By Steve Adubato, PhD

Dr. Peter J. Pronovost is the Medical Director of the Center for Innovations in Quality Patient Care at Johns Hopkins University. Dr. Pronovost has spent a lot of time researching and teaching about the impact poor communication is having on medical care, particularly in America's hospitals. The facts are staggering. Over 44,000 patients die each year from human errors made during their hospital stay. It is estimated that these errors have cost hospitals between $17 billion and $29 billion each year. These errors include wrong site surgery, administering wrong medicines, restraint-related injuries or death and mistaken patient identities.

We're not talking high-tech medical equipment breaking down. Rather, it is about sloppy, lazy and down-right bad communication by healthcare professionals who should know better. But healthcare professionals are really no different than the rest of us when it comes to communication. The only difference is, unlike our communication mistakes, theirs are a matter of life or death.

Consider the following insights offered by Dr. Pronovost, who is one of the country's top experts on reducing medical errors through communication training:

• Nearly 90 percent of every error, not just in health care but in every industry, is about communication.

• Many of these problems stem from a "hierarchical culture" obsessed with who is doing the talking as well as the listening. For example, Dr. Pronovost found that sometimes doctors ignore information from nurses and pilots ignore direction from co-pilots solely because the information is coming from a "subordinate." (How many CEOs and other top executives ignore the advice of those who report to them?)

• Much of this hierarchical culture problem is subconscious, meaning those who ignore important information from those "beneath" them often don't even realize they are doing it. It's an attitude and philosophy that is engrained in people over many years and countless experiences in organizational bureaucracies.

• Because of this organizational phenomenon, those who are ignored often stop communicating or sharing valuable information because they feel their voice is irrelevant.

• To address these serious issues, Dr. Pronovost and his colleagues at Johns Hopkins have developed a three-step communication strategy that he calls an "assertiveness model."

• When you have a particular concern or want to express an opinion, get someone's attention by using his or her first name. (For example, a nurse might say to a doctor, "John, the patient's platelet count is low.") Pronovost argues that using a doctor's first name helps break down artificial barriers and the hierarchical culture that often impedes effective communication.

• State exactly what you believe should be done to remedy the situation and seek agreement. ("I would like to transfuse platelets. Can we agree on that?") The key here is not to assume you have been understood or that you are on the same page with someone else until you've heard a verbal response to that effect. If there is no response, repeat what you've said.

• Finally, if there is no agreement, bump it up the chain of command and make it clear that your objective is to make sure we communicate clearly and effectively.

While Dr. Pronovost coaches and trains in the field of medicine, this communication "assertiveness model" has value in any professional setting. The goal is to reduce the risk of miscommunication and hold ourselves to a higher standard in the way we engage others in the workplace. Anything less is unacceptable.

Write to me about miscommunication in your workplace and what specific actions you took to remedy the situation.