Gregory R. Zinser
Vice President, Anesthesia Business Consultants, Jackson, MI
As you were gathered around the table for Thanksgiving dinner with your family counting your blessings, I’m pretty sure that e-mail was not one of them. For most of us, e-mail is both a blessing and a curse. On the positive side, it is so incredibly convenient that I wonder how we survived on both a personal and professional level before the first one was sent in 1971. Imagine having to wait days or weeks for a message to reach its destination; or having to actually call someone on the phone to communicate with them immediately. By the way, isn’t it interesting that the first cell phone call was made just a few years after the first e-mail was sent? My theory is that the call was made to apologize for saying something in an e-mail that was taken the wrong way, or asking to be taken off of a group e-mail list. Cell phones and e-mails have transformed our communications, created instant availability and given more reasons for some of us to miss the simplicity of life in the 1960’s.
But I digress. Getting back to e-mail, the healthcare industry is a prime example of how it can be used to increase productivity. The sheer volume of meetings in our industry is legendary. The complexities of coordinating multiple departments and multiple facilities require constant communication that, before e-mail, relied on the quality of your phone system and diligence of your inter-office mail courier. There is no doubt that e-mail is quicker, more efficient and allows us to communicate instantly with large groups that would take weeks to assemble in a meeting.
However, these same characteristics also make it difficult to manage in that there has never been a communications method capable of offending or confusing so many people in such a short period of time.
In the very demanding work environment of healthcare, it is often impossible to resist the temptation to instantly remove an item or two from our long list of daily tasks with a quick message or reply, and a click. While the following reminders are primarily directed at business e-mails, I suspect you will find that some will also apply to personal communications with family and friends. In any case, I hope you will find them helpful as you attempt to avoid the pitfalls of e-mail communications.
Proper Use of E-mail as a Communications Tool
Don't use e-mail to avoid personal contact or uncomfortable situations. When possible, face-to-face and voice-to-voice communications are much more effective in many situations, especially when sending complex, confusing or emotional messages.
E-mail Courtesy and Greetings
A simple greeting at the beginning of every e-mail will help you to avoid a negative impression. Just add a Hello, (name) or Hi, (name), just as you would if it were a phone call, and your e-mail will be taken in a completely different light. When you start an e-mail with a question or demand because you’re feeling pressured or in a bad mood, your message may be perceived as bossy or demanding. By adding courtesy, you are perceived as someone the other side will want to assist, respond to and go the extra mile for. Courtesy, consideration and taking the time to communicate as a kind and courteous person will not only increase the likelihood of a positive response, but will also speak volumes as to what it will be like to work with you.
When sending to someone you’ve never met or a new contact, assume the highest level of courtesy. Hello, Dr. Smith, Mr. Anderson, Ms. Jones, etc. would be appropriate until your new contact lets you know it is OK to do otherwise ("call me Bob" or "you can call me Amy"). You may also be able to pick up clues on when you can use a more relaxed tone by how contacts approach you, as well as how they sign off. Most people don’t mind being called by their first name, however, that can be perceived by some as taking premature liberties in the relationship if used too soon.
Remember that your tone can’t be heard in e-mail. Be cognizant that the other side doesn’t have your voice (or eye contact or your body language) to determine your tone. That leaves you with the responsibility to ensure the proper and desired tone is conveyed in your e-mail communications by virtue of the words you choose and how you choose to use them. Especially in business communications, when you don’t have off-line indicators to determine tone and intent, it is critical you take the time to choose and use your words carefully. E-mail is now a significant relationship building tool and you may have only one chance to impress a business associate, smooth over a misunderstanding or reflect a level of professionalism and education that instills confidence in those who don’t know you. Take your time, read your e-mails out loud before clicking send and work on your vocabulary and communication skills constantly so you can take full advantage of opportunities to impress and build trust.
If your e-mail is emotionally charged, walk away from the computer and wait to reply. Review the sender’s e-mail again to be sure you are not reading anything into it that simply isn’t there. With e-mail, never assume what someone means. Take them at their word. Particularly with business e-mail, you should not risk reading more into what is there based on either your feelings or what you think the other person meant. On the other hand, if you type it, you had better mean it. When it comes to your e-mail communications, "I didn’t mean it that way!" simply does not apply. You have the ability to make sure you relay what you really mean by virtue of the words you choose and the tone you set.
Don’t rely on formatting or caps to make your points. The English language is filled with verbs and adjectives for every occasion. Improve your vocabulary and hone your written communication skills so you can relay your intent and tone by choosing the appropriate words to do so. Using abbreviations under the assumption that your reader knows what they mean should also be avoided, particularly in the acronym-filled healthcare industry. By making this extra effort, you can communicate with clarity and professionalism while not leaving any guess-work to formatting.
Use of E-mail Distribution Tools
- Copy and Blind Copy: Use the blind copy and courtesy copy appropriately. Don't use BCC to keep others from seeing who you copied; it shows confidence when you directly CC anyone receiving a copy. Do use BCC, however, when sending to a large distribution list to avoid e-mail clutter when people "reply to all" or when privacy is an issue. Be cautious with your use of CC; overuse simply clutters inboxes. Copy only people who are directly involved.
- Reply to All: Always refrain from using "reply to all" when reprimanding or criticizing anyone via e-mail. These matters should be handled in person or on the telephone with only those directly involved. Use the “reply to all” button only in situations requiring collective input and only if you have something to add.
- Return Receipt Requests: Use this button with discretion! You need to think about whether or not you really need proof that your e-mail was opened and read.
Do your best to respond to your business communications as quickly as possible. Responding promptly, even to just send a "thank you," helps build relationships and avoid misunderstandings. This is a professional courtesy issue that should not be underestimated. By not responding promptly, you risk appearing unorganized, uncaring or, worse yet, being outperformed by your associates who understand the importance of appearing efficient and on the ball. When someone takes the time to e-mail another, common courtesy dictates that you respond on a timely basis. Try to adopt the rule that all questions deserve a response. Also, if you are unable to respond within 24 hours because you are out of the office without access to e-mail, set your out-of-office assistant and, if applicable, designate a person to contact in your absence.
Remember that e-mail isn’t private. E-mail written on a company computer is considered company property and can be retrieved, examined and used in a court of law. Never put in an e-mail message anything that you wouldn't put on a postcard. Remember that e-mail can be forwarded, so unintended audiences may see what you've written. You might also inadvertently send something to the wrong party, so always keep the content professional to avoid embarrassment.
HIPAA E-mail Compliance
While HIPAA (the Health Insurance Portability and Accountability Act of 1996) doesn’t prohibit using e-mail as a medium for sending electronic patient health information (PHI), it has ensured that the security of patient information via e-mail-based communication is not compromised through the HIPAA Security Rule, which specifies standards for making transmission of PHI via e-mails secured.
These standards underline the importance of implementing HIPAA policies and following recommended procedures, aimed at maintaining the integrity of PHI by restricting unwarranted access to e-PHI. The standard for Transmission Security is extensive and provides specifications regarding the encryption requirements and other integrity controls that should be maintained when sending PHI via e-mails.
A covered entity must ensure that e-mail messages containing PHI are secured when being sent through unencrypted links too. All covered entities should assess the nature of their open communication networks and adopt suitable means to ensure the safety of e-PHI sent by e-mail.
Whatever your position, one of the most critical elements of success that is probably not in your job description is Communications Manager. There are three primary methods of communication that all require a different set of skills. While the ability to communicate on the phone and in person will always be extremely important, the ability to write well and use email effectively as a time management and relationship building tool is now the most important of the three, due to its frequency of use, power to improve your efficiency and productivity and the many ways it can work against you if not managed effectively.