Strategies for sharpening your verbal dexterity when you work together.
| This is the fourth and final article in the series on spoken communication in teamwork. When we work together, most of our communication happens out loud. The articles are especially about how you minimise communication that goes missing, comes out wrong, gets misread or misunderstood in busy situations. Many of the tools are drawn from experience in aircraft cockpits and operating theatres, and they’re about how you get past the classic barriers in spoken communication:
understood doesn’t get done |
The relay is an event where several team members take over from one another to deliver one combined performance. The runners, made up of the very best sprinters, have to keep to their lane for the whole race and start at staggered points. The baton is a short stick that the first three runners hand to the next ones in changeover zones 20 metres long. It can sound easy, yet the relay is an event most sprinters dread. The difference between the team that comes last and the team that wins gold is often less than a single second. So the baton handover has to be perfect. It’s humiliating if the best sprinters in the world can’t win a relay. And yet it happens – which shows that just because you put together a team of experts, you don’t automatically get an expert team. So how do you make sure communication is spot on, so you don’t drop the baton? How do you make sure that understood also gets done?
Handing over is hard. We know that from the times we’ve been on the receiving end ourselves. We’ve all had to tell our story three times when we’ve called the council or the phone company. At work, a handover often happens just before someone goes on holiday. Lately you’ve been grafting to get to the bottom of a few cases, and even if you manage that, you may not also manage to brief your colleague on what you did, when, how and why. While you’re away, questions come up about one of your cases – and now your colleagues are left in the dark.
Handover errors: 86%
The handover is, hands down, the point in teamwork where we make the most mistakes. That’s because by far the most of our communication happens out loud. When things are busy, or we’re given too much information, we don’t always remember all of it.
When you’re a patient in hospital, most of the information about you is handed over in writing. Even so, 20–30% of the information is handed over out loud. If you’ve noticed how busy a hospital can get, it doesn’t take much imagination to picture how easy it is to forget something. My guess is that in many other workplaces this figure is far higher. We hand over the bulk of things out loud because it’s faster.
In 2010, researchers studied errors in spoken communication at five Danish hospitals. They went through 84 cases of serious so-called adverse events. According to the Danish patient safety authority, an adverse event is an error that isn’t caused by the patient’s illness – an error that has harmed, or could have harmed, the patient. In 86% of the cases, the researchers found that errors were linked to a handover (L. Rabøl, 2010). Handover errors were defined as verbal information between staff that, in relation to the handover, was missing, wrong, misread or misunderstood (for example when transferring a patient).
In a hospital, a patient is usually handed over when a nurse’s or doctor’s shift ends and they’re replaced by a colleague. It can also happen when a doctor or a nurse steps in to help a colleague because things are busy.
Handover errors were defined as verbal information between staff that, in relation to the handover, was missing, wrong, misread or misunderstood.
| 6 situations where you hand over
You may not think about it, but you actually hand over all the time. It doesn’t only happen when you’re standing at an assembly line passing a task to the next link in the chain. Here are six situations where you hand over (ES. Patterson, 2010):
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4 strategies that make sure understood gets done
Just like with the sprinters, succeeding together takes far more than fast horsepower. So here are four strategies you can use when you have to hand over and make sure understood also gets done:
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- Strategy 1: Blindfold your manager
- Strategy 2: Make checklists
- Strategy 3: Use closed-loop communication
- Strategy 4: Use the 10,000-foot rule
| Strategy 1: Blindfold your manager
In Canada, a hospital team had to practise resuscitation on a dummy (P. Brindley, 2008). The first attempts didn’t go so well. The lead consultant typically did the resuscitation himself instead of delegating. The doctors and nurses didn’t manage to coordinate who was doing what, what they had done and why.
So the facilitator blindfolded the lead consultant. Surprisingly, it improved the teamwork dramatically. Now they told each other every time a piece of work was done, and kept each other posted on the patient’s vital signs. Blindfolded, the team communicated far more clearly, which among other things created greater clarity about who did what.
Inspired by the study from Canada, I did the same thing during a cooking contest. I blindfolded the leader of one of the teams. At first they were naturally unhappy, because they thought it was unfair, but it quickly turned out to be to their advantage. Just like the hospital team, their teamwork improved, because now they had to be far clearer in their communication. The food tasted pretty much the same, but the team with the blindfolded leader clearly won on best teamwork.
The example shows that an obstacle often boosts a team’s creativity. In this case it made the team better at following up on one another by:
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So the facilitator blindfolded the lead consultant. Surprisingly, it improved the teamwork dramatically.
| Strategy 2: Make checklists
A checklist makes sure you don’t forget anything when you hand over. A checklist will be different depending on the company and the task. Imagine if you had a checklist for what you needed to remember to hand over when you go on holiday. Checklists don’t just minimise your handover errors – they also let you hand over faster, because you only need to quality-check once, the first time you make your checklist (AB. Haynes, 2009). |
| Strategy 3: Use closed-loop communication
Another way you can make sure understood gets done is to ask your colleague to repeat what you’ve said and let you know when it’s done. That way of talking is called closed-loop communication, and it’s completely standard in the aircraft cockpit and the operating theatre (M. Härgestam, 2013).
The exact origin of closed-loop communication isn’t known, but there’s no doubt it was used in the early days of radio – especially in the military. When two people talked over long distances by radio, there was a need to know the information had been received. That’s why these expressions are standard in radio communication:
In teams that practise closed-loop communication, every transmission therefore gets a reply. In writing, that can be when you send an email. You get an email back from your colleague confirming the email was received, and you get one more email when the task is done. Closed-loop communication is especially well suited to working under stress.
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Closed-loop communication
In teams that practise closed-loop communication, every transmission therefore gets a reply. In writing, that can be when you send an email. You get an email back from your colleague confirming the email was received, and you get one more email when the task is done.
How to roll out closed-loop communication
- You need to build a culture where everyone on the team dares to “speak up”, and where it’s fine to explicitly double-check one another. In the beginning you have to keep asking for closed-loop communication until it becomes a habit for everyone
. - Agree where and when you’ll use closed-loop communication. Start by finding the situations where handover errors typically happen, and where you spend a long time quality-checking
. - Set a concrete expectation for what you want to get out of your closed-loop communication. Help each other with precise feedback, and give recognition for your improvements in spoken communication
. - Take stock every two weeks of how it’s going.
| Strategy 4: Use the 10,000-foot rule
Have you ever tried to signal that you mustn’t be disturbed? I have, and it never works. No matter how hard I stare into the screen, not everyone picks up on it. You’ve probably also had a colleague come over for a chat right in the middle of something important. What if it’s a manager? Do you then push aside what you’re doing, or do you cut in and say: “I can’t talk right now!”
The aviation industry has worked out that it causes big problems if there’s no set of rules for when the cabin crew may pass a message to the pilots. It’s called the “sterile cockpit”, and it means that when the plane is below 10,000 feet, which is about 3 km, the pilots may not be spoken to (Airbus, 2010).
The 10,000-foot rule helps you work out when you may interrupt one another at work. Whether your colleague says “I’m below 10,000 feet” or something else isn’t that important, as long as you all know what it means. The key thing is that you know when the rule can be set aside. Experience from the cockpit shows that flight attendants are often unsure when that’s the case. Because it can be just as dangerous if a flight attendant smells smoke in the cabin and doesn’t tell the cockpit because the plane is below 10,000 feet.
So the question is: when is important information important enough to interrupt you at work? It’s not enough to ask a colleague whether you may disturb them when they’re busy – because what you’re bringing may be more important than what they’re busy with.
That’s why Japan Airlines has set out the following exceptions for when the pilots may be spoken to even though the plane is below 10,000 feet (R. Baron, 1995). How might this list translate to your work?
If you struggle with a lot of interruptions, or have tasks that demand concentration, I’d recommend you test the 10,000-foot rule. |
It’s called the “sterile cockpit”, and it means that when the plane is below 10,000 feet, which is about 3 km, the pilots may not be spoken to.
Example of a visual indicator that you’re below 10,000 feet
Are you willing to change your culture?
When you talk about how to make sure understood also gets done, it’s important your discussion doesn’t turn into a debate about whether you trust each other or not. The strategies I’ve described will only work if you trust that you all have good intentions when you follow up. It’s important you acknowledge that we make the most mistakes, by far, when we hand over – not because we’re uncommitted, but because handing over is hard. The American healthcare system has acknowledged this by setting up the so-called I-PASS Institute. There, training doctors in handovers is mandatory, because it can be shown that when communication is standardised when patients are handed over, fewer mistakes are made.
It does take, though, that you’re willing to break with your old culture. The strategies I’ve suggested will only add value if you see each other as resources it pays to delegate to, rather than doing the work yourself.
Jon Drummond, the American coach for the women’s Olympic relay team, made this comment about how much chemistry matters for a handover: “I don’t care that you don’t like each other. I just need you to like each other for the 40 seconds the race lasts. Once you cross the finish line, you can all hate each other again. But in that split second, in that 1.9 seconds when you hand over the baton? That’s when I need you to love each other like a twin sister.” (S. Borden, 2012)
Sources and further inspiration
L. Rabøl, 2010, Postgraduate Medical Journal
Patient Handoffs: Standardized and Reliable Measurement Tools Remain Elusive
ES. Patterson, 2010, The Joint Commission Journal on Quality and Patient Safety
The Blindfolded Learner – A Simple Intervention to Improve Crises Resource Management Skills
P. Brindley, 2008, Journal of Critical Care
A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population
AB. Haynes, 2009, The New England Journal of Medicine
M. Härgestam, 2013, BMJ Open
Flight Operations Briefing Notes
Airbus, 2010, Managing Interruptions and Distractions
The Cockpit, the Cabin, and Social Psychology
R. Baron, 1995, AirlineSafety.com
For U.S. Relayers, Dread of Another Dropped Baton
S. Borden, 2012, The New York Times
