"Communication is the Vehicle for Building Relationships"
“At a time when trust in healthcare — and among those working in healthcare — is decreasing pretty dramatically, we had better find a way to tell stories that can win back hearts and minds.”
This was the sentiment shared recently by Donald Berwick, MD, MPP, FRCP, KBE, President Emeritus and Senior Fellow at the Institute for Healthcare Improvement (IHI). During a recent conversation, Don and I discussed why strategic communications — including storytelling — is essential to earn trust, develop strong relationships, and build will for change.
Jo Ann Endo (JE): Why do you think leaders and teams often overlook the importance of developing a strategy for communicating about improvement work?
Don Berwick (DB): I think it comes down to time and priorities. Leaders, especially executives, are incredibly busy. They’re always putting out fires, so they naturally tend to focus on the problems right in front of them. Communication, though, is a long-term strategy. It’s not a quick fix — it’s an investment that takes time to show results, and often, those results are subtle and built over time.
JE: Are you saying that, because communications tactics don’t typically produce instant results, they can easily be overlooked?
DB: Overlooked, postponed, deprioritized. I remember Dr. Robert Waller from the Mayo Clinic advising me to convey important messages “8 times, 8 ways.” His point was that if you want a message to stick, you need to repeat it multiple times and find different ways to communicate it.
JE: I’m glad you mentioned “8 times, 8 ways.” I think people sometimes interpret that as repeating the same thing over and over again, but it’s about more than that, isn’t it?
DB: Yes. People absorb information in different ways, and repetition alone won’t be effective. I’m an auditory learner, so if you tell me something, I’ll remember it. But for others, visual cues might work better. Presenting a message through multiple methods and formats helps reach people in ways they’re most likely to engage with. And let’s face it, with so much noise out there, just saying something louder won’t necessarily break through. You have to reach people where they are.
JE: And what about two-way communication? I think this is another nuance of “8 times, 8 ways” that sometimes gets lost. Testing messages and studying the responses can help refine the strategy.
DB: If you can engage in a dialogue rather than a one-way broadcast, you’re much more likely to connect and build trust. Two-way communication is not only more respectful but also far more effective. It does take more time, but the value of that feedback can’t be overstated. It allows for adjustment, for tailoring the message in response to what’s resonating — or not — on the other end.
JE: We found that to be true with many of IHI’s large-scale initiatives. Constructive criticism and ideas we heard from the field were invaluable. The relationships we built kept those lines of communication open.
DB: Exactly. The people doing the work day-to-day often know things that leadership doesn’t. They’re the ones who can tell you what’s working and where things might fall short. Building these relationships isn’t just about pushing out a message. It’s about listening and, more importantly, showing people that their input matters.
JE: So, when we talk about a strategic approach to communication, we’re essentially talking about relationship-building, right? If people don’t trust you, it doesn’t matter if your message is perfectly crafted.
DB: Yes. Communication is about trust at its core. In a world where there’s so much misunderstanding and mistrust, especially in healthcare, communication needs to focus on dialogue. Communication is the vehicle for building relationships.
JE: And trust isn’t built overnight, especially in challenging environments like healthcare.
DB: Right. The issues we’re tackling are significant, and the changes required are big. For any of it to succeed, we need everyone’s support, and that starts with trust. Sending out a memo isn’t going to cut it. Yelling from the rooftops won’t work either. When you’re in authentic dialogue with people, they’ll open up with insights that are crucial for success. And, if we’re serious about the importance of relationship-building, we have to be serious about communication.
JE: What are the keys to effective strategic communications?
DB: The first key is listening. The beginning of a communications strategy is silence. Too many people start communication by talking, but if you aren’t listening first, you’re already going off track. Lead with curiosity. Approach every communication effort with a desire to understand before seeking to be understood. This mindset shift changes how people engage with your message. The second key is viewing communication as a continuous series of tests.
JE: You can use Plan-Do-Study-Act (PDSA) cycles to test different messages.
DB: Yes. All communication should be regarded as a test. You can’t just create a communications strategy, execute it, and consider it done. Communication is dynamic; it requires constant feedback and adjustment. Ask yourself: “Did what we try last week work? What did we learn?” This feedback loop is essential for building messages that truly resonate.
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Effective communication means more than transmitting information. It’s about listening, adapting, and building trust through every interaction. Communication isn’t just a tool; it’s the very foundation on which we can build the relationships that are crucial to making meaningful change.
As Don said toward the end of our conversation, “If you're standing still on communication, you’re going backwards.”
Note: This interview was edited for length and clarity.
Photo by Marcin Czerniawsky | Unsplash
