Recently, I was driving my children’s babysitter home to a gated community and needed to enter the code into the entrance keypad. I asked the 15-year-old babysitter: “Do I put the pound sign in before I enter the numbers?” She looked at me quizzically, “What?” “The pound- sign, it’s on the paper with the code your mom gave me, do I actually enter it?” She continued to look confused. I tried again, “You know the number sign?” She slowly answered, “You can just push the numbers, you don’t have to POUND them.” Clearly we’re not communicating, so I showed her the paper with “#3425” scribbled on it, and asked “That pound sign before the three, do I enter it?” Her eyes lit up, “Oh, yeah, yes, the hashtag sign? Yeah, you enter that.” Hashtag sign? I laughed and shook my head, “Yes, the ‘hashtag sign’”.

I thought about how often something that seems so simple can so easily become lost in translation or misunderstood. Pausing the conversation for clarification can feel embarrassing, or like the momentum of the conversation has slowed, but without this simple pause to clarify, you may never move forward, stuck behind a gate wondering what a pound sign is.

I am seeing the importance of pausing to clarify as I have been working with new groups and in new projects. Recently, I was actively engaged in a meeting, when suddenly the topic changed to something unfamiliar. I tried to follow, but the words being used didn’t seem to have the same meaning to me as they did to everyone else. The meeting and conversation continued with vitality; I sat dumbly on the sidelines. In addition to this language barrier, there was a location barrier. Since working remotely, none of us were in the same room; no one could see the look of confusion come over my face. By the time I realized I was lost, it felt too awkward to pause the conversation and ask for definitions. Next thing I knew the meeting was over. It didn’t seem like my lack of understanding of the last part of the meeting mattered that much, so I moved along with my day, until I got an email follow-up about the call and realized, I needed clarification. I swallowed my pride and reached out to a co-worker who had also been in the meeting and confessed I was confused. Within 5 minutes I was on a call and caught up. It wasn’t a difficult concept. The fact that I didn’t have an understanding of the concepts and terms in the context others did is what made it difficult.

I also expect that at some point I will be on the other side of the equation, where I am the one using words and concepts that others may not have the same understanding. I taught high school for 7 years and remember that my best lessons always started with a hook that was on every student’s level. I would assume the class knew nothing, and then build my lesson up, adding more information as I went, bringing everyone along with me. While this method works better for presentations, simply pausing for questions to ensure understanding can be easily accomplished in a less structured meeting.

The culture or norms established in the group or company have an impact on effective communication. I worked in bedside nursing for years and a common saying among nurses was that “a nurse that doesn’t ask questions is the nurse you need to be afraid of.” Someone who thinks they know everything is bound to end up making a mistake, and in health care, mistakes can have deadly consequences. Having a culture in place that allows for a free flow of questions, conversation, and mutual respect decreases the risk of mistakes because people have confidence to ask questions, double check understanding and move forward with all the knowledge needed to make a positive impact.

For the next few months, we will be exploring several aspects of communication, viewed from different specialties and experiences throughout our team. Stay tuned for more insights on communication in health information systems including clinical documentation improvement, artificial intelligence, evaluation and management documentation, laboratory terminology implementation, software development requirements gathering and more.