Communication is a two-way process, and good communication requires many skills. The two-way process consists of a person that will provide information to another person in the form of verbal, written, feelings, or expressions. The person sending the information is considered the sender, and the person receiving the information is the receiver. It is imperative that the receiver gives feedback to the sender to inform the sender that they received the information the sender was trying to relay. This type of communication does not come naturally and needs to be practiced and perfected to create the professional teamwork and great patient relationships required for positive outcomes. Good communication will allow teams to effectively solve problems and decrease patient safety errors. In the healthcare arena, many workers are surprised by the difficulty of this task, which adds stress to the work environment. In the operating room, for example, everyone is very busy and task oriented towards a good patient outcome, this focus allows teammates to answer questions with a very short answer so that they can continue with the task they were performing. Short answers can be interpreted or misconstrued which causes more stress within the team. 
The sender relays the information, feeling, or ideas that they want to communicate to the receiver; the receiver cannot just acknowledge that they heard or saw the information, the information may be perceived as positive or negative and can change the outcome the sender wants to get. To be effective, the receiver must provide feedback to the sender. Feedback is a response from the receiver that includes an acknowledgment but also a recap of what they thought they understood from the sender. By recapping the thought, the sender has an opportunity to agree that the message was received correctly or be able to restate their original intentions for clarification. This process allows the receiver a chance to also ask questions for their understanding of the message. This type of communication and clarification process does not take any additional time or time away from the tasks we are performing but does allow for much better patient care.
There are many additional factors that can get in the way of effective communication with a two-way communication process and it can inhibit “active listening.” The delivery of a sender’s message is as important as the content of the message. The tone of a message can be misinterpreted very easily, which is why a feedback mechanism is necessary. Verbal communication is written or verbal and contains an underlying tone and can have a dramatic outcome on the receiver’s interpretation. This can cause many conflicts not only in the workplace but also with the patients being served. In the operating room our answers are usually required to be very brief and contain the most accurate information, but we still need to be very aware of the tone with which that information is delivered. The tone of the information or feelings behind the words of the sender can cause misunderstandings and miscommunications. The written form of verbal communication seems to create more negative feelings because of implied tone than communication that takes place face-to-face. It is easy to interpret a wrong tone simply by the words written; this happens many times in the surgical environment because teams are detailed, task oriented, and state their messages to only reflect the information wanting to be delivered, pleasantries are usually forgotten.
Another factor is nonverbal communication, which includes body language, touch, and silence. The body language applies to both the sender and the receiver; either party can exhibit good/poor body language. A person’s body language can show their true emotions on the subject matter even when their words are saying something different. Some body language examples include walking abruptly away after receiving/giving information, rolling eyes, sighing, shaking their head, lack of eye contact, hands on hips, rigid posture. Touch can be used to express empathy or control. In most instances, the action seems innocent, but another may find it unacceptable. Personal boundaries must be adhered to for team members and patients. Finally, silence sends a very strong message that may indicate the person is contemplating the message; the message may have left them speechless, or in total shock which has rendered them speechless. During this time it is important to allow the person to process the message and to give them time to contemplate a response. Dead space does not need to be filled with idle chatter.
Before a receiver can give good feedback, he or she must have positive listening skills and allow the sender to confirm message delivery. There are several tips to be a good listener:
Active Listening requires participation. Our teammates and patients will greatly appreciate this improved communication tool.
Cultural competence is important. Working and communicating with people from other cultures can alter the communication techniques outlined above. People from different cultures have their own set of "norms," and they do not necessarily conform to what people in the United States see as the "norm." Medical health professionals need to attend training programs or informational sessions to understand different cultures, especially in the demographic region they serve. People deserve to preserve their cultural values, and everyone needs to be respected for who they are. Training, knowledge and cultural awareness allow for better teamwork, communication, and better patient outcomes.