Communication: How does the neighbor actually do it?

Interview with Dr. Lisa Terfrüchte, Center for Netherland Studies, University of Münster, and Prof. Achim Baum, Institute for Communication Management, University of Applied Sciences Osnabrück


In Europe, or rather: at least between Germany and the Netherlands, the answer to this question often is not more than a subject for jokes. A current research project about strategic communication in hospitals now wants to show that and how neighbors actually are able to learn from each other when they look to the other side of the fence.
Photo: Dr. Lisa Terfrüchte

Dr. Lisa Terfrüchte; ©private

In the Interview with, Dr. Lisa Terfrüchte and Prof. Achim Baum talk about the comparison of the online communication of German and Dutch hospitals, what their organizational communication looks like and what effect this has on their crisis communication: transparency and participation create confidence.

What is the objective of the "Organizational Communication in Hospitals" project?

Prof. Achim Baum:
Like everywhere in Europe, the health care systems in the Netherlands and Germany are undergoing a highly dynamic development and are subject to strong streamlining efforts. This begged the question: if Europe continues to grow together, will the health care systems and their communication also become more alike? We are researching this question from our perspective as communication experts.

There is an increasing professionalization especially in the area of health communication. Unlike in the past, hospitals now need to present themselves very differently as organizations internally and externally.

Dr. Lisa Terfrüchte:
Patients increasingly get their information online about health subjects and hospitals as service providers. Our primary focus therefore is on online communication via home pages and social media and in an international comparison: what does the respective visual language look like? What topics are being communicated? What do website structures look like?
Photo: Prof. Achim Baum

Prof. Achim Baum; ©private

What exactly is "organizational communication"?

Terfrüchte: This refers to an organization’s internal and external strategic communication. This includes -among others- employee loyalty, target group orientation or brand building for instance. This is important for hospitals, because they are companies that compete with each other and are subjected to constant scrutiny in a mass media environment. You need strategic communication to deal with this.

In your eyes, what are characteristics of transparent and effective hospital communication?

Baum: You just mentioned the two basic adjectives. Hospitals that compete need to be effective. And you want to be transparent. Patients are responsible or at least should become that way, for instance with the help of the internet and they no longer blindly trust physicians. Especially when a crisis occurs in a hospital, people rightfully demand transparency that can rebuild trust. On the one hand, this is possible via social networks. On the other hand, there is always a risk here that the discussion moves away from rational arguments and consideration towards a strongly emotional view, since everybody can easily state their own opinions here.
Photo: The folded arms of a woman

Cooperation is advised: Silence and resistance cause public distrust when it comes to throw light on mistakes; ©

So does transparency mean to clearly admit mistakes?

Baum: If mistakes have been made, you should contribute to their resolution of course. However, the way hospitals need to communicate in a crisis very strongly depends on the individual case. In general, you should explain as rationally and clearly as possible what is happening at the hospital to maintain trust. Silence typically triggers the public to mistrust instead.

Terfrüchte: Crisis communication is a part of organizational communication. Another part is what I call "preventative communication", which is ultimately geared towards preventing a crisis. This addresses organizational aspects where mistakes might happen, for instance important processes and procedures or employee coordination. Actually, internal organizational communication plays a key role in this.

Baum: In these situations, it makes the old adage that employees are your company’s best ambassadors palpable. Sometimes they actually escalate a crisis, if they are upset with their employer and want to use the crisis to express their anger.

What opportunities and risks does online and social media communication yield for hospitals compared to the traditional media?

Terfrüchte: Social media in particular makes public relations significantly more complex for hospitals. Of course, opportunities lie in communication becoming more active and direct; your own topics can be addressed and there is an increased chance to position yourself. Hospitals circumvent journalism as a channel and gatekeeper and are able to achieve a larger target group orientation.

I see a risk in communication becoming faster and therefore more complex as I have mentioned. We notice that even though many medical facilities want to use social media, they do not have a real strategy or the staff for it. Here they have no control over shitstorms and negative opinions and there is an increased risk of no longer being able to manage the situation without a strategy. In some cases, a hospital may actually not even notice when, how and where it has become a target of social media, because communication controlling, an important part of organizational communication, is missing or does not work properly. This means that the channel itself is not the solution for great public relations, but rather its strategic use.

What similarities and differences are there in the communication of German and Dutch hospitals?

Terfrüchte: We notice significant differences in the online communication study. German hospitals are nowhere near as represented in social media as Dutch hospitals are. There, hospitals are also more target group oriented in their communication. More than half of the Dutch hospitals also have web pages suitable for children, which are aimed at making the hospital more understandable for kids.

Baum: Cultural differences also play a role in terms of crisis communication. Business communication is determined by the overleg principle in the Netherlands. Simply put, the Dutch would like an explanation as to why something is necessary or why it happened before they are ready to act accordingly, because they are used to being included. Germans are more likely to listen to expert advice or expect boss positioning without questioning things in particular.

Overleg means the Dutch are willing to compromise and consensus-oriented in all areas. Flat hierarchy structures are meant to ensure everybody understands what things are about and then behave accordingly in a rational manner. I believe that this also accounts for the high importance of the social media. People discuss more and are more often included in decision-making. Ultimately, this also becomes noticeable in crisis communication.
Grafic: Silhouettes of people with speech bubbles

Everyone has a say: The overleg principle governs commercial communication in the Netherlands, since everyone contributes in deliberation to find a compromise; © rawpixel

Terfrüchte: Overleg is a principle that makes internal communication easier, which ultimately influences crisis communication. Of course, there are also hierarchies in the Netherlands, but the point is to have everyone join in the conversation when it comes to deliberating and finding a compromise. Here we often find participative leadership. This is also evident for instance in the patients rights councils, which are statutory in the health care system in the Netherlands. In every hospital and every medical facility, patients are able to join in the conversation and communicate in these panels, which can lead to a different kind of decision-making. This is also crisis prevention and contributes to transparency.

To sum things up, what can both German and Dutch hospitals learn from their neighbors?

Baum: The principles we explained are especially effective in the hospital environment and the patient-physician relationship: communication and exchange create confidence. Yet you should not get the impression that everything works better in the Netherlands. The health care system was drastically reformed there in 2006, which was also being criticized. Free choice of medical practitioner and hospital like we have in Germany is not available as such in the Netherlands.

Terfrüchte: Though we avoid stereotyping, it still is noticeable that in the Netherlands there is a fundamentally different understanding of codetermination and perhaps an interaction that appears more open to communication, free of barriers and thus more transparent from a German point of view. This is also evident when you compare online communication in Dutch and German hospitals. The internal communication in turn that’s implemented in overleg makes stronger inclusion of employees and patients possible, which allows for different types of feedback in the organization.
Photo: Timo Roth; Copyright: B. Frommann

©B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.