During large-scale events such as the COVID-19 pandemic, people are inundated with information from all sources, including some that may be inaccurate.1 Communication during such times isn't simple, and responding in a transparent manner while addressing political and ethical challenges isn't easy to do.2 Incorrect information can generate anxiety and a sense of panic, further potentiating the negativity of the situation.1 As noted by Roy Boukidjian, system vice president of infection prevention for CommonSpirit Health, “As the news develops and civilians and individuals, including healthcare workers, get concerned [about] what they're hearing, [those] concerns and anxieties lead to potential errors and mistakes. ...Constant communication and education [are] absolutely necessary.”3 Communication needs to be timely, regular, accurate, credible, consistent, appropriate, and relevant.
Effective communication is a fundamental leadership skill that becomes crucial in times of crisis. Barbara Reynolds, senior crisis and risk communication advisor for the CDC, makes clear the vital role that communication can play during a pandemic, “The right message at the right time from the right person can save lives.”4 The worldwide COVID-19 pandemic has challenged business, industry, and healthcare. As our knowledge about ways to combat the virus expands, essential information must be disseminated appropriately, consistently, and efficiently. This premise is especially true for healthcare leaders.
This article reviews basic communication principles, examines the role of information processing during times of stress, and explores common barriers to effective communication.
Communication is defined as “transferring thoughts, information, emotion, and ideas through gesture, voice, symbols, signs, and expressions from one person to another.”5 Communication can occur through a variety of methods, including verbal, nonverbal, written, and visual. No matter the method used, it requires a sender, a receiver, and a delivery medium.6 Leaders must understand the importance of information delivery and be dedicated to developing an effective dissemination process. Hospitals and healthcare systems need to have agile methods of transmitting information in an open and timely manner during crisis periods.7
Communication, especially in times of crisis, must convey clear and consistent messaging. Leonard Marcus, founding codirector of the National Preparedness Leadership Initiative, emphasizes the importance of consistent messaging from leaders to quell confusion and improve understanding of vital instructions.8 Because communication from leadership can be conveyed through different methods, leaders must pay careful attention to detail to ensure message consistency across all selected approaches. One way to ensure effective messaging is to identify who's in charge of communication and appoint a team for centralized communication as applicable.3,7,9 The team, which includes key leaders, should be up-to-date on the facts and the main source of information during the crisis, give regular updates to applicable parties, and be transparent and succinct.
In relation to communication with employees, leadership should have a designated place and method for communication and communicate as things change, at minimum once a day.9 In relation to communication with customers, information that adds value for the customer audience should be shared and caring and empathy conveyed.9 Having comprehensive communication plans for both internal and external stakeholders is critically important.7 As illustrated, leaders play a crucial role within each level of the communication process by ensuring that the message is accurately received and then clearly restated through the appropriate medium chosen for the correspondence.
The CDC describes inconsistent messaging from experts as a common pitfall in communication effectiveness during crisis.4 Leaders must obtain information from credible sources, understand the information, and carefully disseminate the information in a manner congruent with the original expert's message. Experts in crisis communication have identified six key principles for leaders to consider when disseminating information: “be first, be right, be credible, express empathy, promote action, and show respect.”4
Information in times of crisis is time-sensitive and, for many, the first source of information becomes their preferred source.4 When expressing empathy, leaders build trust and rapport by acknowledging challenges and feelings of suffering. To restore order and calm anxiety, leaders can promote action by assisting others to gain a sense of control in their current situation. And showing respect is the thread that ties the key communication principles together to promote cooperation and calm when people feel most vulnerable.4
Research has also identified four factors that promote trust and credibility: caring/empathy, honesty/openness, dedication/commitment, and expertise/competence.10 When communicating, the spokesperson, whether communicating verbally or in writing, needs to state the facts as known (openness), provide answers if known and state what he or she doesn't know (honesty), and be an expert about the subject being discussed (expertise/competence).
The key communication principles aren't the only elements to consider when attempting to deliver a clear message. There are several potential barriers to communication that must be overcome for communication to be most effective. Crisis situations such as a worldwide pandemic can alter the way people process information.11 Leaders must understand this basic principle to increase the effectiveness of their communication. The CDC has identified four ways that people process information during a crisis.11
First, people tend to simplify messages because increased stress can affect one's ability to remember multiple facts. To combat this issue, leaders must use simple, clear, precise messages.11 Repeating the key message, outlining action steps using positive versus negative messaging, and keeping the length of messages to three or four directives improves message reception.12 Second, people tend to hold on to their current beliefs and changing these during crisis situations can be difficult.11 It's important for leaders to use credible sources when preparing and delivering crucial messages.12 Third, crisis leads people to seek additional information and opinions for confirmation before taking action. Finally, people tend to believe the first message they hear in crisis or pandemic situations, leading to rumors. It's important that leaders release simple, accurate, and consistent information as soon as possible.11-13
Additional psychological barriers and mental states during stress that affect information processing include feelings of uncertainty, fear, anxiety, dread, denial, hopelessness, and helplessness.11 Leaders can face these challenges by acknowledging uncertainty and emotion; portraying an accurate assessment of the situation; and providing clear, consistent messages that promote positive courses of action.4,11
In addition to psychological and mental barriers to communication, leaders are continually faced with barriers that can severely limit the effectiveness of communication. These common barriers include miscommunication, misunderstanding, misinformation, and ambiguity.14 A word, phrase, or sentence can be considered ambiguous if it has more than one interpretation or meaning.15 An example of an ambiguous statement is “I saw a man in a tree with a telescope.” In this case, did I use a telescope to see a man in a tree, or did I see a man in a tree who had possession of a telescope? See Communication miscues for examples of ambiguity and miscommunication that can lead to confusion.
Master the art
According to popular author Anthony Robbins, “To effectively communicate, we must realize that we're all different in the way we perceive the world and use this understanding as a guide to our communication with others.”19 Essential fundamentals of the communication process can't be overlooked or taken lightly. Challenges to communication can be exacerbated in times of crisis with the addition of significant psychological and mental barriers that can limit information processing. To be effective, leaders must demonstrate mastery of communication skills, especially during the current pandemic.
“The chicken is ready to eat.”
This is an ambiguous statement. Does this statement mean that the chicken is hungry and awaiting food or does it mean that the chicken has been cooked?
“Cover your coughs and sneezes with your elbow.”
More detail can be provided with this statement by adding information about the best way to cover your mouth/face when coughing or sneezing, such as: “Place a tissue over your nose and mouth and cough into the tissue, then dispose of the tissue.” Additionally, information may be added to explain how to cough or sneeze into your elbow, such as: “Turn your head to the side, bend your arm, and cough or sneeze into your elbow.”
Example: Miscommunication and ambiguity
“A healthy at-home tip for COVID-19 is to try to go to bed and wake up at about the same time each day.”
We understand the essence of what this means but trying to go to bed and wake up at the same time doesn't work. We can't control when we wake up or even when we can fall asleep. In times of stress, it's easy to see how even the simplest message can lend itself to confusion and misinterpretation. It's important that the message is clear and imparts, to the best of your ability, the information you wish to convey. One of the major challenges in communication stems from the communicator's unawareness that his or her choice of words may lead to multiple interpretations.16 Spending extra time crafting messages before they're sent can help avoid misunderstandings.17 Consider if your message is the right message for the audience receiving it; a message for one audience may be inappropriate for another. Additionally, when reviewing the tone of a message, consider the current environment and think about whether the message could be misinterpreted due to social or economic factors.17 The challenge for leaders is to carefully craft messages that are clear and can only be interpreted to have one meaning.
An additional barrier to effective communication is failure to listen. If the receiver doesn't listen intently, he or she may misunderstand the message. In addition, if the receiver appears distracted or uninterested (such as looking at messages and sending texts) during the conversation, the speaker/sender may assume that he or she isn't engaged in the conversation and not listening. It's important to actively listen and show empathy to validate the other person.18 Active listening can be accomplished in three ways: acknowledging, which conveys to the speaker/sender that you're paying attention; paraphrasing, which conveys your effort to correctly understand the message; and empathizing, by trying to illustrate that you see and understand the person's point of view.18 Other keys to active listening include not interrupting during the message and using appropriate nonverbal body language.18
1. Modern Healthcare. The COVID-19 pandemic: targeted and factual health communications are exactly what patients need. 2020. www.modernhealthcare.com/patient-care/covid-19-pandemic-targeted-and-factual-health-communications-are-exactly-what-patients
2. Abraham T. Lessons from the pandemic: the need for new tools for risk and outbreak communication. Emerg Health Threats J
3. Masson G, Vaidya A, Bean M. The coronavirus playbook: how 12 health systems are responding to the pandemic. Becker's Hospital Review. 2020. www.beckershospitalreview.com/infection-control/the-coronavirus-playbook-how-12-health-systems-are-responding-to-the-pandemic.html
4. Centers for Disease Control and Prevention. Crisis and emergency risk communication (CERC): introduction. 2018. https://emergency.cdc.gov/cerc/ppt/CERC_Introduction.pdf
5. Communication Theory. Types of communication. www.communicationtheory.org/types-of-communication
6. Kacharava K, Kemertelidze N. Visual and verbal communications: similarities and differences. Eur Sci J
7. Chopra V, Toner E, Waldhorn R, Washer L. How should U.S. hospitals prepare for coronavirus disease 2019 (COVID-19). Ann Intern Med
. 2020; 172(9):621–622.
8. Cohan A. Consistent, transparent messaging from leaders needed in coronavirus crisis, expert says. Boston Herald
. 2020. www.bostonherald.com/2020/04/08/consistent-transparent-messaging-from-leaders-needed-in-coronavirus-crisis-expert-says
9. Argenti PA. Communicating through the coronavirus crisis. Harvard Business Review
. 2020. https://hbr.org/2020/03/communicating-through-the-coronavirus-crisis
10. Bowen D. A working guide to communicating about coronavirus. PR Week. 2020. www.prweek.com/article/1674843/working-guide-communicating-coronavirus
11. Centers for Disease Control and Prevention. Crisis and emergency risk communication (CERC): psychology of a crisis. 2019. https://emergency.cdc.gov/cerc/ppt/CERC_Psychology_of_a_Crisis.pdf
12. Centers for Disease Control and Prevention. Crisis and emergency risk communication (CERC): messages and audiences. 2018. https://emergency.cdc.gov/cerc/ppt/CERC_Messages_and_Audiences.pdf
13. Centers for Disease Control and Prevention. CDC clear communication index. 2019. www.cdc.gov/ccindex/pdf/ClearCommUserGuide.pdf
14. Edwards R, Bybee BT, Frost JK, Harvey AJ, Navarro M. That's not what I meant: how misunderstanding is related to channel and perspective-taking. J Lang Soc Psychol
16. Keysar B. Communication and miscommunication: the role of egocentric processes. Intercult Pragmat
18. BlessingWhite. Don't panic! The neuroscience of calm leadership. 2013. https://blessingwhite.com/dont-panic
19. Dunne C. 40 Team communication quotes to inspire your team. Tameday. www.tameday.com/team-communication-quotes