Communication Under Pressure

Communication Under Pressure

Team communication during high stakes, high pressure situations is frequently identified as an issue which compromises performance. What are the pressures making communication difficult? How do our physiological and psychological responses to pressure compromise our ability to communicate with the rest of the team? What tools can our teams employ to improve how we share information in these situations?

 

What are the pressures?

Accurate and comprehensive exchange of information is vital for effective teamwork in the execution of complex, high stakes tasks.  Our ability to send and receive information in circumstances of high pressure is however compromised by a number of challenges.

  • The cognitive capacity we have to actively listen is reduced when we have a high cognitive load
  • Time pressure limits the duration of information exchanges
  • Time pressure reduces opportunities to question and clarify ambiguous information
  • Multi-agency and flash teams may misunderstand each other’s professional jargon and keywords
  • Visual and audible distractions reduce our ability to focus our attention on those communicating with us
  • Poorly managed body language can be perceived as negative and critical
  • States of stress and frazzle can result in defensive or even aggressive communication styles.
  • Fatigue compromises our ability to interpret non-verbal communication in others

 

When we are operating under pressure there is limited time for communication. People are prone to passing information to their colleagues more quickly than they would normally. They are also less likely to plan and prepare the structure and content of what they are going to say before they start speaking. This results in the passage of unstructured and incomplete information. In normal circumstances, with no time pressure, ambiguous information is questioned and clarified by the person receiving it. In high pressure situations there often isn’t the opportunity for this clarification phase to take place. These factors can lead to misunderstanding, confusion and ultimately, erroneous decisions and actions. 

Each of us has a limited cognitive capacity. Unfortunately, only a small percentage of us have the ability to truly multi-task. As a result, we can listen, watch, carry out a physical task or make a decision at any one time. We don’t have the cognitive ability to do all these things at once. In pressured situations we frequently develop “task fixation” with all of our attention focussed on a practical procedure or on processing information we have received. In these situations, we don’t have the ability to simultaneously listen to what others are saying to us. In complex situations involving multiple people, even when we are trying to actively focus on the person speaking to us, our attention can be distracted by the events happening around us. 

In particularly challenging situations we may move from a state of pressured flow to one of stress and overloaded frazzle. When this occurs our sympathetic nervous system is stimulated, causing a number of physiological and emotional changes as part of a “fight or flight” response. Often this is an almost instinctive, instantaneous reaction which has “bypassed” any rational, objective assessment of the situation. Once in this state we tend to perceive the circumstances surrounding us being potentially harmful and hostile. We focus all of our attention on the potential threat immediately in front of us. We lose our peripheral vision and our ability to hear what is happening around us is compromised. This was effective thousands of years ago when humans faced physical attacks on a regular basis. It is however not a helpful state to be in when making complex decisions and carrying out challenging tasks as part of a team. 

Fatigue also significantly compromises our ability to communicate with each other. How accurately we interpret body language in other people has been shown to deteriorate significantly when we are tired. Fatigue also makes us more lassez-faire. We’re less likely to make the effort to question or clarify information passed to us. 

Our teams need to be aware of the various ways pressure affects their ability to communicate accurately. They also need to learn and practice tools to address these challenges.

 

Tools for improving communication under pressure
 

Ready to receive?

Finding the right time to communicate is critical. As described above, it’s common for people to say something to another member of the team when that person isn’t actively listening or is distracted. This results in the person passing the information thinking that it has been received and acknowledged by their team mate when in fact it hasn’t been heard at all. 

Before we start speaking we need to ensure we have our team mate’s attention and that they are ready to receive the information. Our situational awareness will allow us to know when there is a lull in the tempo of activity or when the person we need to speak to has gone “heads in” on a complex task. Focussing the person’s attention by using their name, putting your hand on their shoulder and ensuring that they maintain eye contact with you are useful techniques. Clearly asking the person “I have something I need to tell you, are you ready to listen to me?” is necessary to ensure that are free from other tasks and distractions.

 

Structure and planning

Planning the structure and content of what you are going to say in advance is essential for minimising the time taken to pass the information. It also reduces the chance of ambiguous information being communicated and misinterpreted. 

The order in which we pass information is important. We are all prone to “order bias”. This means that we are most likely to receive and process information which comes at the beginning of what someone is saying to us. Information further down the list is less likely to be taken on board.

Using standardised communication structures can be helpful in ensuring that all of the required information is passed and in improving how well it is understood. A commonly used example of this is SBAR: situation, background, assessment and recommended actions. 

 

Read back and closed loop communication

If a particularly important piece of information has been passed to a colleague, then we should check that they have received it accurately and if they have any questions. A useful technique is having the receiving person read back the information to the sender. If it is read back accurately this should be confirmed by the sender. This is known as closed loop communication and is a technique commonly used in aviation when air traffic controllers are communicating with pilots. 

 

Repetition and clarity

Another technique used when passing critical information is repetition of important words and phrases. “I repeat…”. Numerical values can be repeated in two forms. When handing responsibility for patient care from the helicopter team to the hospital trauma team it is potentially harmful for the doses of drugs given to the patient in the pre-hospital phase to be misunderstood. In the handover statement, if we have given the patient 16mg of morphine, we say “sixteen, one six milligrams of morphine.” 

Controlling our speed when speaking is important to ensure clarity. Effective use of tone, with emphasis on key points of information is also vital. 

Using abbreviated terms such as “isn’t, didn’t or won’t” can easily be misinterpreted and should be avoided. It is more effective to state clearly “is” or “is not”. 

 

Keywords and jargon

All professions have profession specific terminology. This jargon is an effective method of communication in time limited situations. Acronyms and concise terms to describe problems, equipment and actions can be used to rapidly and accurately pass information. They are usually unambiguous and hence less likely to cause misunderstanding. 

Highly performing teams often have their own, in house, keywords to achieve brevity and accuracy in time critical situations. When working in multi-professional situations they can however, these terms can cause confusion if everyone present isn’t aware of their meaning and relevance.

 

Non-verbal communication

Implicit, non-verbal communication is just as important as how we communicate explicitly by speaking. Facial expressions and body language can convey a considerable amount of information to other members of the team. 

Managing non-verbal communication is especially important for the team leader. Implicit communication can be used to positive effect in stressful situations. Maintaining positive body language helps to communicate confidence, competence, progress and optimism. Conversely, in stressful situations which are not progressing well, negative body language demonstrating anxiety or frustration can have a detrimental effect on the confidence and coherence of the group. This is an even greater risk when working with people unfamiliar to you in ad-hoc, flash teams. 

If working with a close colleague as part of a wider team when things are not going to plan, facial expressions can be used to subtly communicate how you are feeling and your assessment of the situation, without the need to let the wider team know. 

Practicing and maintaining awareness of how we are portraying ourselves, through posture and facial expressions, is vital to maintain effective teamwork. 

Exchanging information among the team in challenging circumstances requires communication techniques which differ from those used in normal situations. Our teams benefit from being aware of the reasons why our ability to communicate when pressured or stressed is difficult. They need to be conscious of the effects of poor communication due to psychological and physiological responses to pressure or fatigue. 

We can provide our teams with the tools to reduce the risks of miscommunication. These techniques need to be learned, understood and practiced during pressured simulation scenarios. The effectiveness of communication should also form a routine part of post event debriefs. 

 

© Core Cognition