and positively affects employees' well-being. This article discusses the benefits of practicing effective communication in the workplace and provides strategies for workers and organizational leaders to improve communication effectiveness.

Workplace Communication Matters

Effective workplace communication benefits employees' job satisfaction, organizational productivity, and customer service (Adu-Oppong & Agyin-Birikorang, 2014). We summarized Bosworth's (2016) and Adu-Oppong and Agyin-Birikorang's (2014) works below related to the benefits of practicing effective communication in the workplace.

• Reduces work-related conflicts
• Enhances interpersonal relationships
• Increases workers' performance and supervisors' expectations
• Increases workforce productivity through constructive feedback
• Increases employee engagement and job satisfaction
• Builds organizational loyalty and trust
• Reduces employees' turnover rate
• Facilitates the proper utilization of resources
• Uncovers new employees' talents

Strategies to Improve Communication Effectiveness

Effective communication is a two-way process that requires both sender and receiver efforts. We summarized research works and guidelines for good communication in the workplace proposed by Cheney (2011), Keyton (2011), Tourish (2010), and Lunenburg (2010).

Sender's strategies for communication planning

• Clearly define the idea of your message before sharing it.
• Identify the purpose of the message (obtain information, initiate action, or change another person's attitude)
• Be aware of the physical and emotional environment in which you communicate your message. Consider the tone you want to use, the configuration of the space, and the context.
• Consult with others when you do not feel confident or comfortable communicating your message.
• Be mindful of the primary content of the message.
• Follow-up previous communications to verify the information.
• Communicate on time, avoid postponing hard conversations, and be consistent.
• Be aware that your actions support your messages and be coherent in your verbal and behavioral communication style.
• Be a good listener, even when you are the primary sender.

Receiver's strategies during a conversation

• Show interest and attitude to listen.
• Listen more than talk.
• Pay attention to the talker and the message, avoiding distractions.
• Be patient and allow the talker time to transmit the message.
• Be respectful and avoid interrupting a talker.
• Hold your temper. An angry person takes the wrong meaning from words
• Go easy on argument and criticism.
• Engage in the conversation by asking questions. This attitude helps develop key points and keep a fluid conversation.

Effective communication practices are essential for any successful team and organization. Organizational communication helps to disseminate important information to employees and builds relationships of trust and commitment.

Key points to improve communication in the workplace

• Set clear goals and expectations
• Ask clarifying questions
• Schedule regular one-on-one meetings
• Praise in public, criticize in private
• Assume positive intent
• Repeat important messages
• Raise your words, not your voice
• Hold town hall meetings and cross-functional check-ins.

Adu-Oppong, A. A., & Agyin-Birikorang, E. (2014). Communication in the Workplace: Guidelines for improving effectiveness.  Global journal of commerce & management perspective ,  3 (5), 208–213.

Bosworth, P. (2021, May 19). The power of good communication in the workplace . Leadership Choice. Retrieved May 18, 2022.

Cheney, G. (2011). Organizational communication in an age of globalization: Issues, reflections, practices . Waveland Press.

Keyton, J. (2011). Communication and organizational culture: A key to understanding work experience . Sage.

Tourish, D. (2010). Auditing organizational communication: A handbook of research, theory, and practice . Routledge

Lunenburg, F. C. (2010). Communication: The process, barriers, and improving effectiveness.  Schooling ,  1 (1), 1-10.

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1. WHAT IS TECHNICAL COMMUNICATION?

1.4 Case Study: The Cost of Poor Communication

No one knows exactly how much poor communication costs business, industry and government each year, but estimates suggest billions.  In fact, a recent estimate claims that the cost in the U.S. alone are close to $4 billion annually! [1] Poorly-worded or inefficient emails, careless reading or listening to instructions, documents that go unread due to poor design, hastily presenting inaccurate information, sloppy proofreading — all of these examples result in inevitable costs. The problem is that these costs aren’t usually included on the corporate balance sheet at the end of each year; if they are not properly or clearly defined, the problems remain unsolved.

You may have seen the Project Management Tree Cartoon before ( Figure 1.4.1 ); it has been used and adapted widely to illustrate the perils of poor communication during a project.

The waste caused by imprecisely worded regulations or instructions, confusing emails, long-winded memos, ambiguously written contracts, and other examples of poor communication is not as easily identified as the losses caused by a bridge collapse or a flood. But the losses are just as real—in reduced productivity, inefficiency, and lost business. In more personal terms, the losses are measured in wasted time, work, money, and ultimately, professional recognition. In extreme cases, losses can be measured in property damage, injuries, and even deaths.

The following “case studies” show how poor communications can have real world costs and consequences. For example, consider the “ Comma Quirk ” in the Rogers Contract that cost $2 million. [3]   A small error in spelling a company name cost £8.8 million. [4]   Examine Edward Tufte’s discussion of the failed PowerPoint presentation that attempted to prevent the Columbia Space Shuttle disaster. [5] The failure of project managers and engineers to communicate effectively resulted in the deadly Hyatt Regency walkway collapse. [6]   The case studies below offer a few more examples that might be less extreme, but much more common.

In small groups, examine each “case” and determine the following:

• Define the rhetorical situation : Who is communicating to whom about what, how, and why? What was the goal of the communication in each case?
• Identify the communication error (poor task or audience analysis? Use of inappropriate language or style? Poor organization or formatting of information? Other?)
• Explain what costs/losses were incurred by this problem.
• Identify possible solution s or strategies that would have prevented the problem, and what benefits would be derived from implementing solutions or preventing the problem.

Present your findings in a brief, informal presentation to the class.

Exercises adapted from T.M Georges’ Analytical Writing for Science and Technology. [7]

CASE 1: The promising chemist who buried his results

Bruce, a research chemist for a major petro-chemical company, wrote a dense report about some new compounds he had synthesized in the laboratory from oil-refining by-products. The bulk of the report consisted of tables listing their chemical and physical properties, diagrams of their molecular structure, chemical formulas and data from toxicity tests. Buried at the end of the report was a casual speculation that one of the compounds might be a particularly safe and effective insecticide.

Seven years later, the same oil company launched a major research program to find more effective but environmentally safe insecticides. After six months of research, someone uncovered Bruce’s report and his toxicity tests. A few hours of further testing confirmed that one of Bruce’s compounds was the safe, economical insecticide they had been looking for.

Bruce had since left the company, because he felt that the importance of his research was not being appreciated.

CASE 2: The rejected current regulator proposal

The Acme Electric Company worked day and night to develop a new current regulator designed to cut the electric power consumption in aluminum plants by 35%. They knew that, although the competition was fierce, their regulator could be produced more affordably, was more reliable, and worked more efficiently than the competitors’ products.

The owner, eager to capture the market, personally but somewhat hastily put together a 120-page proposal to the three major aluminum manufacturers, recommending that the new Acme regulators be installed at all company plants.

She devoted the first 87 pages of the proposal to the mathematical theory and engineering design behind his new regulator, and the next 32 to descriptions of the new assembly line she planned to set up to produce regulators quickly. Buried in an appendix were the test results that compared her regulator’s performance with present models, and a poorly drawn graph showed the potential cost savings over 3 years.

The proposals did not receive any response. Acme Electric didn’t get the contracts, despite having the best product. Six months later, the company filed for bankruptcy.

CASE 3: The instruction manual the scared customers away

As one of the first to enter the field of office automation, Sagatec Software, Inc. had built a reputation for designing high-quality and user-friendly database and accounting programs for business and industry. When they decided to enter the word-processing market, their engineers designed an effective, versatile, and powerful program that Sagatec felt sure would outperform any competitor.

To be sure that their new word-processing program was accurately documented, Sagatec asked the senior program designer to supervise writing the instruction manual. The result was a thorough, accurate and precise description of every detail of the program’s operation.

When Sagatec began marketing its new word processor, cries for help flooded in from office workers who were so confused by the massive manual that they couldn’t even find out how to get started. Then several business journals reviewed the program and judged it “too complicated” and “difficult to learn.” After an impressive start, sales of the new word processing program plummeted.

Sagatec eventually put out a new, clearly written training guide that led new users step by step through introductory exercises and told them how to find commands quickly. But the rewrite cost Sagatec $350,000, a year’s lead in the market, and its reputation for producing easy-to-use business software.

CASE 4: One garbled memo – 26 baffled phone calls

Joanne supervised 36 professionals in 6 city libraries. To cut the costs of unnecessary overtime, she issued this one-sentence memo to her staff:

After the 36 copies were sent out, Joanne’s office received 26 phone calls asking what the memo meant. What the 10 people who didn’t call about the memo thought is uncertain. It took a week to clarify the new policy.

CASE 5: Big science — Little rhetoric

The following excerpt is from Carl Sagan’s book, The Demon-Haunted World: Science as a Candle in the Dark, [8] itself both a plea for and an excellent example of clear scientific communication:

The Superconducting Supercollider (SSC) would have been the preeminent instrument on the planet for probing the fine structure of matter and the nature of the early Universe. Its price tag was $10 to $15 billion. It was cancelled by Congress in 1993 after about $2 billion had been spent — a worst of both worlds outcome. But this debate was not, I think, mainly about declining interest in the support of science. Few in Congress understood what modern high-energy accelerators are for. They are not for weapons. They have no practical applications. They are for something that is, worrisomely from the point of view of many, called “the theory of everything.” Explanations that involve entities called quarks, charm, flavor, color, etc., sound as if physicists are being cute. The whole thing has an aura, in the view of at least some Congresspeople I’ve talked to, of “nerds gone wild” — which I suppose is an uncharitable way of describing curiosity-based science. No one asked to pay for this had the foggiest idea of what a Higgs boson is. I’ve read some of the material intended to justify the SSC. At the very end, some of it wasn’t too bad, but there was nothing that really addressed what the project was about on a level accessible to bright but skeptical non-physicists. If physicists are asking for 10 or 15 billion dollars to build a machine that has no practical value, at the very least they should make an extremely serious effort, with dazzling graphics, metaphors, and capable use of the English language, to justify their proposal. More than financial mismanagement, budgetary constraints, and political incompetence, I think this is the key to the failure of the SSC.

CASE 6: The co-op student who mixed up genres

Chris was simultaneously enrolled in a university writing course and working as a co-op student at the Widget Manufacturing plant. As part of his co-op work experience, Chris shadowed his supervisor/mentor on a safety inspection of the plant, and was asked to write up the results of the inspection in a compliance memo . In the same week, Chris’s writing instructor assigned the class to write a narrative essay based on some personal experience. Chris, trying to be efficient, thought that the plant visit experience could provide the basis for his essay assignment as well.

He wrote the essay first, because he was used to writing essays and was pretty good at it. He had never even seen a compliance memo, much less written one, so was not as confident about that task. He began the essay like this:

On June 1, 2018, I conducted a safety audit of the Widget Manufacturing plant in New City. The purpose of the audit was to ensure that all processes and activities in the plant adhere to safety and handling rules and policies outlined in the Workplace Safety Handbook and relevant government regulations. I was escorted on a 3-hour tour of the facility by…

Chris finished the essay and submitted it to his writing instructor. He then revised the essay slightly, keeping the introduction the same, and submitted it to his co-op supervisor. He “aced” the essay, getting an A grade, but his supervisor told him that the report was unacceptable and would have to be rewritten – especially the beginning, which should have clearly indicated whether or not the plant was in compliance with safety regulations. Chris was aghast! He had never heard of putting the “conclusion” at the beginning . He missed the company softball game that Saturday so he could rewrite the report to the satisfaction of his supervisor.

• J. Bernoff, "Bad writing costs business billions," Daily Beast , Oct. 16, 2016 [Online]. Available:  https://www.thedailybeast.com/bad-writing-costs-businesses-billions?ref=scroll ↵
• J. Reiter, "The 'Project Cartoon' root cause," Medium, 2 July 2019. Available: https://medium.com/@thx2001r/the-project-cartoon-root-cause-5e82e404ec8a ↵
• G. Robertson, “Comma quirk irks Rogers,” Globe and Mail , Aug. 6, 2006 [Online]. Available: https://www.theglobeandmail.com/report-on-business/comma-quirk-irks-rogers/article1101686/ ↵
• “The £8.8m typo: How one mistake killed a family business,” (28 Jan. 2015). The Guardian [online]. Available: https://www.theguardian.com/law/shortcuts/2015/jan/28/typo-how-one-mistake-killed-a-family-business-taylor-and-sons ↵
• E. Tufte, The Cognitive Style of PowerPoint , 2001 [Online]. Available: https://www.inf.ed.ac.uk/teaching/courses/pi/2016_2017/phil/tufte-powerpoint.pdf ↵
• C. McFadden, "Understanding the tragic Hyatt Regency walkway collapse," Interesting Engineering , July 4, 2017 [Online]: https://interestingengineering.com/understanding-hyatt-regency-walkway-collapse ↵
• T.M. Goerges (1996), Analytical Writing for Science and Technology [Online], Available: https://www.scribd.com/document/96822930/Analytical-Writing ↵
• C. Sagan, The Demon-Haunted World: Science as a Candle in the Dark, New York, NY: Random House, 1995. ↵

Technical Writing Essentials Copyright © 2019 by Suzan Last is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Effective Communication Case Study Analysis

Introduction Johnson & Johnson is one of the world’s biggest health care companies.

In the early eighties, the company faced a challenging task of responding to public relation crises. These crises were grave to an extent that they could spell the company collapse were they not handled with utmost care and creativity. Public relation and effective communication play a pivotal role in handling crises not only in companies but also in other organisations. The Johnson & Johnson Tylenol crisis case presents the real impact of public relation and effective communication in solving and changing public perception. Public perception is very important in maintaining customer loyalty on product as well as marketing.

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Effectiveness of Communication Effective communication is very important in running an organisation (Fielding, 2005). It involves sending of relevant information to the required person without any problem. There are several benefits of effective communication. These benefits include good relationship and good understanding among others. In an organisation, communication is critical in many ways. For instance, effective communication is used to motivate employees, change the public perception concerning a given product.

In the case of Johnson and Johnson , effective communication made it possible to regain the tarnished image of the company, which resulted out of Tylenol product death. The company used effective communication to explain what happed and to convince the public that it was not their mistake. In addition, effective communication made the public convinced by the company’s concern, which was done through advertisements that were designed to warn the public not to use the product until the cause of death was determined. This strategy actually worked to the best interest of the company. Different Public Targeted by the Company The different public involved were internal and external.

Johnson & Johnson had an obligation of convincing both the internal and external audience regarding the situation of where its original product, extra-strength Tylenol, had been allegedly used as a weapon to kill three people. Internal and External Public The recognition of the role of employees as stakeholders, with hom to communicate corporate crises, should be emphasized in any company. It should be noted that this can cause enormous pressure and ambivalence for any affected company and its staff. In order to avoid rumors, false information and public statements made without proof, all external and internal public have to be communicated with. Companies should never underestimate the role of effective communication during crisis (Daniela, Radebaugh, and Sullivan, 2011). This is because companies which ignore the importance of employee normally bear substantial economic damage due to the lack of trust, low morale, and the eventual loss of dedicated workforce.

The changing landscape in people’s management has called for the initiation and implementation of effective communication strategies aimed at increasing the levels of organizational performance (Armstrong, 2007). The role of people as a key ingredient in the realization of organizational goals forms the main reason behind their valued importance. A dissection of literature on HRM and effective communication shows that several companies employ various perspectives to achieve higher levels of employee satisfaction. Employees’ satisfaction is very important, more so during crisis. Impact of the Communication The communication by the company clarified the allegation which was made without investigation. In addition, effective communication helped in regaining public trust on the use of the product.

Moreover, effective communication was used to market the company despite the crisis. How the Communication was Handled by the Company The company did a very good job and provided a benchmark on how to handle public relation crisis. However, the message could have been communicated effectively The types of key tools available to carry out the public relations function include: Media Relations The company management led by its chairman Burke appeared on TV and radio, and explained the crisis of newspapers. In addition, media was given freedom to access the company premises and investigate the situation on the ground. This media relation played a bigger role in coming out of the crisis.

Media is quite important is creating a positive or negative impression, and therefore, the company’s good mediaa relation helped it in creating a positive impression on the public (Lordan, 2003). Media Tours The company also gave media an opportunity to tour its production plants and investigate any information concerning the crisis. Re-launch The company organized for a new package and re-launch of the product. The re-launch made the product have a new look with improved security feature for safety. This was significantly designed not only to gain the public trust but also to reinforce the message that contamination could have been the cause of the product poisoning.

Sponsorships The company decided to invite the investigative news program 60 Minutes to film its management strategy sessions for the new launch. This enhanced the company’s image among the people. Among the other public relations tools are: Newsletters The company also could produce newsletters explaining their goals, values, and the other relevant information targeted to enhance its positive image to the publicSpecial Events The company could also organize tournaments, family retreat, and free medical camp for the community to enhance its public relation program. Speaking Engagements The company could also directly engage the public through debates and speaking engagement. This is important in hearing the first hand information on consumers’ expectation and perception. Employee Relations Community Relations and Philanthropy.

The company had an opportunity of involving in community projects as well as taking part in philanthropic activities. This is a powerful move to create a great public relation. The activities can be in the form of a corporate social responsibility. In conclusion, Johnsons & Johnson managed the crisis very well and offered a great lesson to other businesses insightful information of how to handle effective communication and public relation subject.

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Science, health, and public trust.

April 3, 2024

Communicating trustworthiness and fostering trust

By John C. Besley, Ph.D., Ellis N. Brandt Professor, Michigan State University*

Trust in people, organizations, and groups forms the basis for many of our daily actions. We trust pilots when we travel on the planes they fly, doctors when we take the pills they prescribe, and agriculture companies when we eat the food they sell.

Unfortunately, health communicators can’t simply expect trust from their audiences. But complaining about possible losses in reported confidence will not build trust. What health communicators can do is provide real reasons for why a person should see scientists, doctors, and research entities as trustworthy in specific contexts.

How can communicators convey why scientists or claims should be considered trustworthy? Researchers have spent a great deal of effort parsing the dimensions of trustworthiness beliefs. This work can help communicators decide what to try to communicate to help build trust.

One of the most common models of trust from organizational psychology distinguishes between beliefs about:

• ability (i.e., expertise),
• benevolence (i.e., goodwill, caring, pro-social motives), and
• integrity (i.e., honesty, morality, authenticity).

This type of model provides a framework for research that suggests  people generally see scientists as having substantial expertise but are less sure about scientists’ motives and integrity. This means health communicators likely need to focus on figuring out how to communicate the benevolence and integrity of the scientists they feature.

While different scholars use differently terminology (e.g., warmth and competence ), a common element of various trust models is distinguishing between trustworthiness beliefs (i.e., perceptions) and behavioral trust (i.e., acting on trust by getting on a plane or taking a pill). The expectation is that communicating meaningful trustworthiness information can help foster trustworthiness beliefs and that, over time, these trustworthiness beliefs can help foster behavioral trust.

A key here is remembering that communication isn’t just about message design. There are myriad aspects of communication. We communicate through how we behave, what we say, the tone and style, who communicates, when the communication occurs, and the mode of communication.

In planning, we have found that communicators can build behavioral trust by asking specific questions keeping these principles in mind. For example, ask “how could we communicate our eagerness to listen?” rather than vague questions like “how can we build trust?”

Paying attention to these trustworthiness dimensions can also help with ongoing evaluation. Too few organizations collect regular, actionable information about how key audiences perceive them. For example, finding out if a priority group sees a scientist as skilled, caring, and honest will tell you more than simply asking that group whether they trust them. Communicators can then use data about these types of perceptions to help them develop strategies for more effective communication.

It is easy to talk abstractly about trust, but communicators must think about trust in more nuanced ways. They need to ask how intended audiences perceive the research they cover. This will give them insights into how to do the hard work of behaving and communicating in ways that earn trustworthiness. Only by doing this can we build the capacity to persuade people to behave in more evidence-based and intentional ways.

*Besley is co-author of Strategic Science Communication (JHUP 2022).

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One Health communication channels: a qualitative case study of swine influenza in Canada in 2020

• José Denis-Robichaud 1 , 6 ,
• Suzanne Hindmarch 2 ,
• Nancy N. Nswal 1 , 5 ,
• Jean Claude Mutabazi 3 ,
• Mireille D’Astous 1 , 5 ,
• Marcellin Gangbè 3 , 6 ,
• Andrea Osborn 4 ,
• Christina Zarowsky 1 , 5 ,
• Erin E. Rees 1 , 3 , 5 , 6 &
• Hélène Carabin 1 , 5 , 6  

BMC Public Health volume  24 , Article number:  964 ( 2024 ) Cite this article

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With increased attention to the importance of integrating the One Health approach into zoonotic disease surveillance and response, a greater understanding of the mechanisms to support effective communication and information sharing across animal and human health sectors is needed. The objectives of this qualitative case study were to describe the communication channels used between human and animal health stakeholders and to identify the elements that have enabled the integration of the One Health approach.

We combined documentary research with interviews with fifteen stakeholders to map the communication channels used in human and swine influenza surveillance in Alberta, Canada, as well as in the response to a human case of H1N2v in 2020. A thematic analysis of the interviews was also used to identify the barriers and facilitators to communication among stakeholders from the animal and human health sectors.

When a human case of swine influenza emerged, the response led by the provincial Chief Medical Officer of Health involved players at various levels of government and in the human and animal health sectors. The collaboration of public and animal health laboratories and of the swine sector, in addition to the information available through the surveillance systems in place, was swift and effective. Elements identified as enabling smooth communication between the human and animal health systems included preexisting relationships between the various stakeholders, a relationship of trust between them (e.g., the swine sector and their perception of government structures), the presence of stakeholders acting as permanent liaisons between the ministries of health and agriculture, and stakeholders' understanding of the importance of the One Health approach.

Conclusions

Information flows through formal and informal channels and both structural and relational features that can support rapid and effective communication in infectious disease surveillance and outbreak response.

Peer Review reports

Influenza virus surveillance and response to spillover between species are situations that can benefit from a One Health (OH) approach, as they occur at the intersection of animal, human, and ecosystem health sectors [ 1 ]. An improved understanding of intersectoral communication across OH domains is important because many emerging diseases are of animal origin [ 2 ], and many global forces (increased mobility of people, animals, animal products and goods, climate change, agribusiness expansion, deforestation, etc.) are increasingly altering environments to put animals and humans in close contact, facilitating disease spillover in both directions. Identifying formal and informal structures, processes or practices that support OH communication could improve the integration of the OH approach in different systems.

Human infections with swine influenza virus subtypes have been reported in North America [ 3 , 4 ], and these are reportable under the International Health Regulations (IHR), although data suggest that transmission of influenza from humans to pigs is more frequent [ 5 ]. Here, we report a human case of influenza A H1N2v occurring in Alberta in October 2020. It resulted in rapid collaboration and investigation by human and animal health sectors, but there is limited information about how and why effective communication and coordination occurred between and within these sectors during this event. Bridging this gap requires gathering information from multiple points of view, to which qualitative methods are well suited [ 6 ]. Describing the context and narrative of a specific case study enables identification of patterns that can then be validated in other contexts. Our study objectives were to describe the OH communication channels and flow of information among stakeholders involved in human and swine influenza surveillance and response activities in Alberta (Canada) and to identify elements encouraging and inhibiting OH communication, specifically related to information sharing between livestock Footnote 1 and public health professionals. Our research question was therefore to determine what factors impede or support information sharing between sectors during the occurrence of a human case of zoonotic influenza.

To describe the mechanisms and performance of communication channels, we used interpretive process tracing [ 6 , 7 , 8 ]. We started from the detection of the emergence of a human case of influenza A H1N2v in Alberta in October 2020. We then sought to understand the communication channels related to the surveillance of influenza in pigs and humans generally and how these and other channels operated in this specific case. Our research team included animal and public health researchers and government employees, but none were directly involved in case management or regional surveillance systems related to this event. We relied on the experience and knowledge from our collaborator from the Animal Health Science Directorate of the Canadian Food Inspection Agency (CFIA) to identify some key stakeholders.

Documentary research and interviews with stakeholders influenced each other in an iterative process. The Canadian Animal Health Surveillance System (CAHSS) was a starting point for documentary research, as it already mapped the surveillance system within multiple animal production industries [ 9 ]. Additionally, we used a report created after the 2009 H1N1 pandemic [ 10 ] and a recent study about laboratory and syndromic surveillance in the swine sector [ 11 ] to create a preliminary outline of Canadian influenza communication channels.

We initially identified ten stakeholders occupying strategic positions in the case study communications channels, representing federal and provincial governments, animal and public health, and Canadian swine health surveillance systems. Additional stakeholders were identified through snowballing and findings from concurrent documentary research [ 12 , 13 ]. Interviewees were invited to participate in a one-hour individual semistructured interview to identify and explore structural links and information channels.

We developed semistructured interview questions during the initial phases of the documentary research and created a general interview guide to identify the case study communication channels and the barriers and facilitators for communication between animal and human health stakeholders (Table  1 ). The guide was tested with a team member involved in animal health surveillance who did not participate in developing the questions. The data from this pilot were kept for the analyses. The research team met throughout the project to discuss and assess the guide and minimize biases [ 14 ]. For example, interviewers adapted the guide to make it relevant to each interviewed stakeholder by choosing questions that aligned with their work and position. Some questions were also rephrased or complemented to fill gaps identified during previous interviews. Changes and additions were reviewed by members of the research team, all of whom assessed the questions from their own disciplinary vantage point to ensure these alterations were consistent with the global objectives of the study and did not reflect the implicit assumptions or biases of any one discipline or sector. While the main interviewer was an animal health specialist, she was joined by at least one other member of the team from another discipline during all interviews. Having one interviewer with deep subject matter expertise ensured continuity and rigour across interviews; having a second research team member from a different disciplinary vantage point served as a check to reduce confirmation bias.

Interviews were conducted in English or French between September and December 2021, and (with permission) audio recorded on Zoom (Zoom Video Communications, Inc.) or Teams (Microsoft corp.). Interviews were transcribed and cleaned and then coded and analyzed in NVivo (Luminvero©). To protect anonymity, all interview quotes in this report are presented in English. Participants did not receive compensation. We contacted 23 stakeholders from the human ( n =13) and animal health ( n =10) sectors, of whom eight (human: n = 6, and animal: n = 2) declined or did not reply to our invitations (nonparticipation proportion = 35%). Fifteen participants from the human ( n = 7) and animal ( n = 8) health sectors were interviewed in November and December 2021. Employees of the federal (Public Health Agency of Canada and CFIA) and provincial (Alberta Health Services and Alberta Ministry of Agriculture) governments, stakeholders from the swine health surveillance system and from academia participated in the interviews (Table  2 ).

Through an interpretive process tracing approach, we explored how actors described their practices, how they perceived their actions, and how information flows [ 8 , 15 ]. We used interview transcripts combined with documentary research to create a map of the communication channels among stakeholders involved in human and swine influenza surveillance in Alberta and in the specific H1N2v zoonotic human influenza case. We then synthesized this information graphically using an online collaborative platform (Miro; RealtimeBoard, Inc.). We identified two distinct categories of communication channels: formal and informal. Formal channels were those that entailed an institutionalized, official structure, often including established written protocols, guidance documents, or terms of reference specifying how actors holding specific positions of authority were to communicate with each other. Informal channels were ad hoc, created by the involved stakeholders to suit a particular situation, and were often dependent on personal relationships between individuals, rather than institutionalized relationships between offices or job functions. We used an iterative thematic analysis [ 16 , 17 ] to identify barriers and facilitators to information sharing in this case. Themes and subthemes summarizing participants’ perspectives were discussed among members of our research team, and representative quotes were selected. We used this information about facilitators and barriers to identify elements that, more broadly, may support or impede information sharing between animal health and human health stakeholders.

While our study focused on a human case of swine influenza, it quickly became clear that the surveillance systems in place prior to the event were important. Surveillance systems have multiple goals. For influenza in Canada, surveillance aims to detect and monitor the viruses, and to inform vaccines and policies [ 18 , 19 ].

Routine communication structures

We describe below the usual communication channels in the swine sector, the human health sector, and across these two sectors.

Routine communication channels for the surveillance of influenza virus infection in the swine sector in Alberta

Figure  1 B shows communication channels as they flow (from left to right) in Alberta. Influenza virus in pigs is provincially notifiable Footnote 2 in Alberta, British Columbia and Saskatchewan, but it is not federally notifiable. At the regional level, the Canada West Swine Health Intelligence Network (CWSHIN) combines and analyzes the data from British Columbia, Alberta, Saskatchewan, and Manitoba. It includes clinical impression surveys from swine veterinarians, laboratory diagnostic data from provincial and university laboratories (presence of pathogens, or serological or anatomical indicators), and condemnation rates from federally inspected slaughterhouses [ 11 ]. Once analyzed, the information is shared quarterly with veterinarians (reports, as private communications) and producers (reports, as public communications) and, when requested to address animal, human, or ecosystem concerns, with provincial governments (Fig.  1 B). While some analyzed data are publicly available via reports for producers, our participants stated that there are no other direct communication channels between the CWSHIN and public health stakeholders. However, the regional surveillance networks (CWSHIN, Ontario Animal Health Network, and Réseau d’alerte et d’information zoosanitaire) are part of the Canadian Swine Health Intelligence Network (CSHIN) and the CAHSS, which include members from the National and Provincial pork councils, veterinary colleges, diagnostic laboratories, provincial governments, CFIA, Agriculture and Agri-Food Canada (AAFC), Public Health Agency of Canada (PHAC), and national and regional veterinary organizations and networks.

Structural communication links identified for human ( A ) and swine ( B ) influenza surveillance in Alberta. Information is usually shared from left to right: from laboratories, through the Provincial Surveillance Initiative system, back to the patients and referring physicians, as well as surveillance groups within the provincial government. Some information (anonymized) also flows to the federal government: from veterinarians, laboratories, and abattoirs to Swine Health Intelligence Networks (e.g., CWSHIN and CSHIN) to governments (provincial and federal). There is also publicly available information shared by the Community for Emerging and Zoonotic Diseases to various stakeholders (from right to left). Dashed lines: samples; Full lines: data; Dotted lines: results/summaries. Blue: field stakeholders; Yellow: laboratories; Purple: intelligence; Red: government. CAHSS Canadian Animal Health Surveillance System; CEZD Community for Emerging and Zoonotic Diseases; CFIA Canadian Food Inspection Agency; CSHIN Canadian Swine Health Intelligence Network; CWSHIN Canada West Swine Health Intelligence Network; GPHIN Global Public Health Intelligence Network; PHAC Public Health Agency of Canada; PSI Provincial Surveillance Initiative

Routine communication channels for the surveillance of influenza virus infection in the human sector in Alberta

In Alberta, laboratory data flow through a single laboratory information system (Provincial Surveillance Initiative; PSI), and information is automatically transmitted to stakeholders (e.g., physicians, patients, and surveillance units within the Ministry of Health; Fig.  1 A) via an online platform. This system allows the linkage of clinical and epidemiological data with laboratory data at the provincial level.

The data about influenza collected by the healthcare system are gathered provincially and then anonymized and shared with FluWatch, a national surveillance program for influenza and influenza-like illnesses (ILI) [ 18 ]. The program monitors, inter alia, health care admission for influenza or ILI, laboratory-confirmed detection, syndromic surveillance, outbreak and severe outcome surveillance, and vaccine coverage; it shares weekly reports online [ 18 ]. At the provincial and federal levels, we were unable to identify other communication channels for providing human influenza surveillance information to animal health stakeholders.

Routine communication channels between the swine and human sectors for the surveillance of influenza in Alberta

Many swine health surveillance stakeholders are members of the Community for Emerging and Zoonotic Diseases (CEZD). This multidisciplinary network of public and animal health experts from government, industry and academia was developed to support early warning, preparedness, and response for animal emerging and zoonotic diseases [ 20 ]. Open source signals are extracted automatically via the Knowledge Integration using Web Based Intelligence (KIWI) [ 21 ] and manually by the CEZD core team (CFIA employees). This team assesses signals daily, with rolling support from volunteer members and from expert partners from federal and provincial governments, academia, and industry when needed. Signals are then shared with the CEZD community, including through immediate notifications of important disease events, group notifications and pings, quarterly sector-specific intelligence reports and weekly intelligence reports.

Although CEZD was growing during the 2020-2021 period [ 22 ], membership is voluntary, as it is the case for CAHSS. Moreover, both networks cover multiple species and diseases, which serves to maximize the reach of the communities but can result in an overwhelming amount of information for members whose main interest is in another sector, such as human or ecosystem health. This large amount of information primarily relevant to other sectors can lead members to leave or not join these two networks.

Communication channels between sectors during a human case of swine influenza in Alberta

In all cases where a new influenza subtype, including an animal influenza subtype, is identified from a human case, this must be reported to the World Health Organization (WHO) under the IHR [ 23 ]. In Canada, PHAC is the body responsible for notifying the WHO of such cases. We examined the IHR-reportable case of a human infected with an animal influenza subtype identified in October 2020 in Alberta. The event we examined happened during an exceptional period for ILI as it was less than a year after the WHO declared the 2019 novel coronavirus disease (COVID-19) a global pandemic. At that time, influenza activity remained below average, most ILI symptoms were due to COVID-19 cases, and most public health and human health resources were dedicated to managing the pandemic [ 24 ].

In the case we investigated, the influenza subtype identified through sequencing performed at a provincial laboratory on October 29, 2020 (Fig.  2 ) in the human case was a variant similar to a swine influenza virus (A H1N2v). Samples from the human case were then sent to a reference laboratory, the National Laboratory of Microbiology (NLM) of PHAC, for confirmation. A provincial laboratory stakeholder also contacted a University Animal Health Laboratory colleague and sent the human sample in parallel for sequencing and confirmation that the variant was a swine virus.

Timeline and communication links during the human influenza A H1N2v case in Alberta. Dashed lines: samples; Full lines: data; Dotted lines: results/summaries Blue: field stakeholders; Yellow: laboratories; Green: intelligence; Red: government, Purple: international.  CEZD Community for Emerging and Zoonotic Diseases; CFIA Canadian Food Inspection Agency; CMOH Chief Medical Officer of Health; CSHIN Canadian Swine Health Intelligence Network; CVO  Chief Veterinary Officer; CWSHIN Canada West Swine Health Intelligence Network; GPHIN Global Public Health Intelligence Network; PHAC Public Health Agency of Canada; PSI Provincial Surveillance Initiative; WHO World Health Organization

Because the human case was IHR reportable and had potential for high visibility, the provincial laboratory immediately contacted the Alberta Chief Medical Officer of Health (CMOH). Provincial and federal government stakeholders (Alberta Health, Alberta Health Services, Alberta Agriculture and Forestry, PHAC, CFIA) were called to an evening meeting to raise awareness and ensure that the situation was managed in a way that satisfied provincial, federal and international obligations. This “H1N2v working group” was put in place quickly, apparently following the initiative of the Alberta CMOH (not confirmed as no interview was conducted with the initiators of this working group).

The information PHAC received through formal communication channels (e.g., from the NLM) took longer compared to the original call by the CMOH and the H1N2v working group. For this study, we did not have access to the guidelines in place for such an event, and it is unclear if the other stakeholders (provincial Ministry of Agriculture and CFIA) were officially needed to be involved.

Because swine influenza is endemic in the porcine population and this case was of importance for human health, the provincial public health stakeholders led the initiative, with the support of other stakeholders. The H1N2v working group met at least twice following the initial meeting. Additionally, follow-up data was gathered at the provincial level via multiple channels (public health, animal health, epidemiological, and laboratory investigations), and findings from the various investigations were shared with PHAC daily for a week and then weekly for two additional weeks. Information sharing between provincial and federal public health entities seemed to follow a formal process, but while we had access to the communication template, none of the interviewed participants had information about the structure supporting this initiative.

In the meantime, regional public health partners (within Alberta Health Services) were mandated to conduct the field investigation for the human case and its contacts with humans and pigs, supported by Alberta Agriculture and Forestry and stakeholders from the swine sector (e.g., Alberta Pork). The investigation’s goal was to clarify whether the infection was contracted from animal-to-person (directly or indirectly) or person-to-person. The public health investigation, the available information about swine influenza in the province (obtained from the CSHIN report), and the farm investigation performed in collaboration with an Animal Health Laboratory all provided supporting data.

The human and animal investigation data were collected by multiple stakeholders. The communication of results followed formal structures through Alberta Health (case, laboratory and epidemiological investigation results) and Alberta Agriculture and Forestry (farm investigation results) and were ultimately shared with PHAC. Interviewees reported that coordination of the two provincial ministries in this case was facilitated by the public health veterinarian, whose position is shared between the two ministries. Interviewees also said that in the investigation’s early stages, the swine sector’s participation in the farm investigation (an informal channel, via Alberta Pork) facilitated communication between the government and the farm involved. This highlights the importance of strong formal and informal government-industry relationships, which ensured that farmers and stakeholders trusted the system enough to support the investigation.

While the investigation was still ongoing and a clearer picture of the case and its transmission was emerging, a decision was made to make the information public. Our interviews did not identify the process leading to this decision, but six days after the initial notification to the government officials, an Alberta CMOH press release was distributed, with information stating there was limited risk for the general population. This now-public information was then identified by at least two Canadian event-based surveillance (EBS) systems that distributed the information to their communities. One of the EBS interviewees mentioned, however, that they received an email from the Alberta Agriculture and Forestry the night before the press release so they could prepare for it and have a notification ready to be shared. This informal communication channel seemed to arise from a preexisting relationship between stakeholders involved.

Encouraging and inhibiting elements involved in OH communication

The communication channels evident in our case study allowed us to identify elements involved in the information flow between animal and human health stakeholders (Table  3 ). Identifying what information needed to be shared between sectors was influenced by actors’ understanding of the evidence needed to trigger decisions and actions. During the surveillance phase, information was available online from the animal health (CWSHIN, CSHIN, CAHSS, CEZD) and human health (FluWatch, Global Public Health Intelligence Network) sectors. However, it was difficult to quantify how much these sources were used by different stakeholders. We identified little other communication between animal and human health stakeholders during this phase. Stakeholders reported having very limited time and resources to consult and use information from other sectors, suggesting a need for policies and structural integration of OH. For example, having a public health veterinarian appointed at both the provincial agriculture and health ministries was mentioned as a key element facilitating communication and coordination (Quote 1).

Quote 1. “When the pandemic started, we had our public health veterinarian position empty. […] That position is essentially fully dedicated to working between the two ministries [Agriculture and Health]. It [the impact of this vacancy] showed itself in terms of just some gaps for them working on things without consulting us, but then [when] that position was filled and the other relationships were in place, everything just went really smoothly. […] it demonstrated the importance of those relationships and… having a good liaison between the two departments.”

During the outbreak, surveillance, laboratory, and industry information on swine influenza was quickly available to human health stakeholders. Animal health stakeholders, however, noted that the communication was, unfortunately and as in many cases, only one way. Barriers to within- and cross-sector communication included complicated or lacking communication channels. In our case study, there was a formal channel between the provincial and federal government due to the IHR requirements, but this is not the case for non-IHR-reportable zoonotic diseases. Moreover, the CMOH’s phone call to other stakeholders to create the H1N2v working group occurred faster than the formal communication channels.

Established professional connections facilitated information flow between stakeholders who understood each other’s needs and interests. While a lack of formal channels was identified as a pitfall due to potentially missed communication opportunities, many participants mentioned that established, informal relationships and networks facilitated information sharing – both the assessment of how much and what type of information to share and with whom it should be shared. Informal and formal communication channels were also affected by privacy and ethical concerns. Raw data, usually confidential, obtained from either the animal or human health sectors cannot easily be shared, adding to the complexity of formal communication channels. Analyzed or summarized data (i.e., information) were easier for both animal and human health sectors to share in reports or online platforms.

Trust, which can be defined as the perceived benevolence, integrity, competence and predictability of the other [ 25 ], was identified as the foundation for good communication among different stakeholders, whether via formal or informal channels. Here, previous interactions between stakeholders likely served as a basis for trusting that the person receiving the information would be kind, competent, honest, and predictable when using it. From the perspective of animal health stakeholders, however, trust was more difficult: the perceived anthropocentric perspective of health initiatives, including OH initiatives [ 26 ], created fear that shared information might not be reciprocated and would have negative repercussions on animals and producers (Quote 2).

Quote 2. “You need to build trust and it takes a long time […] you need to build that trust with individual livestock sectors, that human health is not going to destroy the sector a . The [animal health] sector is generally very cautious because their perspective is very rarely considered […] if you have a human pathogen […] in livestock and it can potentially transfer to people, all the burden is very often on the livestock. […] Human health has a lot of resources and animal health doesn't, but they get all [the burden]. It's a matter of who [has] the cost and who's benefiting.” a While the stakeholder interviewed did not give additional details, they could have been referring to the case of a herd where an emerging influenza virus (H1N1v) was identified, which resulted in depopulation of the herd [ 4 ]. This was a severe consequence for the farmer, while the source of the virus was determined to be an infected human. They could also have been referring to the possibility of zoonotic events decreasing the marketability of meat because of public perception or export restrictions. This was unfortunately not discussed further in the interview

Interviewees suggested that information sharing requires two main steps: (1) identifying what information must be shared and (2) sharing that information with another sector (Fig.  3 ). Once stakeholders within a sector had information, the first step was identifying what should and can be shared, with whom, and through what channels. This could be facilitated or impeded by actors’ perceptions of other sectors’ needs, the type of information that is available, and the resources available. For sharing information itself, both the presence and type of communication channels were critical for external information sharing with other sectors – but so were trust and the availability of resources. Preexisting relationships among stakeholders also shaped actors’ understanding of each other’s needs, the presence of informal channels, and trust.

Elements linking the steps involved between obtaining information and sharing information to another health sector

* The two sectors examined in the present case study are animal health and human health

This case study highlights the complex communication structures for influenza surveillance and response in both human and animal health sectors and the limited links between these sectors. It illustrates the importance of rapid and open communication channels between these sectors in both surveillance and response contexts. While day-to-day surveillance aims to detect and monitor influenza viruses, the detection of a human case harboring an animal subtype resulted in a specific response, which triggered different channels. While information flows through formal and informal channels, trust is a critical component in all types of communication: between animal and human health actors, between government and livestock sectors, and between international, federal, provincial and territorial, and regional jurisdictional levels. Developing and maintaining relationships among stakeholders requires time and resources but is essential for mutual understanding of information needs and rapid communication.

While previous studies found that communication is a key factor for OH initiatives [ 27 , 28 ], we were able to identify processes that were in place when good communication occurred. These findings offer a new perspective that could be useful to many surveillance and response programs. For example, networks and structures are often described for influenza programs, but the communication channels and information flow are not detailed [ 29 , 30 , 31 ]. This is a gap that would be useful to address, especially as we found that while formal structures are necessary, informal structures allow for quicker and more efficient communication and coordination.

Limitations

While the findings from this study highlight key elements of good One Health communication, the retrospective interpretive process tracing of a case study has certain limitations. First, our study was based on an influenza case, for which there are established surveillance systems and protocols [ 11 , 18 , 23 ]. This likely contributed to the effective response but also influenced our findings. We think this could have hidden or minimized some of the challenges faced by stakeholders regarding OH communication. For example, in the case of a disease that has no formal surveillance system reporting guidelines, challenges might be different. Second, we purposively selected a “success story” to illustrate what happens when OH communication goes well. Due to this retrospective selection of our case study, we suspected that communication and coordination went well prior to starting the project. This could have influenced our findings, and it is possible that we would have had different conclusions if we used a case study for which communication and coordination were suboptimal. To mitigate this, we designed the study with an interpretive approach focusing on the interviewees’ own perspectives, with as little preconceived bias as possible [ 8 ]. Third, the case we chose happened during the COVID-19 pandemic. The high focus on ILI during this period could have strengthened some communication channels. For example, many resources were deployed to manage the pandemic, which may have facilitated communication and integration among sectors. Fourth, this could have also affected the stakeholders who agreed to participate in the interviews, which were conducted at a later stage of the pandemic. Indeed, six human health stakeholders who had key positions in this case declined or did not reply to our invitation, and our findings lack their perspective. It is possible that more communication channels between human and animal health exist, but we were not able to identify them. The barriers and limitations we identified are possibly different for stakeholders in the human health sector; additional research related to the involvement of these actors in OH communication would be beneficial. Fifth, due to the limited resources available for this project, the focus of the case study (swine and public health), and the process we used to identify the stakeholders to interview, we did not identify stakeholders from the environment and wildlife health sector, or from other livestock health sectors (e.g., poultry). This is, in itself, a finding, highlighting the limited communication channels among these stakeholders. It is however unclear if our findings about facilitators and barriers are generalizable to all sectors.

While additional research, including larger comparative studies, is needed, our findings highlight the importance of investing time and resources in supporting relationship building, as well as formal communication mechanisms, among stakeholders in the human, animal, and ecosystem health sectors.

Availability of data and materials

No datasets were generated or analysed during the current study.

While the One Health approach should in principle engage stakeholders from human, environmental, and animal health sectors, the scope of the current study focused on public health and livestock health sectors. Throughout the manuscript, we used public and human health interchangeably, as for animal and livestock health.

Reportable and notifiable diseases must be reported to federal and/or provincial governments. Reportable diseases generally pose significant threats to animal health, public health, or food safety, while notifiable diseases are monitored for trends or changes.

Abbreviations

Agriculture and Agri-Food Canada

Canadian Animal Health Surveillance System

Canadian Food Inspection Agency

Chief Medical Officer of Health

Canadian Swine Health Intelligence Network

Canada West Swine Health Intelligence Network

Community for Emerging and Zoonotic Diseases

Event-based surveillance

International Health Regulations

Influenza-like illnesses

Knowledge Integration using Web Based Intelligence

National Laboratory of Microbiology

Public Health Agency of Canada

Provincial Surveillance Initiative

World Health Organization

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Acknowledgments

We want to thank the different stakeholders who generously participated to this project.

This project was funded by the Canadian Safety and Security Program from Defence Research and Development Canada, project 'Improving early warning of emerging threats' (CSSP-2020-TI-2469). This work was supported in part by the Canada Research Chair in Epidemiology and One Health (H.C., grant number: CRC 950-231857).

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HC, ER, CZ, and SH formulated overarching research goals, supervised the research activity planning and execution, and acquired funding. They managed and coordinated responsibility for the research activity planning and execution with the support of MG. SH and CZ developed the methodology, and all authors contributed to the qualitative analysis processes. The investigation and the formal analyses were done by JDR, MD, JCM, and NNN. JCM and NNN curated the data and JDR created the Tables and Figures. JDR wrote the initial manuscript, and all co-authors revised it.

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Ethics review and approval were obtained from the Université de Montréal (CERSES, protocol code 2021-1152, approved on September 15, 2021) and Public Health Agency of Canada (protocol code REB 2021-047P, approved on February 8, 2022) ethics committees. Written informed consent to participate was obtained from all interviewees.

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Denis-Robichaud, J., Hindmarch, S., Nswal, N.N. et al. One Health communication channels: a qualitative case study of swine influenza in Canada in 2020. BMC Public Health 24 , 964 (2024). https://doi.org/10.1186/s12889-024-18460-7

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The ABC’s of executive presence

Ever wondered what sets business executives apart? From their visual presence to their confident demeanor and communication style, top leaders project important cues that shape how they are perceived in the workplace.

Have you ever wondered what makes a business executive look like, well, an executive?

If you’ve given it any thought, you’ve likely noticed a few things about top leaders that stand out.

First, they look the part, meaning, whatever environment they’re operating in — from the basement of a tech start-up to the C-suite in a FORTUNE 100 corporate office — they present a visual image that says, “I’m a leader here.” They also carry themselves with a certain air of confidence and swagger. People conclude they’re in charge because they act like they are. Lastly, they speak with authority, expressing a self-assured demeanor as they do.

If these three things resonate with you, you’ve picked up on the important cues senior managers often transmit.

We sum these characteristics up as executive presence: your ability to project mature self-confidence, a sense you can take control of difficult, unpredictable situations; make tough decisions in a timely way and hold your own with other talented and strong-willed members of the executive team.

Now let’s take a quick tour of the ABC’s of executive presence, exploring each one in turn.

Appearance is how you present yourself in the workplace in terms of dress, grooming and body language.

It’s true standards of dress have changed over the past few years, thanks to the remote work revolution, but that doesn’t mean there isn’t a dress code where you work. Every place has them — formal or informal. 

Regardless of your environment, it’s essential you take the time to understand how you’re showing up  — your success depends on it.

If everyone in your athletic apparel company wears hooded sweatshirts, jeans and trendy sneakers in the office, showing up in a button down shirt and a blazer sends the unmistakable message that you don’t understand “how we do things around here.” 

One of the significant challenges professionals face is identifying their unique personal preferences, style and brand. It is crucial to reflect on how these attributes align with the workplace environment. My sage advice is to gain a thorough understanding of your workplace’s norms and standards before attempting to distinguish yourself. And whether you’re trying to fit in or thoughtfully stand out, this knowledge ensures that your individuality complements rather than clashes with professional expectations when it comes to appearance at work.

Boldness is the embodiment of calmness, courage and self-assurance, especially under pressure.

The foundation of boldness lies in two essential facets: competency in one’s field and the confidence in one’s capabilities. These are the twin pillars of what I term 'overall credibility.'

Credibility emerges from both one’s competence and the collective confidence others place in you. It authorizes one to act with boldness or courage. In leadership, confidence is paramount — it reassures others that the challenges we’re facing or opportunities we’re exploring will work out favorably — and should they not for some reason, we’ll still be okay.

As leadership author Peter Bregman points out in his Harvard Business Review of the same name, “ Great leaders are confident, connected, committed and courageous. ” All of these embody the boldness we want, even seek, in our leaders.

Communication  

Communication relates to how we express our ideas when speaking or presenting. 

As far as leadership effectiveness is concerned, communication is one of the most important skills to be developed. According to Brown University Distinguished Senior Lecturer, Barbara Tannenbaum, “Communication is the skill that makes good leaders great.”

But if you don’t find yourself a natural orator, rest assured, like any skill, all it takes is practice. 

Seasoned executives radiate presence when they speak, projecting their voice clearly with words that are easy to understand. In terms of message delivery, professionals don’t use filler words like ‘um’ and ‘you know’. They’re also thoughtful regarding the pace and tone of their speech so they can reinforce important messages. Some of the best known politicians were former actors and their aplomb delivering messages became hallmarks of their time in office.

💡Tip: To enhance your communication skills, consider recording your presentation. This method can help you identify and reduce the use of unnecessary filler words, a lack of vocal variety and any counterproductive body language.

Action steps

• Assess your personal brand — ask someone who will be honest with you
• Plan one or two key changes
• Make the change and follow through!

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• We will not accept the 05/31/23 edition of this form if it is postmarked  on  or  after  April 1, 2024; and
• We will only accept the 04/01/24 edition of this form if it is postmarked  on  or  after  April 1, 2024.

We will use the  postmark date  of a filing to determine which form version and fees are correct but will use the  received date  for purposes of any regulatory or statutory filing deadlines.

As a reminder, we recently  announced  a  final premium processing fee rule  that increased the filing fee for  Form I-907, Request for Premium Processing Service , to adjust for inflation, effective Feb. 26, 2024. If we receive a Form I-907 postmarked on or after Feb. 26, 2024, with the incorrect filing fee, we will reject the Form I-907 and return the filing fee. For filings sent by commercial courier (such as UPS, FedEx, and DHL), the postmark date is the date on the courier receipt.

Online Filing and Organizational Accounts

On Feb. 28, 2024, we launched new online organizational accounts that allow multiple people within an organization and their legal representatives to collaborate on and prepare H-1B registrations, H-1B petitions, and any associated Form I-907. Information on organizational accounts is available on the  Organizational Accounts Frequently Asked Questions page.

We also launched online filing of Form I-129 and associated Form I-907 for non-cap H-1B petitions on March 25. On April 1, we will begin accepting online filing for H-1B cap petitions and associated Forms I-907 for petitioners whose registrations have been selected.

Petitioners will continue to have the option of filing a paper Form I-129 H-1B petition and any associated Form I-907 if they prefer. However, during the initial launch of organizational accounts, users will not be able to link paper-filed Forms I-129 and I-907 to their online accounts.

H-1B Form I-129 Filing Location Change to Lockbox

Starting April 1, 2024, H-1B and H-1B1 (HSC) Form I-129 petitions are no longer filed directly with the USCIS service centers. All paper-based H-1B and H-1B1 (HSC) Form I-129 petitions are now filed at USCIS lockbox locations. This includes cap, non-cap, and cap-exempt H-1B filings.

We will reject H-1B or H-1B1 (HSC) petitions received at a USCIS service center on or after April 1, 2024. There will be  no grace period  provided.

USCIS has specific mailing addresses for cases that are subject to the H-1B cap. To determine the correct mailing address, please see our  Form I-129 Direct Filing Addresses  page.

If a petition is filed at the wrong location, we may reject the petition. Rejected petitions will not retain a filing date. If we reject a petition because it was filed at the wrong location, it may be refiled at the correct location, or online. H-1B cap subject petitions may be refiled at the correct location, or online, as long as the petition is refiled during the designated 90-day filing window listed on the selection notice.

No More Pre-paid Mailers

As of March 25, 2024, we are no longer using prepaid mailers to send out any communication or final notices for any H-1B or H-1B1 (HSC) petitions. With H-1B intake now occurring at the lockbox or online, we will not be able to use any prepaid mailers for H-1B or H-1B1 (HSC) filings.

The process of printing and mailing H-1B petition approval notices by first-class mail is fully automated. For petitions filed online, myUSCIS account holders will also receive an email or text message notification in their myUSCIS account when there is a case status change on a case in their account, followed by a paper notice by mail.

Receipt Notice Delays

When we receive a timely and properly filed H-1B cap subject petition, the petitioner (and, if applicable, the petitioner’s legal representative) will be provided a Form I-797, Notice of Action, communicating receipt of the petition. Due to increased filing volumes typically seen during H-1B cap filing periods, there are instances where a paper petition is timely and properly filed by mail, but issuance of the Form I-797 is delayed. If you are a petitioner and have confirmation from the delivery service that the petition was delivered, but you have not yet received a Form I-797 confirming receipt of the petition, you should not submit a second petition. If you have confirmation from the delivery service that the petition was delivered and you then submit a second H-1B cap petition for the same beneficiary, you will be considered to have submitted multiple H-1B cap petitions. This will result in denial or revocation of both petitions.

If more than 30 days have passed since the confirmation of delivery and you have still not received a Form I-797, you may contact the  USCIS Contact Center  for assistance.

If you receive notification from the delivery service, or your tracking information suggests that there may be a delay or damage to the package or that the package was misrouted, you should follow the Delivery Service Error Guidance on the  H-1B Cap Season  webpage.