What are some barriers to communication in the hospital environment? How can they be overcome?

One barrier that is present in a hospital setting is the barrier of status.  There is a hierarchy in a hospital, with physicians at the top and all other staff below. A hospital is not a democracy.  Because of the differences in status, there can be many instances in which someone who is ranked below someone else will not communicate, even if there is good reason to do so.  A nurse who sees an physician's...

One barrier that is present in a hospital setting is the barrier of status.  There is a hierarchy in a hospital, with physicians at the top and all other staff below. A hospital is not a democracy.  Because of the differences in status, there can be many instances in which someone who is ranked below someone else will not communicate, even if there is good reason to do so.  A nurse who sees an physician's error, for example, is going to think twice about whether or not to communicate about this.  Anger might be the result, or even firing. This is dangerous and regrettable, but it is part of the dynamic of hospital communication and communication in many other work settings.  Atul Gawande, in his wonderful book, The Checklist Manifesto, makes this point.  He also points to the example of pilots, who are often not corrected by co-pilots who are less experienced, since they are intimidated by the difference in rank or status.  Gawande's argument is that checklists can help to remove this problem in communication, since a checklist is "neutral" and if everyone goes by the list, errors will be minimized, but even more important, anyone can refer to the list as needing completed without having to be worried about how a lower status affects the communication process where status is unequal.