The Hanna/Wilson text describes communication as "generating, transmitting, receiving, and interpreting messages." This definition applies to all communication, whether it is in a factory, between individuals, or in a hospital setting. The hospital in which I work has a problem with the flow of communication. This is common in a tall structure where it is necessary for information to flow downward. Many times, information begins the downward descent not correctly encoded. This leads to misinformation being passed down through the ranks of the hierarchy starting with the Board of Directors, then proceeding to the department heads, then continuing with the department managers, and ultimately stopping with the staff. It is at this point that the "hospital grapevine" is set into motion. This pattern has most recently emerged with the announcement of the restructuring of the hospital. I will discuss how the administration handled the situation, as well as give my recommendations as to how it should have been handled.
The CEO and Board of Directors announced in early l998 that the hospital would be bringing in a group of consultants to "trim the fat" and help the hospital become more competitive and profitable. The consultants arrived and began their examination of every department in the hospital. The group spent about one month interviewing employees, doing time studies, and going over hospital policy and procedures. The staff felt that they had played an integral role in helping the group gather information as well as giving them their opinions' via the interviewing process. However, when the consulting firm left, management failed to share the information with the staff.
The staff lodged complaints with their respective department managers, who in turn informed the department heads, and then the Board and CEO were notified. The upper management decided to schedule meetings for each individual department to discuss the firm's findings. However, meeting times and places changed without prior notice, or the meetings were canceled altogether. The meetings that did take place were unorganized and each department was given different information. Eventually, the concept of the meetings were abandoned entirely.
Administration took a different approach to dispersing the information, or a least part of the information, that had been gathered by the consultants. Three plans for the restructuring of the hospital were set out for the staff to view. No formal forum was designed to discuss the impact that each plan would have on the individual departments. In each plan, departments were moved or merged with other departments with no explanation as to how these departments would be governed. Speculation and supposition began to run rampant among the staff.
Rumors of personnel cuts began to circulate through the hospital. Several versions of the same story were being told. One version was that lab personnel would be eliminated and the respiratory staff would be trained to do the lab draws. In another version, respiratory staff would be cut and nursing would be doing the therapy. This rumor caused a great deal of tension between the departments. Each department became defensive for fear of losing their jobs.
Merging of the departments appeared to be eminent because each plan contained integrating of departments in some fashion. Talk of Pediatrics and Intensive Care fusing with the Medical Surgical floor caused many to wonder about the quality of patient care and the perception that the community would have about the hospital. The "grapevine" was picking up where administration left off, filling in the blanks with conjecture and gossip. As Alexander Pope conveyed in The Temple of Fame, "And all who told it added something new, And all who heard it, made enlargements too." This is exactly what was happening in my hospital.
The problem was intensified by the fact that management did nothing to dispel any of these rumors. Some of the department heads were actually participating in the "grapevine" chain by telling parts of what they heard from upper management. These bits and pieces of information became distorted and blown out of proportion, and because they were coming from middle management, the staff assumed these rumors to be true. Ironically, the "grapevine" is often a good source of information with accuracy around 78-90 percent, according to the Hanna/Wilson text. The informal network, or "grapevine," is one of the most believed forms of