Communicate Effectively with People

Person-centred support is a fundamental aspect of health and community services work. It is a highly effective, evidence-based approach that places the person receiving care and support at the centre of all the planning and decision-making activities that surround them.

Person-centred support requires high-level communication skills from workers so that they can provide information, offer services, ask questions and give advice and guidance appropriately.

Person-centred support means thinking about how to individualise and focus on specific needs and requirements, as well as meeting the interests, preferences and desires of the person in the most effective way possible.

As a worker in community services and health care, you can use your communication skills to help you work effectively with clients in providing person-centred care and support.

Many organisations within health and community services operate on a rights-based approach.

This is a model of support which begins with a slightly different premise to some traditional models, where there is a focus on needs, deficits and remediation or rehabilitation of a loss or problem.

A rights-based approach begins with the concept of fundamental human rights and examines what rights are not being maintained in a given situation. This approach sees all people as holding universal rights and that service provision should work towards upholding or restoring those rights.

With a rights-based model, people who are currently lacking in their ability to assert their rights are empowered to do so and can make decisions, take actions and promote approaches and systems which build their capacity and capability within the community.

If you have ever looked closely at people who communicate, you will notice they use more than just their voice to share a message. This is because communication is about a great deal more than just spoken words.

Communication refers to the whole system which is used to give and receive a message between individuals and groups. To communicate well takes time, effort and lots of practice.

It is important to think about all the components which make up communication when you are working in a community service or healthcare context. This will help you to communicate effectively with a wide range of people and in many different situations.

In a community services or health care context, verbal and non-verbal communication is used widely. It is an essential part of:

• Motivational interviewing
• Communicating with clients
• Providing health and community services information
• Providing individualised support and care
• Making ethical decisions and judgements
• Collaborative planning with clients as part of person-centred support.

Verbal and non-verbal communication can be affected by factors related to the situation, the person and their individual and specific communication needs.

Motivational Interviewing

Motivational interviewing is a technique based on the principles of person-centred support, which aims to build capacity and confidence, and enhance intrinsic motivation for the client.

Motivational interviewing uses four key strategies which can be remembered by the acronym OARS:

• Open Questionsencourage the person to begin talking and sharing their story, without being guided in one direction.
• Affirmations arestatements or gestures which recognise and affirm achievements or positive elements in a genuine manner.
• Reflective Listening can include paraphrasing, repeating and confirming or reflecting on what the other person has just told you.
• Summary Reflectionsallow the listener to reflect on a section or component of the discussion before moving on to the next part of the conversation.

Watch this YouTube video by Bill Matulich on the Introduction to Motivational Interviewing:

It is important to recognise there is a clear difference between motivational interviewing and coercion. In the former, you are accompanying your client on a journey of learning for which they have decided they are ready to embark. In the latter, you are persuading and controlling the journey yourself, without truly allowing the client the right to be in the driving seat.

Verbal Communication

Verbal communication is the part of communication that relates to language. It can include:

• Spoken words
• Sign language
• Assistive and augmentative technology.

Effective verbal communication means that the person who is giving the message and the person who is receiving it can understand each other easily. They take turns in the conversation and use pauses, silences, questions and answers to help add meaning to their communication.

When people communicate using spoken language, they use a combination of sentences, statements, questions and answers to share meaning. In a community services or healthcare context, verbal communication is one tool that is used to provide services to other people.

Workers do this in many ways, such as by offering assistance, asking about someone’s current health and wellbeing or providing information about services and programs which might meet the needs of a person.

Example

For example, for someone who has hearing loss, they may communicate using Auslan, the language of the Australian deaf community, or Signed English, a literal translation of spoken words into sign. Sign language works just like any other verbal language—it allows two or more people to give and receive information so that they can understand each other.
Some people use assistive or augmentative technology as their preferred communication method. They may use a technology tool such as a text to speech device which speaks words aloud that the user has entered into the device as text. This sort of device is often used by people who are unable to communicate verbally, or who find other people do not always understand what they say.

Strategies to enhance understanding and show respect

Strategies to enhance verbal communication include:

Non-Verbal Communication

Watch closely the next time you interact with someone. You will probably notice they are not completely still when they are communicating. It is likely that their body is moving, their hands are making gestures and their facial expression and body position is changing while they speak. This is because people use non-verbal communication as another important part of sharing a message with another person.

Non-verbal communication helps the other person to gain more meaning about the message and to find out about what the person is thinking and feeling as they speak.

Types of non-verbal communication:

• Posture
• Body language
• Eye contact
• Blinking
• Tone of voice
• Facial expressions
• Smell
• Time
• Personal presentation
• Gestures
• Pitch of voice

All of these elements can be used on their own or together to create a package of communication that helps the other person to truly understand the message.

People use non-verbal communication in different ways. Sometimes this can be confusing and may lead to the message becoming confused or mixed. Sometimes the gestures, expressions and movements that one person makes are interpreted differently by the person they are communicating with.

Non-verbal communication is only useful when there is a shared understanding of what a gesture or movement means. Sometimes people from different cultural backgrounds have differing expectations of non-verbal communication. They might use gestures more often when they speak, avoid eye contact with groups of people or use facial expressions in particular ways to emphasise a point or express an emotion.

Watch this video of the power on non-verbal communication.

Strategies to enhance understanding and show respect

Strategies to enhance non-verbal communication include:

• Learning about the different ways that people from cultures other than your own might use gestures, facial expressions and movement as part of their communication
• Thinking about how body language can relate to the emotions and thoughts of the person who is communicating
• Focusing on your own non-verbal communication and making sure it matches closely with what you are saying.

When and how to use Non-Verbal Communication

You should use non-verbal communication in ways that enhance and support the communication you are having with another person. Use gestures, facial expressions and body position to support the message you are trying to convey.

For example, if you are trying to appear confident and assertive, you could stand tall, put your hands on your hips and look directly at the person. If you are trying to show you are listening attentively, you could face the person, orient your body towards them and nod and smile as they speak.

Collaboration vs Confrontation

Collaboration means working together for a common purpose as opposed to confrontation where there may be hostility between individuals. Collaborative communication means exchanging information and discussion with others to achieve a common goal.  Confrontational communication on the other hand is when there are differing opinions that may create a conflict in the way we interact with each other. 

In a health or community services workplace, you may need to provide information to people in many different situations. This could include:

• Explaining how a service is provided
• Giving details about how you can provide assistance
• Engaging with someone to build rapport and understanding
• Providing details of services, programs and options
• Providing information about eligibility for service provision

Sometimes the information you provide can be time critical, meaning it is needed in a specific timeframe or with some urgency. Sometimes the information you provide can be complex, requiring detailed or challenging information to be shared with another person.

To communicate health and community services information effectively, you need to think carefully about strategies that will ensure the details are understood by the person. People have many different needs for information based on their individual circumstances and characteristics.

Strategies that can help communicate service information to people in different cohorts across the community are shown in the table below:

Many of the strategies in the table will be effective for more than one group of people.

For example, you are likely to find that providing a blend of online and print resources is helpful for people who are elderly, those who have a reading need and those for whom English is not their first language.

When you are providing information to other people, it can be tempting to assume they understand exactly what you mean. Sometimes we have read or listened to a piece of information so many times, we feel like we know it off by heart.

It is important to remember that for clients, this may be the very first time they have read or heard the information you are providing, so they are less able to remember it all.

We know that people take in information in chunks and that their capacity to retain details is limited. Most people can only remember a small number of new pieces of information in their memory without a prompt or reminder.

We can communicate information in a way that builds on this capacity, simply by enhancing the information and adding built in reminders.

These can include:

• Examples of the information in action—case studies or short stories where information is applied to a situation can give new information a practical relevance.
• Pictures—the old adage of a picture telling a thousand words is very true and is a great way of helping prompt recall of details or key points.
• Don’t overdo the detail—sometimes less is more, and people can retain more information if you don’t overwhelm them with details which are not critical.
• Captions—we know that people almost always read the captions underneath an image, so use captions as a tool to encourage people to read key points that relate to a picture you have included in some information.
• Remind often—pause and build in reminders about what has been said or written so far, as a way of helping people retain one part of the information before you move on.

Deciding on the features you will use to enhance understanding of spoken or written information will depend on the individuals and groups with whom you work.

Thinking about individual needs will help you decide on the best way to enhance the information you provide.

Once you have provided information to a person, it is important to check they have understood what you meant. This is not as simple as asking ‘Did you understand?’ because most people will generally respond ‘Yes’, and you will never be sure if they have understood what you intended from your communication.

People may not completely understand the information you have provided for reasons related to their own needs and characteristics, as well as to the situation and your own communication approach.

There are many reasons people may be reluctant to tell you they have not understood information you have provided to them. This could include:

• Being embarrassed
• Not wanting to waste your time
• Feeling like you are in a rush
• Having other important commitments of their own
• Thinking they have understood the information
• Not wanting to ask silly questions
• Feeling there is a power imbalance between the parties who are communicating.

Each of these can act as a constraint on the flow of information between yourself and the person with whom you are communicating.

Example

Mike is listening to Annalise explain information to him however he knows he only paid for 45 minutes in the parking meter and he’s already been gone for 39 minutes. Annalise doesn’t appear to be approaching the end of the information. Mike keeps thinking about all the bills he currently has and his recent late rent and how we wouldn’t be able to afford a fine if he got one. Finally Annalise asks Mike if he has any questions. Mike hasn’t been listening or absorbing the information from the last ten minutes because he’s been too busy thinking about the parking meter. He tells Annalise that everything’s fine and ‘all clear’ and thanks her and rushes back to his car. He hopes he wont need the important information that Annalise gave him towards the end of their conversation.

People speak in many ways. If you listen to a group of people closely, you will probably find that there are different rates of speech, as well as different ways of constructing sentences, using expressions and punctuation.

These mechanisms of speech are part of how we add meaning to what we say. They help bring spoken language to life, so that it is more interesting and engaging, and reflects our thoughts, feelings and emotions.

Some mechanisms of speech include:

Punctuation

Punctuation occurs in verbal speech, just as it does in written language. In written language, punctuation is the marks used to define or break up a sentence or phrase, such as a full stop, comma or question mark.

Punctuation also occurs in spoken language, so that people understand where one idea ends and another begins, and so they can attach greater meaning to what is being said. Punctuation occurs when we use a pause, a break or silence, or increase the pitch of our voice to emphasise a point or ask a question.

Grammar

Grammar is the system of putting words together to create sentences and phrases. People use grammar in spoken language in many ways, often depending upon their cultural, linguistic and familial background.

You may hear people construct spoken sentences in different formats and use different linkages between words. Sometimes this can be because they are speaking a language they learnt as an additional language to their first, and so they may take longer to master the grammar conventions of their additional language.

There are many factors which can influence the way an individual responds to and participates in a communication exchange.

These include:

• Language—speaking a different language to the person with whom you are communicating can make understanding and clear sharing of information difficult.
• Culture—sometimes people have different cultural expectations about who and how communication should occur, such as between people of different age groups or genders.
• Religion—this can affect the views, values and ideas that a person brings to a communication exchange, which can affect the understanding and sharing of information.
• Emotional State—some emotional states make clear communication and retention of information problematic, such as when a person is stressed, anxious or distressed.
• Disability—having a cognitive or sensory disability or a condition such as an Autism Spectrum Disorder can affect communication and mean that adaptations or alternative communication methods are needed.
• Health—health can affect the ability of a person to listen to, understand and respond to written and spoken information. This can happen if the person is affected by changed judgement, fatigue, altered mental state or changed levels of consciousness or alertness.
• Age—people who are older, as well as those who are very young, may communicate in different ways based on their level of understanding and their ability to retain information.

Language Features—grammar, speed of speech and punctuation can all make a significant difference to the level of understanding another person has of a communication exchange or a written document.

Example

Patricia speaks very rapidly and has a natural speaking voice which is quite high in pitch. When she works with older clients or those who have a communication difficulty such as dysfluency, she makes sure she consciously slows her speech rate down and lowers the pitch of her voice.

She finds this is a useful way of ensuring her clients are better able to understand what she says.

It is important to carefully check that someone has understood what you meant during a conversation or when you have provided written information.

Reasons for Checking for Understanding

There are many reasons for checking that someone has understood the information you have provided. Sometimes it is simply a matter of doing your job well and making sure you are being effective. Other times, it is vital for the health and wellbeing of the person that you check they are completely aware of important details.

There are many ways you can check someone has understood the information you have given them. Here are some approaches that are particularly useful in a community services or health care setting:

Asking Questions

Asking questions is a great way of finding out how much of the information you have just provided to someone has been understood.

You can use this approach for finding out how someone has interpreted what you have said or written, and for checking how they will apply the information to their own situation.

Retelling

This approach is where you ask a person to repeat key information back to you, so you can see what they have understood and what they have not.

You can use this approach well when you have given complex or detailed information, where it is likely the person may have missed some important parts.

Repeating Key Points

Sometimes it can be helpful to provide information more than once, so that you can remind a person about what is important to retain. Think back over the information you have provided and consider which are the most important points. Summarise these at the end of a document or conversation, so that they are the last thing the person hears or reads.

A summary is a very effective communication tool which works for both verbal and written information and helps reinforce the points, so they are retained.

Writing Important Information Down

People don’t always remember what they hear, but a paper or digital copy of the information can help prompt their memory later. After you have met with a client, you could make notes about your meeting or send them a copy via email or SMS.

Communication is a two-way process, based on the giving and receiving of information. It is a transmission of information back and forth between each party that is involved in the communication.

As part of the communication process, each party will need to:

• Listen
• Hear
• Decipher
• Respond.

Each of these are important aspects of being able to effectively communicate with clients.

Listening Skills

Listening skills take time and skill to refine. Listening skills involve consciously taking in information from a client and thinking about how you can apply your knowledge of their individual needs to provide appropriate support.

If you are listening to a client, you should ensure you are meeting in a location where they feel comfortable, so they are able to communicate freely and openly, and you are able to listen effectively. Check for distractions such as outside noise, movement and other people as these can hinder the listening process.

Make sure you are not interrupted by others, so that you can give the person your complete attention.

Clarifying Information Through Feedback

You may not always be sure you have understood the person with whom you are communicating. In this case, you might need to clarify the information using a technique such as feedback.

People often give each other feedback about their understanding of the communication exchange. This feedback is helpful in working out what has been understood by the other person and what has not.

Feedback also tells you whether you have the attention of the other person and that they are actively participating in a verbal interaction.

Here are some ways you can provide feedback to and clarify information with the other person:

• Looking at them as they speak and making eye contact.
• Smiling and nodding.
• Orienting your body towards them, keeping arms uncrossed.
• Avoiding doing other tasks while they are speaking.
• Asking questions and making affirmative statements.
• Using your facial expression to show interest and engagement.

Each of these communication techniques can help provide positive feedback to the other person which can encourage them to start or continue interacting with you.

Negative Feedback

You can also provide unintentional negative feedback which can stop or hinder a conversation too. This type of feedback gives the other person the message that you do not agree with their ideas, that you are concerned about what they are saying or that you are not interested.

Some examples of negative feedback include:

• Frowning and turning your face away from the individual
• Appearing distracted or lacking interest
• Orienting your body in a different direction
• Completing other tasks at the same time
• Asking a question which is unrelated to the topic.

Feedback can support or hinder clear and effective communication and can give the other person a guide about how their message is being received.

Example

Meg is conducting a home visit with Martha. Martha has told her about how she would like assistance to do her laundry each week because she finds this task too difficult and tiring to do herself. Meg wants to find out if there are specific parts of the laundry process that Martha finds challenging, so she smiles and nods at Martha to encourage her to keep talking. She uses a statement and asks some questions to seek more information:

‘I understand that doing the laundry is difficult for you on your own. Is it the heavy items like sheets and towels that are most difficult for you? Are you able to operate the machine yourself, or do you need assistance to use the machine?’

She then listens closely as Martha tells her how she can no longer turn the dial on the machine because she has arthritis in her fingers, and she finds this frustrating because she used to enjoy doing the laundry and making sure all the clothes, sheets and towels were clean, fresh and hung outdoors in the sunlight.

Meg now knows more about how to offer appropriate support to Martha and suggests that she might enjoy walking out to the line to help a worker hanging out the washing each week.

Once you have clarified the message, it is important to confirm you have understood. This could be by using verbal or non-verbal communication.

Confirming lets the other person know that their communication with you has been understood, so the conversation or discussion can continue.

Here are some ways you can confirm you have understood the message:

• Using a statement such as ‘I understand’ or ‘I get what you are saying’
• Nodding and smiling
• Writing down the information, showing the person what you have written and asking them to check it is correct.

Confirming information is vital, particularly when it is related to specific requirements, individualised needs, health care needs or information which affects care and support of people who are vulnerable or at risk.

The exchange of information occurs in many ways in health and community services settings. Information can be in formats such as:

• In handwriting
• In printed text
• In digital formats
• Through verbal communication.

The format used to exchange information will vary depending on the setting and the task and information requirements. Your supervisor will explain the requirements for information exchange in your workplace.

Types of Information

This table shows some of the types of information that you might exchange in a health or community services workplace:

You can use your written and spoken communication skills to make sure you exchange information effectively.

You should always pay close attention to detail when you exchange information, because incorrect or poorly shared information can have negative outcomes for clients and for the workplace. Make sure you check written work carefully so that you can find any errors which have occurred and correct them.

Think about what you have heard and shared in a spoken conversation so you can record the details accurately.

In many situations, information you exchange with others will be subject to confidentiality requirements. This means you need to know exactly what you can do with information you collect and share.

The rules about confidentiality are designed to protect the rights of the people with whom you work and make sure that information is not shared with people who do not have a right to it.

Your supervisor will explain the ways your workplace protects the rights of clients and others in the workplace in relation to information privacy and confidentiality. They will tell you about:

Legislation

These are the laws which relate to information that you might collect or use in your daily work tasks. One of the most important laws is The Australian Privacy Act (1988) and the associated Australian Privacy Principles.

These principles set out how you should manage information that you collect, and who can access the information.

Policies

These are written documents which explain how information should be managed at work and tell you about how your workplace acts to ensure it complies with legal requirements such as the Australian Privacy Act.

Procedures

These are the step by step guides to help you implement a policy. Procedures give you more detail than policies and you can think of them as the ‘how to’ guide to your daily activities at work.

It is likely that your workplace will have step by step procedures that will help you when completing tasks such as interviewing a client, referring a client for services, completing an individualised support document or requesting additional support needs.

Checking the Requirements

It is important to check the requirements of your workplace to make sure you are communicating correctly and appropriately. Always think about how information should be shared with others and what rules might apply.

Your supervisor can assist you in making sure you understand the requirements.

Example

Sephira is excited about the success of a recent visit she has organised with a group of young people who attend a residential support program. She has taken the group into the city and spent the day visiting the sites and learning to read maps and understand directions.

She writes a short article about the activities and posts it on her workplace social media page, along with lots of photos. She thinks the post looks terrific, but she is dismayed when she gets to work the next day to find her supervisor is less than impressed.

Sephira has not checked whether she can display photos of clients and unfortunately some of the clients in her group had not given permission for their image to be shared online. Her supervisor explains that for one client, there are safety issues because there is a court order that protects the client from a family member who is known to be violent towards the client.

Without realising, Sephira’s actions have put the client at risk of harm by displaying her image in a public social media post. Sephira has learnt an important lesson about checking the policies and procedures that apply to information exchange in her workplace.

Sometimes information needs to be communicated to others in a specific timeframe. It is important that you check if there is a timeframe which applies so you can make sure you follow it. Information can be time critical if:

• It relates to a specific work task or activity, such as a meeting or event
• It is health related, such as a change to health status or a referral to another provider
• It is related to an escalating or changing situation, such as when a client’s needs increase significantly, and intervention is required by more experienced workers
• It is date or time specific, such as an inter-departmental briefing which is happening on a set date and time
• It relates to a milestone or check point for a client or program, such as an individual plan which must be updated every 12 months.

Strategies for communicating in a timely manner

There are many strategies which can help you organise your work and tasks so that information you need to share with others is completed in a timely manner.

Some workplaces provide access to tools and software which can help you organise your work and communication tasks.

Other workplaces encourage you to develop your own systems of work, based on what you find most effective.

Here are some strategies you could try to help you communicate in a timely manner in your workplace:

• Allow enough time in each day for information sharing and communication tasks
• Use technology tools to help you reduce the time it takes you to process information and share it with others
• Use a calendar on your phone, tablet or desk to record important dates and times
• Use a reminder to prompt you about upcoming tasks
• Check you have completed all the information-based tasks that are needed at the end of each week and month.

Example

Janti receives an email from his supervisor to ask for a quarterly report about the program he manages. The email informs Janti that the report will need to be ready by 28 March, so it can be included in the department’s briefing report to the Head of Department. Janti records the date in his calendar and makes a reminder to himself for 20 March.He knows the reminder will help him complete the task well before the deadline, so he can have it ready for his supervisor in time.

1. What are four ways you can show someone you are actively listening to them?
2. What is meant by a rights-based approach?
3. Practice your attention to detail skills. You meet with a client named James Katakis on the 3rd of September this year. You normally meet at 3:30 each week however you have made arrangements to meet him next week but you will be meeting 45 minutes later than normal. You need to let Paula and Jane at work know of the changes at well. Write the details into the following notepad.
4. Why is it important that you provide information as it arises and don't delay passing information on?