2303:?sz DIETARY EEF'AR‘Z‘IKGEEQ’E “"‘ufi‘u T316212 for {he D—cqpmz a“: M; 3. MECHEGAN STATE UNIVERSITY Mfldred Jeaa Chambers 1969' LIBRARY Michigan State University M l. .1. <71?" 6-7111 (.1 6:13:11"! Dietary Departmmnt 1 ‘0‘ (1] 311:; F.) 1 1C1 1 .... 12-114!"- .1 M , SS _ 13311653.” 1 1 DATE lSéUED T0 LWNUMJHVH, Ptthjrwd Jfiwu: 1"11'332312 ' "g: 1 ‘ -' w, .- . ,. -. .. M .. L) .1. 1. ..l .1 1.1.1.13116211' \/ 1.11:? 153411 I'" 1 [11123911 1“ 1:3 [L'H’HHIJ I"! ~ 0 - .1. can}; HNF ' 1."!!‘1 I"! funny” OVA-— . s . .:‘- L'MH’PP‘VT . . . é. / a MICHIGAN STATE UNiVEiiSITY ' COLLEGE or H.225 5302-2022203 EAST LANSiNG, MiCHiGAN PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested. DATE DUE DATE DUE DATE DUE 6/01 c:/CIRC/DateDue.p65-p. 15 ABSTRACT HOSPITAL DIETARY DEPARTMENT COMMUNICATION BY Mildred Jean Chambers The effective Operation of any hOSpital dietary department is largely dependent upon the complex network through which basic Operational and policy information passes. As a leader within this department, it is essential that the dietitian performing professional and/or adminis— trative duties have an understanding of the communication process, the nature of peOple, the nature of organizations, and the problems of communication. The dietitian will get work accomplished better, problems solved more efficiently and goals accomplished more successfully if he will utilize this knowledge and will apply the basic communication principles of; (l) clarifying the idea; (2) knowing the objective; (3) considering the total physical and human setting; (4) determining the appro- priate medium; and (5) measuring the effectiveness of commu- nication. HOSPITAL DIETARY DEPARTMENT COMMUNICATION BY Mildred Jean Chambers A PROBLEM Submitted to the College of Home Economics Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Department of Institution Administration 1969 ACKNOWLEDGMENTS The writer wishes to eXpress her gratitude to Professor Katherine Hart for her guidance during the plan- ning and preparation of this problem and to Dr. Grace Miller for her advice in the preliminary planning of the problem. Also, the writer is grateful for the helpful sug— gestions received from Dr. Everett Rogers. ***** ii TABLE OF CONTENTS Page INTRODUCTION 0 O O O O O O O O O O 0 O 0 O O O O O O O l NATURE OF ORGANIZATIONAL COMMUNICATION . . . . . . . . 3 Significance of Organizational Communication . . . . . . . . . . . . . . 5 Characteristics of the Communication Process . . . . . . . . . . . . . . . 7 Communication in Hospital Dietary Departments . . . . . . . . . . . . . . . . ll COMMUNICATION RESPONSIBILITIES AND PROBLEMS OF THE DIETITIAN . . . . . . . . . . . . . . . . . . . 12 Communication Duties and Activities of the Dietitian . . . . . . . . . . . . 15 Communication Problems of the Dietitian . . . 27 .Applying Basic Principles of Effective Communication . . . . . . . . . . . . . . . 33 SUWY O O O O O O O O O O O O O O O O O O O O O O 0 3 8 BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . 40 iii I N TRODUCT ION As individuals, men start to communicate a few seconds after their formal entrance into this world. The first cry results in an exchange of information and meaning to some other individual. Communication becomes interwoven with man's daily life as he learns to use it to alter his thinking and behavior in the light of new information obtained through interaction. Any communication, whether verbal or nonverbal, allows an individual to share thoughts -with other peOple. This includes speaking and writing, action, bodily movement, gesture, facial eXpression, and color. Any time one human interacts with another some form of communication results, providing a necessary element in i human relationships. The importance of communication is not confined to the individual. Within an organization, communication is the means pecple have of affecting each other. Communica- tions function in the interpersonal relations of the group as a link or means of contact between the members and serve to create necessary human interaction which initiates pro- ductive activity. The fundamental requirement of communication for organized activities is that management understand and utilize communication to accomplish the objectives of indi- viduals and of the organization as a whole. Only through effective communication can policies, procedures, and rules be formulated and carried out. Only with good communication can misunderstandings be ironed out, long-term and short- term plans be achieved, and the various activities within an organization or its subunits be coordinated and controlled. A basic assumption of the communication discipline is that managers can become more effective communicators by understanding the fundamental concepts of the communication process and applying these concepts in an organizational context. It is the thesis of this paper that more effective communication-—that is, more effective sharing of ideas, feelings, and attitudes for the benefit of the organization-- can get work done better, problems solved more efficiently, and goals accomplished more successfully. NATURE OF ORGANIZATIONAL COMMUNICATION Many definitions Of communication have been prOposed. In general it may mean the transfer Of information, facts, ideas, thoughts, or Opinions from one person or group to other persons or groups. Within the context Of the organiza- tion, communication is ideally an initiated behavior on the part Of the sender which conveys the desired meaning to the receiver and causes a desired reSponse behavior from the receiver which will accomplish organizational goals (35). The communication process within an organization is basically the same as that occurring between individuals, except that more persons are involved and the organization itself imposes relationships upon the individuals which will affect the functioning of the process. To deal with the complexities of communication events and the vast quantity Of information generated within an organization, the formal organization molds the communi- cation process along certain lines. Organization charts are developed to define the lines of authority, power, reSponsibility, and accountability among the groupings of the organization. These relationships, typical Of organized activity, directly involve and delineate communication events. Successful coordination of the activities of indi- viduals and units within the organization is made possible with communication. This coordination is necessary if organizational goals are to be accomplished. In an organization the communication network has two distinct but equally important phases, namely, the Official channel of communication and the informal channel, normally called the "grapevine". The formal channel is related to the formally Specified organizational relationships and the informal channel is determined by the undefined relationships that develOp among individuals making up the organization. Both channels carry messages from one person or group~to another, vertically and horizontally, within the communica— tion network. Downward communication helps to tie different levels together and is used to communicate directives, infor- mation, Objectives, policies, and procedures to subordinates. Upward communication is of an informative and reporting nature as progress, suggestions, grievances or problems of the subordinate are carried back up to tOp management. Horizontal communication is primarily that information pass- ing between peOple or departments who are required to engage in coordinated efforts in order to successfully attain sub— unit Objectives. It is used to integrate plans, coordinate work, and compare methods or results. The informal channel may carry the same information as that in the formal chan- nels. Additionally, it conveys friendship messages between friends and status messages between ail members of the organization (21). Every organization, as a system, must have inter- action or cohesiveness between its subsystems if the total complex is to accomplish its Objectives. In providing the information and links between individuals and subunits, effective communication leads toward organizational goal accomplishment. Significance Of Organizational Communication According to Blau and Scott (10) an organization develOps when a number Of men join together as a social unit and are established for the eXplicit purpose of achieving certain goals. The successful accomplishment Of these goals is dependent upon a cooperative effort. This, in turn, is dependent upon an effective communication system which pfo- vides the basis for understanding, for COOperation, and for action. A number Of writers have eXpressed the view that an organization is best described as a communication system. Bavelas and Barrett state that: It is entirely possible to view an organization as an elaborate system for gathering, evaluating, recombining and disseminating information. It is not surprising, in these terms, that the effec- tiveness of an organization with reSpect to the achievement of its goals should be so closely related to its effectiveness in handling information. These same authors also believe that communication is not a secondary or derived aSpect of the organization, "rather it is the basic process out of which all other functions derive."2 Communication activities provide a utilitarian func- tion for the organization when they are initiated to gener- ate, activate, implement or control programs, and to moti- vate peOple to accomplish the programs (45). The communication system.which develOps within an organization is influenced by internal characteristics-- multiplicity of informational sources and destinations, serial or simultaneous relay Of messages, and whether the messages are in transitory or storable form--which interact with qualities Of the organization such as its size, its differentiated structure, and its ability to handle deci- sions in a coordinated manner (21). The ultimate responsibility for considering these factors and for establishing and maintaining a successful communication program lies with tOp management. In being iAlex Bavelas and Dermott Barrett, "An EXperimental .Approach to Organizational Communication," in Business and Industrial Communications: ~A Source Book, ed. by Charles W. Redding and George A. Sanborn (New York: Harper & Row, Publishers, Inc., 1964), p. 95. 2Ibid., p. 96. one Of the first to recognize the importance of communica- tions in organizations, Chester I. Barnard declared that, “the first function Of the executive is to develOp and maintain a system of communication."3 Although the commu- nication climate Of an organization tends to reflect the attitude Of tOp management, it is the reSponsibility of managers at all levels to maintain good communication among their own personnel. When each manager develOps good com- munication within his unit, it can be joined with other units to make a chain which will maintain good communica- tions and ultimately support the accomplishment of goals, even in large organizations (14). Characteristics of the Communication Process Every communication situation differs in some ways from every other one; yet it is\possible to isolate certain elements or characteristics which all communication events have in common. The common aSpects of communication acts allow the develOpment of a general model of the communication process. The model illustrates the relationship Of each element of the event to all other elements. A very basic model of the communication process was eXplained by Aristotle (41). According to his writings, the 3Chester I. Barnard, The Functions of the Executive (Cambridge, Massachusetts: Harvard University Press, 1938), p. 226. three main ingredients in a communication event are the speaker, the Speech, and the audience. The simplicity Of this model does not weaken its applicability, for the model is similar to most of the more modern ones, though they are more complex. Models of the communication process which have been develOped since that time are very similar and vary primarily in the inclusion or exclusion Of one or two extra components, their terminology, or their point Of view based on the perSpective Of the originator. The model illustrated was designed by Herbert G. Hicks and is based primarily on work done by David K. Berlo (9, 24). It pre- sents a relatively simple view of a very complex process. The basic ingredients of the communication process are shown in the schematic form Of the model which follows. i i i imi i i Source->Encoder->Message—>Channel->Receiver-9Decoder->Meaning | T FEEDBACK Human communication occurs because some person or group of persons has a purpose; that is, a reason for engag- ing in communication. Thus, the communication process first includes a source, either single or multiple, that has some thought, need, idea, or information which gives a purpose for communicating. The next element is the encoder who translates the information into a systematic set of symbols, a code, which can be reproduced into the form Of a message which will hopefully communicate the desired information to the intended receiver. The source may be the encoder in person—tO-person communication or in more complex communication situations these elements may be separate. The encoding is done in relation to the media selected to transmit the message. A telegram, for example, is usually worded differently from a book, and both are different from face-tO-face conversation. As the third element Of the model, the message is the actual physical product of the source-encoder's efforts to create meaning for the receiver. Since the message rep- resents the link between source and receiver, it is critical to the success of any communication. The channel is the element in the model which carries the message between source and receiver. Because humans receive information through their senses, there are five channels Open for communicating messages: sight, sound, touch, smell, taste. Sight and sound are the dominant chan- nels used although the others may be very effective for certain messages. Even though a source has a purpose, encodes that purpose and transmits the message along some channel, com— munication has not occurred until the message is received by someone at the other end Of the communication process. Thus, the receiver as the target of the communication is an essen- tial element of the process. 10 Just as a source needs an encoder to translate his purposes into a message, the receiver must be able to decode or must have a decoder to retranslate the message and put it into a form that creates a meaning for him. Whether or not the meaning received is the correct one is dependent upon that element shown in the model as noise. This noise is any interference which occurs through- out the process and results in misunderstanding at any stage. Such misunderstanding reduces the accuracy of communication and causes the communication process to function less than perfectly. The remaining element found in many communication situations is feedback, the reSponse that the receiver makes upon decoding and interpreting the meaning of the source's encoded message. If reSponse occurs, the receiver has become the source of communication and two-way communication has been established. The original source now knows whether or not his message has been received and interpreted cor- rectly. Feedback is valuable if it is used to plan and modify future communication efforts. In View of the complex processes involved in commu— nication events, the varied character of the material com- municated and the different outcomes which occur as a result Of the interactions Of the elements involved, it is not surprising that the communication process Often breaks down. 11 Communication in HOSpital Dietary Departments The effective Operation of any food service depart- ment is largely dependent upon the complex communication network through which basic Operational and policy informa- tion passes. In most organizations a formally recognized procedure of direct communication relative to each individual's job is established in order that he may give or receive information about his activities. Although there is no simple rule for determining the kinds of communication in an organization, free flow of apprOpriate messages and the use of suitable communication methods play important roles if the hOSpital dietary department is to contribute effectively to the over- all goals Of the hOSpital. In the hOSpital dietary department, necessary infor- mation is quite varied and there is a requirement for rapid and accurate communication. The dietitian has numerous man- agerial reSponsibilities which necessitate communication with professional, semi-professional, and non-professional employees both within the dietary department and within dif- ferent departments. For these reasons, the dietitian must have a fundamental knowledge Of the communication process and must utilize effective communication methods and pro- cedures. COMMUNICATION RESPONSIBILITIES AND PROBLEMS OF THE DIETITIAN The dietitian, as a professional member Of the hOSpital staff, is a planner, organizer, director, coordina— tor, evaluator, and reporter. Both the professional and administrative functions of his position require interest not only in the efficient Operation of the dietary depart- ment, but also interest in fitting departmental efforts into the overall hOSpital patient care Objectives (11). AS with any executive, manager, or supervisor, the essential function of the dietitian is to accomplish things through others or to invoke a desired behavior from other peOple. To attain Specified Objectives requires, in addi— tion to technical food service know—how and experience, a knowledge of management skills and techniques. .It involves keeping up with current develOpments in nutrition and food service administration, and growth in the talents Of leader- ship (48). Estimates indicate that 50 to 90 per cent Of the working day of an individual holding a position of leader- ship is Spent communicat1ng (18, 45, 49). In reporting the results of a study of the management activities of directors Of dietary departments, Lipscomb and Donaldson (31) indicate 12 13 that twenty-seven Of the thirty—six directors reSponding report that an average of 68 per cent of their working time is Spent in contact with other persons. Noland and Stein- berg (36) found in surveying the activities of therapeutic dietitians that over 70 per cent of their total working time was Spent on written and oral communications. Thus, the ability to communicate is the management skill most fre- quently utilized by the supervisor or executive. Being involved in both employee-management and intermanagement communication the dietitian serves as a communication link between management and the workers and between dietary and other departments. TO satisfactorily perform this role as a key communicator, the dietitian should maintain contact with all necessary individuals. The use Of prOper channels which are consistently Open will allow information to flow freely in all directions. Burke (12) has outlined two kinds of leadership functions and their related behaviors, all Of which involve some type of communication activity. The first Of these is described as task functions. Task functions are those behaviors of a leader which help a group to meet its pro- duction goals or solve its problems and include: 1. Initiating and contributing, i.e., suggesting ideas, goals, ways of approaching problems. 2. Seeking information and facts; giving information and facts. 3. Seeking Opinions; looking for ways in which peOple are reacting to the problem, what members think about issues and ideas; giving Opinions. 14 4. Summarizing and coordinating; pulling ideas and suggestions together. 5. Decision-making. 6. Recording; keeping a record Of group decisions, ideas, areas of disagreement as well as agreement; acting as a group memory. The second type Of leadership behavior is character— ized as maintenance functions. These include the behavior of leaders and members which help the group to get along better as a group, by increasing morale, cohesiveness, and member satisfaction. Maintenance functions include: 1. .Encouraging and gatekeeping; getting peOple to participate, inducing an atmOSphere which makes it easy for members to contribute, praising, agreeing with, and accepting others; understanding what's been said even when we disagree with it. 2. Harmonizing differences; pouring oil on troubled waters. 3. Compromising; coming half-way to clear up disagree— ments you're involved in, seeing others' point Of View, finding new alternatives. 4. Reducing tension. 5. .Setting standards for the group to achieve in improving its functioning; working on improving group performance and member relationships. 6. Group Observing and feedback--that highly important function of being sensitive to what's happening in the group and how you're reacting to what's going on. .As a leader, the dietitian has the reSponsibility to insure that a prOper balance Of both task and maintenance functions are being accomplished within his area of account- ability. By integrating the group's needs, interests, and efforts with Operational Objectives, policies, and activities, 15 the communication aSpects of these functions can result in an efficient formal communication system. Communication Duties and Activities of the Dietitian The sc0pe of leadership reSponsibility of the dieti- tian will be determined by the size of the hOSpital, the size of the professional staff and his relative position on the staff. He may be employed in a large dietary department as a Specialist in some aspect of administration or thera- peutics and perform only some of the leadership functions. As the only dietitian in a smaller hOSpital he will need to fulfill the obligations and responsibilities for each of these Specialized areas. The dietitian serving as a consul- tant would be required to perform the task functions and the maintenance functions of setting standards and observing and evaluating the group performance. Additionally, he should motivate the employees to carry out the maintenance func- tions and some of the task functions on a day—to—day basis. Whatever his Specific duties and reSponsibilities, the dietitian will be able to perform them more adequately if his communication activities are purposeful and success- ful. Administrative dietitian The American Dietetic Association defines the admin- istrative dietitian as a person who: l6 Applies the principles of nutrition and management to menu planning, food preparation, and service. DevelOps apprOpriate standards for selecting and purchasing food, equipment, and supplies. Is reSponsible for: selecting, training and supervising non-professional per- sonnel who handle, prepare and serve food; for inSpecting purchases received; for sanitation practices in the storage, preparation, and service of food. Prepares reports of financial management, safety practices, and training. Maintains cost control, by evaluating physical layout, employee utilization, equipment and procedures. .Coordinates dietary services with other departments. The interpretation of the activities involved in fulfilling the responsibilities of the dietitian will vary in order to accommodate the needs of each situation. It is possible, though, to classify these into a listing of activities which will be common to similar positions. Generally the dieti- tian designated as administrative will be performing as director of the dietary department, as a Specialist in administration or as the only dietitian who performs each of these functions as well as therapeutic, education, and research functions. Duties and management activities of the director of dietetics were described by Lipscomb and Donaldson (30) in 1964 and in a listing of desirable "job descriptions" for qualified dietitians published by The American Dietetic Association in 1965 (2). Most of these require the use of 4American Dietetic Association, "Dietitians and Nutritionists Defined," Journal of The American Dietetic -Association, XXXVII (August, 1960), 147. 17 some type of communication. An enumeration of many of the activities which are particularly dependent on the success- ful use of communication would include: 1. Directing effective management activities through planning, organizing, coordinating, budgeting, controlling, and evaluating. DevelOping and recommending to the administrator policies and standards for the department which are consistent with the goals of the institution. Interpreting objectives, accomplishments, adminis- trative develOpments, and the needs of the depart- ment to administration. Participating in conferences of department heads. Establishing and maintaining effective intra- and inter-departmental communication patterns. Coordinating and integrating departmental services with those of other departments. Delegating responsibilities to other staff members. Participating in professional and community activ- ities. Planning, organizing, and directing educational programs of the department. DevelOping and maintaining an active and effective staff develOpment program. Planning, advising, and/or participating in the develOpment and execution of educational programs for: medical and dental students and staff; nursing students and staff; dietetic interns; and other groups in the institution. Participating in the formulation and maintenance of an effective and continuous program for the orienta- tion, training, and supervision of departmental personnel. Formulating and directing the integration of current principles of normal and therapeutic nutrition into teaching programs for patients. l8 3. Planning, organizing, and directing research pro- grams of the department. Developing and implementing research programs in administration, food production, normal and therapeutic nutrition, and education. Analyzing, evaluating, and interpreting the research findings. The 1965 report of The American Dietetic Association (2) also defined the administrative reSponsibilities of the dietitian working as a Specialist. Those distinctly involv- ing communication activity include: 1. Planning, develOping, implementing, and evaluating food service for patients and personnel within budgetary limitations and according to current nutritional principles, in order to maintain and improve the nutritional status of patients and personnel. 2. .Maintaining high standards in the training, super- vision, and evaluation of an efficient staff. .3. .Delegating duties and responsibilities to competent individuals. 4. Contributing to overall departmental planning and coordination with other departments. .Although not all-inclusive, analysis of.the reSponsi- bilities cited reveals that the occasions for communication will be: (1) for nonprogrammed activity; (2) to initiate and establish programs, including day-to-day adjustment or coordination of programs; (3) to provide data required for application of strategies; (4) to evoke or stimulate the execution of programs; and (5) to provide information on the results of activities (33). 19 As communication will correSpond to the authority and structural lines of the organization when he communi— cates upward, downward, and horizontally, the director of the dietary department and the administrative dietitian will be performing as an organizational line official in most instances. Line officials are those who have direct reSpon- sibility for accomplishing the objectives of the enterprise. They are in the direct chain of command and have authority over the workers who directly accomplish the objectives. An Official designated as having a staff position will perform in an advisory status and will have authority only in the specific functional area of his expertise (24). The line or staff function an individual performs in an organization and his position in the authority system have an important effect on the nature of the communication activity he is involved in and the resulting communication problems. The administrative dietitian may have Specific job duties to perform and may start out as a Specialist, but as he moves up the organizational hierarchy, he becomes more of a "generalist" and is more occupied by the managerial prob— lems of leadership and motivation (l4). Therapeutic dietitian The therapeutic dietitian is defined by The American Dietetic Association as one who: Plans menus for individuals in accordance with physician's prescription with particular emphasis on (1) nutritional adequacy within the limits of the order, (2) physiologic and psychologic needs 20 of the individual. Integrates the menu plans with the basic institutional menus. Consults with medical, nursing, and social service staffs to gain insight into problems affecting patients' food habits and needs. Instructs patients and their families in normal and therapeutic nutri— tion and how to meet these needs through use of foods suitable to income and culture. Partic- ipates in the training of medical students, student nurses, dietetic interns, and medical staff. 2Manages the therapeutic unit, maintains records, and prepares reports. May engage in research. The individual assigned as a therapeutic dietitian may Specialize in therapeutics, education or research, or a: may perform all of these functions as an integral part of the same position. In reviewing the activities listed in a 1965 report of The American Dietetic Association (2) for therapeutic, educational, and investigative reSponsibilities of the dietitian, it becomes evident that most of these are also dependent upon the use of communication. Some of the duties and activities requiring utilization of communication are: 1. Therapeutic responsibilities. Maintaining or improving the nutritional status of patients by adapting menus, evaluating foods con- sumed, and counseling in principles of nutrition. Consulting with physicians concerning dietary prescriptions and implementing these through meals adapted to the needs of individual patients. COOperating in patients' care by acting as consul- tant to physicians, nurses, medical social workers, and other paramedical persons in all areas of normal and therapeutic nutrition. Ibid. 21 Interviewing, teaching, and assisting patients to satisfactorily fulfill nutritional needs in follow- ing prescribed diets at home. Recording on patients' charts, when indicated, apprOpriate information, including patients' dietary histories, food consumed in the hOSpital, and prog- ress notes on patients' education. Participating and contributing to overall depart— mental planning. Delegating duties and reSponsibilitieS to competent individuals. Supervising, and evaluating dietetic interns, food service supervisors, and other food service person- nel. Educational responsibilities. DevelOping, organizing, and teaching courses or units of instruction related to normal and thera- peutic nutrition. Using effective motivation and teaching techniques in presenting current nutrition and/or management instruction to nursing and medical students, dietetic interns, graduate professional groups, and the public. Preparing manuals, brochures, visual aids, and other materials used in teaching. Research reSponsibilities. Planning diets not previously planned in textbooks or manuals to satisfy the needs of the investigators or medical staff. Planning and giving prescribed diet instructions to patients. COOperating with professional and nonprofessional personnel involved in the research program. Referring recent research develOpments in nutrition and related subjects to the physician. 1; 2.3! 22 Although the therapeutic dietitian may have author- ity over and reSponsibility for the performance of a limited number of personnel, the primary part of his job is as a staff official. Much of his interaction is with peOple other than his superior or subordinates. In the process of communicating horizontally to advise, counsel, consult, or coordinate, an understanding and COOperative attitude is essential. In attempting to influence individuals over whom he has no formal authority, the dietitian must be able to persuade and motivate another individual. To do so requires that he understand another's ideas, feelings, and point of View, and communicate a message which is consistent with the receiver's knowledge, feasible in the existing circum- stances, understood, and accepted as valid and of value to the receiver (50). Staff personnel usually have their own unique vocab- ularies and terms which they use. Such "Special language" is necessary for quick and precise communication; however when such language is used to communicate with peOple not in the Specialty the terms and phrases are meaningless and lead to a breakdown of the communication process (32). This is particularly true of the therapeutic dietitian using nutri- tion and food service terminology. When communicating with patients, physicians, nurses, and other paramedical person- nel, the dietitian must constantly seek to eXpress himself in words that will be familiar to the person to whom he is 23 speaking: words that will mean the same thing to the receiver as they mean to the dietitian as the communicator (46). Consultant dietitian The dietary consultant is defined in the Dictionary of Occupational Titles as one who: Advises and assists public and private estab- lishments, such as child care centers, hOSpitals, nursing homes, and schools, on food service man- agement and nutritional problems in group feed- ing: Plans, organizes, and conducts such activ- ities as in-service training courses, conferences, and institutes for food service managers, food handlers, and other workers. Studies food ser- vice practices and facilities and makes recom- mendations for improvement. Confers with architects and equipment personnel in planning for building or remodeling food service units.6 Each dietary consultant may have different Specific functions depending upon the organization to which he is rendering assistance. Yet, his purpose will be the same as he aims to improve a hOSpital's food service not only through his own administrative efforts, but by advising and motivat- ing others to action. The constituent parts of a consultant's job are: (l) clarifying the request for assistance——determining what is eXpected of him; (2) develOping, with dietary department employees, a working level of mutual trust and confidence; 6Dictionary of Occupational Titles, Vol. 1: Defini- tions of Titles, 3rd ed., 1965, p. 202. ____.__:'3 7.1““ 41:... 24 (3) evaluating food service procedures; (4) establishing goals and priorities in the develOpment of a plan of service; and (5) solving problems through demonstration, teaching,and motivating to improve practices (47). Successful consultation will be based on having a firm graSp of the principles of communication for teaching and motivation. The time limitation under which a dietary consultant works poses some particular communication prob- lems. First, in order to examine and evaluate the dietary department Operations and procedures on the basis of limited observation, the consultant should be a good listener and, at the same time, provide an exchange of information by making tactful comments and asking pertinent questions. Effective consultation depends on develOping a two-way rela- tionship in which the staff will feel free to make available the information a consultant needs to evaluate current prac- tices. Secondly, the decisions made and actions recommended need to be concise, yet be practical and workable solutions adapted to the particular institution. It is necessary for the consultant to communicate suggestions in such a way that the staff understands that they are based on established standards and are not given as criticism. Thirdly, the dietary consultant's aim is to make recommendations that the hOSpital can and will want to put into practice. Such recom- mendations should be eXpressed in terms that can be under— stood by those who will be following through on the sugges- tions (25). 25 -A dietary consultant is not a regular staff member of an institution and in some cases may only have the authority to offer advice and assistance and will lack administrative responsibility for making decisions. Others may occupy a position in an organization which has licensing or standard-setting authority or that controls funds for a hOSpital, so will have greater administrative power and authority. Whether service is offered on a purely invita- tional basis or within the framework of legal licensing or standard-setting authority, the ultimate goal is to increase the knowledge and improve the practices of others. This is usually found to be more effective if the communicative methods used are advisory, motivational, and educational rather than "police-like" action (25). The communication behavior of the dietitian will vary depending on the position he has and the resource he has to support his actions. In his communication efforts, he will be attempting to obtain a certain behavioral response from the receiver. This is frequently a different behavior from that which would have occurred if the communi- cation had not taken place. The communication receiver's decision to innovate or change his behavior will also differ as a result of the relationship between himself and the dietitian. In the situation where the dietitian has super- ordinate power over an employee the decision is an authori- tative one in which the individual has no legitimate 26 influence over the decision, but is ordered to adOpt or reject the behavior. In working with other professional groups in an advisory capacity, the decisions made by the group will be collective in that the group has the Option to adOpt or reject the change; but once the decision is made, all individuals in the group must conform to the decision. Where the dietitian is working with an individual, over whom he has no authority, such as a patient or physician, the individual receiving the communication has almost complete freedom to exercise his choice to adOpt or reject the change. This then would be an Optional innovation decision for the communication receiver (43). The following chart is a summary of the roles the dietitian may have as a communicator, his resource for influencing a change in the receiver's behavior, his com— munication behavior for a certain role, and the related decision of the receiver to make or reject a change in behavior. 27 Most Type of Main Resource ApprOpriate Audience in Changing Communication Innovation Role Behavior Behavior Decision ‘Administrative 2Administrative Authoritative Authority Dietitian hierarchical power Therapeutic Technical Technical Collective Dietitian competence advise EXpertise Optional Some admin- Authoritative 'Authority istrative hierarchical power Consultant Technical Technical Optional Dietitian competence advise Expertise Collective Communication Problems of the Dietitian Successful coordination and accomplishment of goals within the hOSpital depends upon the abilities of each indi- vidual to communicate. As do all other managers, dietitians depend upon communication in order to fulfill their reSpon— sibilities for planning, consulting, making. instructing, recording, organizing, directing, evaluating, coordinating, and decision Although the content of the communication may dif- fer, the dietitian uses the process for the same purposes as all other executives. For this reason, the problems he faces, 28 the barriers he encounters, and the skills he needs to communicate effectively are the same as those which apply to all other communicators. Identification of reasons for communication failures or the precipitating factors in the breakdown of the communi— cation process have been presented by many authorities in the field of communication (9, 13, 17, 22, 26, 45, 50). In general, communication difficulties arise from language, organizational, interpersonal, individual, or economic and time barriers, or a combination of these. Language barriers arise because words mean different things to different peOple. Those which one individual speaks or writes represent ideas or experiences which belong to him. The group of symbols which are used to transmit these ideas and experiences to someone else may not be effective because the other individual's eXperiences will have been different. Rogers (43) has described this pro- icess of listening to and interpreting language on the basis of past experiences and existing Opinions as selective per- ception. The amount of distortion occurring because of language difficulties will depend upon the adequacy of the language to convey the precise ideas of the sender, the loss of meaning which occurs in the process of translating the message from one person or level to another, and the incon- gruency in the frames of reference of the sender and receiver (45). The problem of language differences is a 29 particularly notable one for Specialists or staff officials communicating with individuals outside of the Specialty. The distortion resulting from the inefficiency of language can be minimized. One way is for the sender to get a feedback from receivers to check whether they have truly understood the content of the message. Redundancy in which the message is reiterated or repeated is another tech— nique the sender can use to increase the understanding or acceptance of the message (45). On the results of an experimental study of interpersonal communication, Triandis (51) suggests that the communicator who can familiarize him— self with his audience's dimensions and can construct his messages so that they are channeled within the dimensions used by the audience, will increase the probability of successful communication. Communication problems within an organization may be created or amplified by the very existence of the organiza- tion. For example, the physical distance between individ- uals who convey information and those who receive it may contribute to delays and misunderstandings. Authority relationships create an hierarchical status and position structure which by its very existence produces a restraining force against communication (28). There are strong forces acting against free communication of information critical of persons at an upper level (28). Pleasant matters and achievements are more likely to be passed upward than are 30 unpleasant matters or information about errors or diffi- culties that would reflect negatively upon the competence of the subordinate (39). This filtering and editing of information occurs at each supervisory level as the informa- tion passes upward in the hierarchical structure. The infor- mation management needs to make decisions, to understand the temper of the work force, and to see what problems face them can be so inaccurate when it reaches the tOp echelon that it has lost most of its value (37). Information downward is also subject to a filtering process as each superior omits that information he feels the subordinate has "no need to know" or "right to know" (8). .Each communication source has a certain status or position and the receiver of a message -will interpret what he hears as the message, or sees as accompanying expressions and behavior, in terms of his feelings, perceptions, and prejudices about the sender who occupies a certain organizational position (22). Read (39) suggests that free and accurate exchange of information may depend significantly upon positive and harmonious relation- ships between organizational members, particularly those who differ in formal power. Interpersonal barriers to communication are due to individual differences in background, experience, values, standards, and motivation. PeOple do not share the same values or see and assume the same things. There is a natu— ral tendency to judge, to evaluate, to approve, or disapprove the statement of another person from one's own point of view 31 or frame of reference. This can lead to distortion, misinterpretation, or misunderstanding. The evaluation tendency can be avoided by listening with empathetic under- standing (42). The facility for perceiving the expressed idea and attitude from the other person's point of view, to sense his feelings, and to achieve his frame of reference in regard to what he is talking about, is known as empathy (7, 43). The inabilities of the individuals participating in a communication event to receive and transmit information may create additional barriers in the communication process (50). There is no communication until and unless the mean— ing which is received by the listener is the same as that which the sender intended to send (22). It is the reSpon- sibility of the sender to get his idea across. To enhance the potential effectiveness of his communication, the originator must adapt the tools and techniques of communi- cation to the purpose, the circumstances, the subject, the audience, and the total situation (50). .Economic and time barriers are encountered when communicators, either sender or receiver, do not have the time to read, write, say, or hear the message accurately or to comprehend and act upon it prOperly. The gathering, preparation,or presentation of complete information may be too costly, so the message communicated may be less than the Optimum. Additionally, the timeliness of information is 32 essential to its full usefulness. In order for communica- tion to be effective, it must contain the necessary infor— mation and be transmitted at the prOper time in order that its purpose or objective is accomplished. Efficiency of the communication is determined by the total cost of preparation, production, transmission, and comprehension relative to the effectiveness (50). This effectiveness and efficiency must be the concern of the originator of the communication. Many of these Specific communication problems stem from the common causes of the organizational structure which is an impediment to the free flow of communication and the technical hetrOphily which results from the differing attri- butes or knowledge levels of the individuals who are inter— acting (43). The general problem of organizational communi- cation is then one of a sequence of understandings: of the nature and background of peOple, of the nature of communica- tion, of the nature of organizations and, finally, of the nature and effect of communication skills (50). For each communication event in which the dietitian participates, he may encounter barriers of a different nature and with a different impact. The one or many which create a breakdown in the communication process, which is an integral part of professional activities, may or may not be a problem in the communication required for personnel administration or interdepartmental relationships. Organizational communication can be thought of as directional—-upward, downward, or horizontally from the 33 sender. Barriers such as status or interpersonal relation- ships which are detrimental to the communication between superior and subordinate in the vertical dimensions of the communication network will possibly have much less impor- tance in the horizontal and lateral communication with colleagues, other departments, and clients. Organizational communications should be thought of as being purposeful and directional. Each purpose and each direction pose different technical and psychological problems which must be under- stood and solved if the communication is to be successful (26). Applying Basic Principles of Effective Communication Communication is an integral part of every manage- ment job. Even though no two persons communicate alike, it is still possible to advance as guidelines some general principles of good communication which were prOposed by many authors as the means to increase the effectiveness of man- agerial communication (8, 15, 22, 34, 35, 38, 50). Clarify the idea 9; problem Time must be taken and an effort made by the commu- nicator to get the intended communication straight in his own mind. If the message is not clear in his mind, it is certain the receiver will not understand it. A message which is clear, consistent, complete, and concise or a 34 careful and precise identification of the problem will help formulate the desired idea in the mind of the receiver. Know the objectives Before communicating, the sender must ask himself what he really wants to accomplish with the message. The purpose of a communication is generally related to the direction of the information flow. -As it follows the author- ity pattern of the hierarchical structure and moves downward, it is intended to inform, instruct, motivate, direct, re- direct, evaluate, or keep in touch with subordinates. That which moves up the hierarchical ladder will be to report progress and problems, offer solutions, or provide other information which tOp management needs to make decisions. Lateral communication for interchanging information and ideas is essential for coordination, efficiency, and team- work. Once the audience and the goal of the communication have been identified, then the language, tone, and total approach should be adapted to serve the Specific purpose. Consider the total physical and human setting Many factors other than just words influence the overall impact of a communication. It is important to make sure that the environment is conducive to clear communica- tion through careful selection of time and place. The manner in which an idea is expressed may affect a listener's 35 reaction to a message. To plan the most effective presenta— tion of a message, it is necessary to take into account the. information, attitudes, education level, background, eXperi- ence level, and eXpectations of those to whom it is directed. Careful analysis of receivers and circumstances will enable the communication source to know what can be said and how; thus he will be able to communicate more effectively. Determine the medium £9 be g§2g_ Different kinds of communication are more apprOpri- ately or effectively presented in one form or another. It is important that the sender of a communication be aware of the characteristics of the media or channels available to him. He should be able to choose the prOper medium for a particular message and know how to use the medium skillfully. Written, oral, or nonverbal means may be used to communicate. Written messages have the advantage of pre— senting the information in its original form without "interpretation" by anyone between the sender and receiver. It may be preserved for later use. Oral communication has the advantage of providing an Opportunity for discussion between sender and receiver which allows for more immediate clarification of the message. The determination of whether to use the written or the oral medium should be based on the purpose of the com- munication, the nature of the receiver,and the abilities of the sender. Often a combination is most successful as one 36 reinforces the other. That which will best insure that a message is received accurately should be used. The communicator has the reSponsibility to improve his ability to utilize the transmission Skills of speaking and writing in order that his communication will achieve its purpose. Measure the effectiveness 9: the communication To provide for future improvement in communication, its accuracy Should be evaluated as often as possible through the use of "feedback". This means the communicator must guard against the assumption that simply sending a message insures its success. The sender must become a receiver and make full use of the reception skills of observing, listening, reading, thinking, interpreting, and relating. This is essential in order to determine whether the message was received and the barriers of communication overcome so that what was sent was actually understood. In order to evaluate overall communication effec- tiveness, a manager would be advised to heed John Gardner's statement that, "every tOp executive . . . sitting at the center of a communications network should periodically emerge from his world of abstractions and take a long un- 7 flinching look at unprocessed reality". Observing the 7John W. Gardner, Self-Renewal: The Individual and the Innovative Society (New York: Harper & Row, Publishers, Inc., 1965), p. 79. 37 effect of his communication when it reaches its ultimate receiver is one of the best ways a manager can evaluate the effectiveness of the communication process which he starts when he sends out an initial message. Most communicators, regardless of natural endowment, can improve themselves as communicators. That which can be done to aid in this improvement is to plan carefully what to communicate, to whom to communicate, and how best to do it. It is necessary to say what has to be said simply and clearly, considering the nature of the receiver and the organization, and the psychological barriers that may inter— fere. Overriding all of the principles that apply to the process of communication must be the recognition, by the dietitian, of the importance of effective communication in the accomplishment of most of his duties and reSponsibil- ities (l9). SUMMARY Communication, whether in terms of one person, two persons, or an institutional network, is accomplished through the performance of those functions entitled source, encoder, decoder, and receiver. Messages are always involved and must exist in some channel. How these go together, in what orden.and with.what kind of interrelation- ships depend on the situation, the peOple involved and the reason for the communication. 2As a manager, the dietitian is primarily a commu- nicator. His effectiveness will depend on the climate and communication policies of the organization, his awareness of the communication requirements of his position and his knowledge and skill in applying the principles of good communication. The primary medium of communication within an organi- zation will probably be oral, but this will be supplemented with written documents. The basic principles of effective communication apply regardless of the medium: clearly organized supporting ideas, with a Specific objective are adapted to the receiver and are communicated in a manner and at such a time and place as to be most successful; feedback 38 39 is used by the communicator to insure that the message received correSponds to that which he intended to send. 2In fulfilling his professional and managerial responsibilities, the dietitian is eXpected to keep supe- riors informed, work cohesively with other departments, and lead his subordinates, by directing and motivating. The successful accomplishment of these functions, largely dependent upon successful communication, will enable the hOSpital dietary department to achieve its goals, which in turn leads toward the achievement of the overall hOSpital objectives and the advancement of the medical care program. 10. BIBLIOGRAPHY American Dietetic Association. "Dietitians and Nutri- tionists Defined." 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Human Relations, XIII (August, 1960), 279-287. Vesterinen, Pirkka I. HOSpital Dietary Department Communications. Unpublished Master's Thesis, Cornell University, 1965. MICHIGAN STATE UNIVERSITY COLLEGE OF H’T'EIIE LIGITOIMCS EAST LANSING, MiCHIGAN A PROBLEM 1969 I CHAMBERS, Mildred Jean Hospital Dietary Department Communicat ion IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIlllIlIIII 31293 02429 2561 u—. .