Transformative Communication

Editor's note: This text-based course is a transcript of the webinar, Transformative Communication, presented by Robin Arthur, PsyD.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

After the course, participants will be able to: 

• Explain the difference between transformative and transactional communication in healthcare and leadership contexts, and describe how communication skills foster trust, collaboration, and psychological safety with patients and colleagues.

• List 3 common barriers to productive dialogue and describe evidence-based strategies for controlling emotions, offering respect, and validating others in high‑stakes conversations in healthcare.

• Describe and outline a personal or team-based stress management plan that integrates evidence-based practices into daily clinical and leadership work.

Introduction

Welcome. I'm so glad you're here. Communication is something we do every day. And yet in healthcare, the stakes are even higher than almost anywhere else. Every word, every pause, every gesture can mean the difference between clarity and confusion, trust and mistrust, safety and error. Imagine this. Every patient, every colleague, and every family member leaves a conversation with you feeling heard, respected, and more hopeful. That's the promise of transformative communication. Nelson Mandela said, "If you talk to a man in a language he understands, that goes to his head. If you talk to him in his own language, that goes to his heart." In healthcare, we want to do both. And that's what we're going to be working towards today.

Why Communication Matters in Healthcare

Communication in healthcare has been researched for decades, and there is a large body of evidence to demonstrate that the need for excellence in communication in healthcare is critical, whether we are working with patients, participating on a team, or providing supervision to others. Recent qualitative and mixed-method studies from healthcare contexts underscore that communication is not a mere auxiliary skill but a central mechanism by which patient care, supervision, collaboration, and professional development are enacted. Trust, clarity, and responsiveness define supervision and patient care, and they also reduce burnout. Additionally, team communication is directly linked to patient outcomes and continuity of care. These studies make it clear that investing in robust communication skills is foundational. It is not optional for high-functioning healthcare environments, safe supervision, and optimal patient care, which is what we are all looking to achieve. I am going to browse through the most recent research studies I found and let you read them on your own as well. I found studies from 1920 to 2025 that all show that communication is essential. This one in particular showed that for telehealth training, which many of us are doing now, it is imperative that not only are we on the screen with the patient, we have to be even better at our communication. The authors of this study highlighted that empathy, listening, and validation in virtual sessions drive patient engagement and satisfaction. All telehealth training should explicitly incorporate interpersonal communication modules as well. They also conducted simulations and demonstrated that simulation-based communication training is necessary in continuing education for healthcare teams. This study showed that healthcare providers need a sophisticated communication model to enhance trust, respect, and dialogue. This other study showed that the results emphasize the importance of psychological safety and mutual respect for effective feedback in team development. We know in healthcare, we all work in teams, and communication is not always optimal. That communication framework encourages us and helps us not to burn out as well.

Communication Defined

When we talk about communication, we often think only of words. But communication is much broader. It is an entire process of exchanging information, ideas, and meaning. It can be one-way, where you are talking to someone, or transactional, involving you and several people, or perhaps you and one other person. It may focus on tasks or on data. Communication also varies in clarity, tone, and impact. Transformative communication, on the other hand, creates connection, trust, and meaning. It actively shapes perspectives and outcomes. It balances facts with empathy and respect while encouraging collaboration, resilience, and growth.

In healthcare, all of these modes are at play all of the time. Communication occurs in multiple forms. We know it can be verbal or nonverbal, involving tone, body language, and facial expression. In fact, we know that only 7% of what we actually convey to others is through our words. All the rest is our body language, our facial expression, and the tone of our voice.

Communication can be written, such as email, notes, and documentation. It can be very formal or very informal, like in your break room. Lastly, you can have interpersonal communication or mass communication. You could be talking to just a couple of people, or to the entire hospital if you are in a hospital setting. When we think about communication, one way I look at it is that, in any communication, three things are happening at all times. This is a bit adapted from Marsha Linehan’s model of dialectical behavior therapy. She talks about how many things are going on in communications at once. When I first learned that, I thought about how I had never even considered all the things happening in communication because I was just busy communicating. Let me show you these, and hopefully, that is going to help you in the future.

Foundational Aims of Communication

One of the first things we look to do in communication is gain something we want, which refers to our task or outcome goals. There is a lot of evidence suggesting we really need to work on those. When we aim to achieve an outcome in our communication, we must ensure our language is clear. We stick to the matter at hand, and even if someone tries to deter or dismiss us, we stay focused on that goal. For example, if a nurse uses an SBAR, which stands for Situation, Background, Assessment, and Recommendation, to request a medication change, that clear structure leads to safe and immediate adjustments.

Think of a time when you asked for something at work. Did you state it clearly and directly, or did the request get lost? The second thing that happens when you communicate is the effort to strengthen the connection. Communication builds trust and cohesion, and positive team relationships reduce conflict and increase job satisfaction. When we have good relationships at work, we are happier as well. If a therapist disagrees with a parent about the frequency of therapy, instead of arguing, the therapist validates the parent's concerns and co-creates a plan to preserve trust. We know that when treating a patient with involved parents, the relationship is vital for continuity of care. Consider the last difficult conversation you had with a patient or colleague. What did you do to keep the relationship intact, even if you disagreed? We want to be collaborative and friendly rather than aggressive, ensuring the other person thinks positively about the interaction when it is finished.

The third aim of our conversations is to preserve integrity, particularly your professional integrity. Think about a school IEP meeting where a therapist calmly advocates for therapy hours despite administrative pushback. She preserves her professional integrity even if compromises are made. Similarly, imagine a physical therapist in a discharge planning meeting where a physician recommends sending a patient home the next day. If the physical therapist is concerned that the patient is not yet safe to walk or transfer, they might say that, based on the assessment, the patient still requires assistance and recommend continuing inpatient therapy for 2 more days to reduce fall risk. They might add that while they respect the focus on medical stability, their concern is mobility safety, noting that everyone shares the goal of preventing readmissions. If pressured, the therapist remains firm, stating that as the professional responsible for functional safety, they must advocate for a safer discharge date.

In that conversation, there was a goal, a relationship to maintain, and the therapist's integrity. When clinical opinions are respected, the team recognizes that expertise, the plan is adjusted, and trust across disciplines is ensured. It is essential to realize that in different moments, one of these three things—the goal, the relationship, or the integrity—may be the most important. In an emergency room, a physician issuing a necessary order focuses on the goal above all else. When you are in conversation with others, keep in mind whether your goal, the relationship, or your personal integrity is the priority. Sometimes it is one, and sometimes it is all of them. When integrity is most important, you must remember that your values and morals matter.

The Goal is Good Dialogue

Dialogue represents a free flow of meaning. The point is not to win or to dominate but to create a shared understanding. In healthcare, this matters because loss of trust, tension, and errors happen when we are not in a healthy dialogue. We want to shift from debate to dialogue, and we are going to explore how to do this. These skills are not always innate; often, we have to learn them. Our objective is to create that meaning and understanding, but knowing these things is not always easy. They are not always easy to perform in the moment.

Transitioning from a mindset of competition to one of collaboration requires us to be intentional about how we listen and how we respond. When we are in a debate, we are listening for flaws in the other person's argument so we can counter them. In a dialogue, we are listening to understand the other person's perspective so we can build a more complete picture of the situation. This shift enables the transformative communication we discussed earlier, leading to better outcomes for our patients and more supportive environments for our colleagues.

When Is Good Dialogue Difficult?

So let's talk about when good dialogue is difficult. It gets hard to keep the dialogue going, especially in a really stressful environment. It is easiest when the stakes are low, but when the issue is critical, it is much harder. The truth is, the conversations that matter most are the hardest to have. I think we all can agree on that.

Conversations are difficult when the issue is essential. They are also difficult when opinions vary. As we heard in a couple of the scenarios already, opinions can vary so that emotions might run higher. In healthcare, these conditions, where the issue is imperative, opinions vary, and intense emotions are involved, are common.

But when good dialogue exists, and all opinions can be heard, things improve. I call that productive discourse. When we can navigate these high-stakes moments without losing our ability to listen or our willingness to speak our truth, we create an environment where patient safety and professional satisfaction can actually thrive. It requires us to stay present even when our instinct might be to shut down or to lash out.

Productive Discourse Leads To...

Some people may see discourse as a negative, but it is not. Productive discourse is what we are looking for. It is not about winning an argument. It is about creating space where all perspectives can be heard. When done well, it leads to diverse expertise and highlights blind spots. It leads to safer and more effective patient care. Also, when we have productive discussions, we save time on important issues and become more efficient. Instead of rehashing conflicts later and repeating mistakes, problems are addressed directly and constructively.

Lastly, and importantly, when people feel heard and respected, meetings become more engaging and collaborative. People leave with a sense of shared ownership of what is happening. Let us take a care planning meeting for a patient with chronic heart failure who has been readmitted several times already. The nurse practitioner shares that the patient is struggling with medications at home. The social worker adds that the financial stress of trying to get to the office is making it hard for the patient to keep their appointments. The cardiologist emphasizes the need for tighter medication management. You can see that multiple viewpoints are being expressed. Instead of debating whose issue is most important, the team quickly identifies the critical barrier.

The team realizes the patient does not have reliable transportation for follow-up visits. From there, the nurse practitioner suggests a practical solution: arranging home healthcare and medication delivery so the patient receives care promptly. The meeting is friendly, collaborative, and efficient. Everyone leaves feeling aligned with a clear plan that supports the patient and reduces the chance of another admission. That is what productive discourse makes possible. But again, what might deter that in our settings?

Barriers to Productive Discourse

While productive discourse has clear benefits, common barriers can derail it. One is that single voice, the one that dominates the conversation. When this happens, others hesitate to share their valuable insights, and critical information gets lost. Another barrier is emotion escalation. When your emotions go up, the shift in the room moves from problem-solving to conflict. In those moments, what is happening with the patient often gets lost. Disrespect, whether it is subtle or overt, undermines trust and makes people less likely to engage openly. Finally, unclear goals or a lack of structure can confuse. We waste time, and our issues may still be unresolved.

Identifying these barriers is the first step toward overcoming them in our daily practice. When we recognize that one person is dominating a conversation or that emotions are starting to run high, we can use our communication skills to redirect the interaction back toward a productive dialogue. By maintaining a focus on mutual respect and clear objectives, we ensure that the team remains centered on providing the best possible care for the patient.

Things That Impair Communication

Let's look at ourselves personally. What are some things that individually impair communication? Sometimes it's a lack of skills. If you have never been taught how to communicate on a level other than just exchanging words, you may not know how to deeply listen, regulate your emotions, or deliver clear feedback. Many of us do not get this training even while studying to become practitioners. We get a lot of the nuts and bolts of our profession, but developing our communication skills sometimes gets lost. That is why you must take a course like this, and I am glad all of you are here.

Also, if the goal is unclear, people are talking but not aligned with what they are trying to achieve. If you are not sure what you are trying to achieve individually, you are not going to be as clear in your communication. Again, emotions play a role. When you personally become emotionally overloaded with stress, frustration, or fatigue, that can leak into your words and derail your message. This is how we are affected at an individual level. We also see impairments when we focus on immediate goals instead of longer-term needs, which sometimes happens when we are emotionally overloaded.

Lastly, if we are in a disruptive or distracting environment, it is tough for us individually to be able to communicate effectively. The environment matters. If it is loud, rushed, or chaotic, it is going to make it harder to connect and be understood. Think about a scenario involving insufficient training. You might be in a meeting with a junior person who has not learned communication skills, and they start talking about what the patient needs. This creates an unclear purpose or objective. If the other team members are trying to figure out what this person is saying, things get lost. Sometimes another team member becomes impatient when someone is not communicating effectively and gets angry or upset.

Each one of these things moves us away from what is really important. Perhaps one person focuses on the immediate need rather than the long-term need. For instance, if you are a speech and language pathologist working on swallowing for a patient and that is your sole concentration rather than what they need for discharge, the bigger picture is missed. If you are having a meeting in a room where people are coming and going, as we all know happens in patient rooms, the family might get upset as well. We really want to focus on these things ourselves. We must make sure we have training, a clear purpose, controlled emotions, a focus on long-term goals, and an environment that allows communication to flow freely.

Dialogue Vs. Debate

The difference between debate and dialogue is fundamental to how we interact. When you are debating, your goal is to win, to persuade, and to prove a point. When you are listening in a debate, you are simply waiting to reply, to refute, or to find a way to persuade the other person. Your focus is on positioning: who is winning, who is losing, who is right, and who is wrong. Your tone can become defensive and competitive, and the outcome is that one side wins while trust weakens. We want to look for both sides winning. In dialogue, our goal is to understand, connect, and co-create meaning. You are listening to learn and explore. You are focusing on all the interests and shared values, and your tone is curious and respectful. The outcome of this approach is a shared understanding and stronger trust. By choosing dialogue over debate, we move away from confrontation and toward the collaborative spirit essential to effective healthcare.

A Model For Communication: CONNECT

As we move forward and learn a model of communication, we are going to be moving from debate to dialogue. Before we move on, let us look at a few models of communication. Across US healthcare systems and business leadership programs, several evidence-based communication frameworks have become standard practice. We talked about the SBAR, which stands for Situation, Background, Assessment, and Recommendation. It was developed to standardize clinical communication, and it has dramatically improved patient safety outcomes.

Then there is TeamSTEPPS, developed by the Agency for Healthcare Research and Quality. It builds on the SBAR and integrates teamwork, leadership, and mutual support as essential safety tools. Tools like DESC or CUS help clinicians and team members express concerns assertively and resolve conflicts respectfully. These models empower professionals to speak up and protect patient safety. Nonviolent communication is used in both the private and healthcare sectors, teaching strategies to manage high-stakes, emotionally charged conversations with respect and intention.

The AIDET model has become central to patient care experience initiatives. It helps clinicians connect with patients through structured introductions, clear expectations, and gratitude. We hope to experience this when we see our own providers, and we should do this for our patients. The PEARLS framework encourages empathy, apology, respect, legitimization, and support to promote rapport. The crucial conversations model is another go-to, especially in business environments, to manage high-stakes moments.

You might ask why I created a new model. In my leadership work with organizations and the business community, I was frequently asked to provide communication training. However, many organizations cannot afford some models or cannot allow employees to be away from work for 2 to 5 days for training. Instead, I looked at all of these models, and my consulting company created what we are about to learn. It takes less time, is more affordable, and is easy to understand for individuals and groups. It is based on our many years of practice and evidence-based research.

Let us look at a couple of scenarios. At 4:45 pm on a busy Friday at a rehabilitation hospital, Sarah, a nurse practitioner, has been fielding calls from a family waiting for discharge. She is frustrated and snaps at Jamal, a physical therapist who is still charting. She asks why the patient is not discharged and tells him he should have managed his time better. Jamal feels caught off guard and defensive, pointing out that he had eight patients and suggesting Sarah should have checked the pharmacy earlier. Neither is listening; both feel disrespected, and the tension grows. Sarah leaves to tell the family to wait another hour, and both practitioners feel demoralized. The documentation gets rushed, and their professional relationship deteriorates.

In another scenario at an outpatient clinic, Alex, an occupational therapist, is running behind schedule. His patient, Mrs. Lopez, is frustrated with her slow recovery from a wrist fracture. When she says the therapy is not working, Alex sighs and tells her she is likely not doing her home exercises. Mrs. Lopez feels unheard and insists she is doing them. Alex defensively tells her that pain is part of recovery and she must push through it. Mrs. Lopez goes quiet, leaves early, and cancels her next appointments. Alex thinks the patient doesn't want to do the work, but there was actually a breakdown in communication with no validation or shared goals.

These scenarios occur frequently in healthcare, and by improving our communication, we can reduce these mistakes. The model we will work through today is called the CONNECT model. It serves as both a reminder and a roadmap. C is control your emotions, O is offer respect, N is name the facts, N is note the response, E is explain your position, C is common goals, and T is test assumptions. While it may look like many steps, these letters overlap and flow together. Let us jump in.

C=Control Your Emotions

C represents the first step in our model: Control your emotions. Emotions run high in healthcare. Stress, urgency, and human suffering are all part of our daily landscape. Controlling your emotions means recognizing what you are feeling, regulating your reactions, and responding in ways that maintain safety and trust. It means you control your emotions rather than letting them control you. Effective behaviors include pausing before reacting, using a calm tone of voice, and acknowledging your feelings without letting them dictate your words. Ineffective behaviors involve snapping at a colleague, sighing in frustration at a patient, or simply shutting down and disengaging.

Consider a physical therapist in a hospital who feels irritated when family members repeatedly challenge the treatment plan. Instead of snapping back, she pauses, breathes, and says that she hears how overwhelming this is before walking them through what is happening. In that moment, her self-control transformed the communication. That little micro-practice of pausing and taking a slow breath changed the whole environment. Research shows that emotions have an evolutionary tendency to act. All feelings are good, and there are no bad emotions; there are only negative ways we express them. Our interpretation, not just the event itself, shapes those emotions. Emotion regulation, when done correctly, improves safety and performance in healthcare.

Controlling your emotions is not always easy, especially when vulnerability factors are present. These include sleep deprivation, illness, and hunger. In healthcare, we often skip meals or eat unhealthy foods high in sugar and caffeine, which makes it harder to regulate ourselves. Intoxication is another factor that impairs this ability in everyday life. Emotions are hardwired and motivate us to action while communicating meaning to others. Since only 7% of what we communicate is through words, our tone and body language do the rest. Regulating our emotions protects clarity, empathy, and trust.

Putting your feelings into words reduces emotional reactivity. When you are feeling something, you need to give it words, or it will sit and percolate. I often say that emotions love themselves; fear loves fear and will continue to grow unless you name it. The minute you name the emotion, you can control it much more effectively. If you can name it, you can tame it. Emotions follow a predictable chain: an event happens, our interpretation or appraisal shapes our response, and that emotion prepares us to behave in a prescribed way, known as an action tendency. Often, that primal tendency, like lashing out in anger, is incompatible with our professional goals.

Nurse leaders with high emotional regulation scores demonstrate fewer safety incidents. Imagine a patient care assistant who a patient yells at for a long wait. The event is verbal aggression. The interpretation might be that the patient is being disrespectful, leading to anger and an impulse to snap back. If the assistant pauses and reinterprets the behavior as a sign of the patient's fear, they can instead reassure the patient, preserving safety and trust.

When emotions rise, the skill is not to suppress them but to feel them and evaluate your interpretations. Ask yourself if your understanding is accurate or if there is other evidence to consider. Let your goals, not your impulses, determine your behavior. For example, a speech therapist who feels dismissed when interrupted by a teacher during an IEP meeting might realize the teacher is under pressure and choose to collaborate rather than become defensive.

You can practice this by pausing for ten seconds before responding in stressful, non-emergency moments. Another tool is mood tracking, where you write down one word for your emotion three times a day while off work to identify patterns. As Viktor Frankl, a psychiatrist and Holocaust survivor, said, between stimulus and response, there is a space, and in that space is our power to choose our response. This ability to determine meaning and response, even under extreme stress, is within our control.

O=Offer Respect

Respect is the foundation of trust. Offering respect means signaling to patients, families, and colleagues that their perspective matters even when you disagree. This distinction is vital; you can show respect without reaching an agreement. Effective behaviors include listening without interrupting, using respectful titles in professional situations, and validating the other person's contribution. Ineffective behaviors include eye-rolling, dismissive language, talking over others, or giving the silent treatment.

Picture a physical therapist in a private practice who listens to a patient insisting on unrealistic recovery times, such as wanting to walk without a walker in two weeks. Rather than shutting the patient down, she says she admires their motivation and suggests setting a safe, achievable goal together. She offered respect to the client. In your personal life, consider a situation where a teenager rolls his eyes when reminded to do homework. While the instinct might be to scold him for being rude, pausing to acknowledge that he is tired after practice and offering to make a plan that works for both of you addresses his frustration rather than the disrespect. Respect means preserving dignity for both yourself and the other person.

In your work environment or at home, I want you to consciously use one phrase of respect, such as acknowledging their input or thanking them for raising a concern. Watch how the dynamic changes; people often take a deep breath when they feel respected. In high-stress environments, respect communicates that you see and hear the other person's perspective. It improves patient adherence and satisfaction, builds team trust, reduces errors, and buffers stress and burnout. When we validate others' competence, likability, and fundamental goodness, we protect their dignity. Self-respect is just as important. Acknowledge your own opinion and validate yourself with the same grace.

Consider a nurse who disagrees with a resident's treatment plan. Instead of dismissing it, the nurse might say she sees where they are going and respects the reasoning, then asks to share an alternative concern. This validates the resident's competence while raising critical safety concerns. Albert Einstein said he spoke to everyone in the same way, whether they were a garbage man or the president of a university. Respect is about human dignity, not status. In healthcare, this is critical for our patients, colleagues, and those we supervise.

Another form of respect is the power of an apology. None of us is perfect, and our behavior will be perceived as disrespectful at times, even if we did not intend it. It is important to apologize in those moments. Without an apology, explanations of your intent can sound dismissive. Apology is not a weakness; it is a bridge back to trust. Research shows that apologies repair patient-provider relationships and reduce legal risks. Even if harm was not intended, the perception matters.

Imagine a community mental health setting where a therapist interrupts a patient to keep track of a session. If the therapist notices the patient feels dismissed and apologizes for cutting them off, it acknowledges the impact and preserves the relationship. For many, apologizing feels shameful, but it actually keeps shame out of the picture by focusing on creating a future together. Maya Angelou said, "People will forget what you said and did, but they will never forget how you made them feel." Each day, try naming a colleague or family member who did something helpful and send them a quick thanks. In your next difficult conversation, try using phrases that acknowledge their point of view before sharing your own. This is the essence of dialogue.

N=Name the Facts

Naming the facts anchors the dialogue in objectivity. It means clearly stating observable information without judgment. Judgment is one of the quickest ways to end a conversation and make someone feel bad. The minute we put judgment into a conversation, someone has to be right and someone has to be wrong. The reality is that most of the time, things are gray. By removing judgment from our language, we significantly improve our communication. I find that when I teach this, people often don't realize how judgmental they can be, because we live in a judgmental society. If we can change this one thing, we will be much more effective.

Effective behaviors in naming the facts include focusing on measurable facts, using neutral language, and separating data from interpretation. Ineffective behaviors include exaggeration, blame, or selective admission of facts. Imagine a clinician in a community mental health setting facing a frustrated patient. Instead of saying that the patient is always skipping sessions, she says that they have missed two of their last four appointments. She then pauses to allow the patient to respond. Facts reduce defensiveness and open space for problem-solving. In your following conversation, try replacing judgmental language with a neutral statement of fact. Instead of saying a patient never follows instructions, you could say the exercises were not completed this week. When you pause, the patient is more likely to tell you exactly why they struggled rather than making excuses or getting angry.

I encourage you to remove judgment from your dialogues, as it is never helpful. Now that you are aware of this, you will likely hear yourself making judgments. When I work with people on this, I have them stop and turn those judgments into statements of fact. This builds awareness and helps them realize that facts will never get us into trouble in our relationships or correspondence. When conversations get difficult, returning to the facts is one of the best ways to de-escalate. Facts provide common ground and reduce errors. The Joint Commission has provided research showing how sticking to facts in the SBAR format improves clarity and safety.

In healthcare teams, naming the facts often includes using I statements. For example, saying that you feel overwhelmed when three new patients are admitted at once is an inarguable statement about your experience. This is very different from saying that someone overloaded you, which feels like an attack. You cannot argue with someone else's experience when it is framed as an I statement. These statements are a core part of evidence-based conflict management strategies.

In a hospital setting, during a shift handoff, a nurse might tell a colleague they did not provide enough information, which can lead to blame. Alternatively, saying they do not feel confident starting care without knowing the patient's allergies is a fact paired with an I statement, which is solution-focused. In your personal life, if a roommate forgets to pay rent, instead of calling them irresponsible, you can state that the rent was due on the first and it is now the fourth, then ask what happened. Naming the facts replaces judgment with clarity. Edward Deming, a pioneer in quality improvement, said that without data, you are just another person with an opinion. Healthcare thrives on evidence, and communication is no different. In your next interaction, try replacing a judgment with a neutral fact and see the power of letting go of judgment.

N=Note the Response

Communication is not one-way. The minute you walk into a room, you start communicating whether you are talking or not. People look at you, and you might look at them; that is an interaction that occurs before a single word is spoken. It is only one way if you are in a room all by yourself. After you share information, you must note how the other person responds, both verbally and nonverbally. Learning to pause in the conversation helps the dialogue keep going rather than turning into a debate where you feel the need to rush forward.

Effective behaviors include observing tone and body language, asking clarifying questions, and reflecting exactly what you heard. Ineffective behaviors involve ignoring cues, pushing forward with your agenda no matter what, or assuming you have been understood. These mistakes often happen when we are in a hurry at work and feel the pressure of an unfinished to-do list. For example, in a school setting, a speech therapist might explain progress to a teacher, and the teacher might cross her arms with a skeptical tone. Instead of continuing, the therapist should pause and acknowledge the hesitation, then ask for the teacher's perspective. In your personal life, if a partner goes quiet after an argument, you might usually try to fill that silence. Instead, pause and note that they have shut down, acknowledging that it seems complicated for them to talk right now. Recognizing that the emotional cue keeps the door open for repair.

Consciously pause after delivering information and check the other person's response. Ask yourself what you are noticing. Sometimes the most influential thing we can do is listen. You can also try a meeting countdown by writing down three key points before responding. If a colleague says they feel therapy is always pushed to the end of the day, a dismissive response would be to say that is how schedules work. A validating reaction would be to acknowledge the concern that therapy delays impact outcomes.

Validation is a critical skill in all of our interactions. I learned about validation through a form of therapy called Dialectical Behavior Therapy (DBT), developed by psychologist Dr. Marsha Linehan. It is a skills-based approach that I believe should be taught to everyone. Validation means recognizing that another person's thoughts, emotions, and actions are understandable in their context. In healthcare, this can prevent conflict from escalating. If a nurse feels no one is listening during rounds, responding that it makes sense given the number of voices in the room validates her experience. This does not mean you agree with everything, but it shows you respect her internal experience. Validation is often misunderstood; it is not agreement, but an acknowledgment of the other person's reality. You are saying you see why they feel that way, given their experience.

The definition of validation is finding that little bit of truth in the other person's perspective. When a family member says you are not doing enough for their loved one, you could defensively say you are doing everything possible, or you could validate them by saying you see how terrifying this is and that it makes sense they would want every treatment possible. Think of a time when someone validated your feelings without agreeing with you; it feels good just to be heard. Marsha Linehan noted that validation is recognizing that your experience is understandable given the circumstances. We even need to validate ourselves.

Validation is not a soft skill; it has hard outcomes. It reduces the pressure in the room because people no longer feel they have to fight to be heard. In healthcare teams, invalidation looks like cutting someone off or minimizing feelings, which erodes trust. Validation improves relationships, facilitates problem-solving, and reduces the need to prove who is right. If an occupational therapist is overwhelmed by schedule changes, telling them it is just part of the job is invalidating. Saying you see how stressful the changes are builds trust.

There are levels to this practice. First, be present with your undivided attention rather than texting or looking at a phone. Second, mirror and paraphrase to show you get it. If someone says they cannot keep up with admissions, reflect that they feel overwhelmed by the pace. Third, look for what is not being said, such as noticing a heavy sigh and acknowledging the exhaustion. Fourth, understand the context and history. If a patient is skeptical of rehab, recognize that they have had a hard time with it before, so their skepticism makes sense. Finally, showing equality is vital in healthcare. Communication works best when there is mutual respect, regardless of rank. Validation collapses the hierarchy and emphasizes shared goals.

E=Explain Your Position

We now move on to the following letter, E, which explains your position. While respect and facts matter, so does your perspective. Explaining your position means clearly and calmly stating your reasoning and concerns without defensiveness. Effective behaviors include linking your reasoning to evidence and being concise with your I statements. Ineffective behaviors involve over-explaining, using jargon to assert authority, or avoiding sharing your view entirely.

Imagine you are in a large hospital team huddle and a physician proposes an aggressive discharge plan. Instead of staying silent, a nurse might say they are concerned about discharging today because the patient's oxygen level dropped twice overnight, and they recommend monitoring for another 24 hours. This is clear, respectful, and evidence-based. In your personal life, if a spouse claims you never do what they want regarding a vacation, you might respond by saying you understand why they feel that way, but from your perspective, you are worried about the cost this year. By explaining your position rather than counterattacking, you move from blame to understanding.

Clarity matters when explaining your position, and emotional intelligence enhances these skills. Notice the difference between accusing someone of not prioritizing discharges correctly and stating that, from your perspective, you are concerned that delayed discharges are impacting patient flow. The latter is assertive but does not shut down the dialogue. Similarly, instead of labeling a patient as non-compliant, you could say you are worried that missing sessions may slow their recovery and then ask what is making things difficult. This approach respects the patient's lived experience and makes them a partner in their care.

Evidence shows that balancing advocacy with inquiry improves decision-making and decreases conflict. The goal here is not debate but dialogue. Think about a time when you held back an opinion in a clinical interaction. We have all done it. How could you have reframed that into an I statement to express your concerns? This is where assertiveness meets empathy. We want to honor rather than dismiss the other perspective while being respectful in our framing.

C=Common Goals

When we focus on common goals, we transform conflict into collaboration. In healthcare, this means remembering that while perspectives differ, everyone is working towards the same endpoint: effective patient care and a supportive team culture. Common goals create alignment in high-stress settings like hospitals, where siloed perspectives easily escalate into conflict. We want to use effective behaviors like sharing objectives, inviting collaboration, and using inclusive language. We want to stay away from ineffective behaviors like focusing only on your own personal priorities or using divisive paraphrasing like my way versus your way.

Imagine a disagreement arises between an occupational therapist and a parent over the frequency of therapy. Instead of debating the schedules, the therapist says that both parties want the child to be independent with daily tasks and suggests finding the best plan to achieve that. The common goal is for the child to become independent. In your personal life, if two partners are arguing about the dishes piling up and one says the other never cleans up, they can reframe the issue. They can state that they both want a calmer evening routine and ask how to divide the work so it feels fair. Common goals turn conflict into teamwork.

The key principles of common goals are to respect both parties, acknowledge both perspectives, and promote collaboration rather than comparison. This reduces defensiveness. For example, instead of saying someone is not following the discharge plan correctly, you could say that both of you want the patient discharged safely and on time, then ask how to align the approach to make that happen. Instead of telling a patient they are not cooperating with therapy, you could say that you both want them to regain independence as quickly as possible and suggest a discussion on what makes the process manageable for them, by identifying that shared "why," we can move past the "how" that is causing the friction.

T=Test Assumptions

Testing assumptions is the final step of the CONNECT model. You have likely noticed how these stages chain together and overlap to form a complete roadmap. Take a look at the image of the lion. He looks calm, maybe even sleepy, but if you were walking across the savannah, your brain would not register peacefulness. It would instantly sense danger. This is the negativity bias, a psychological tendency to notice and remember negative experiences more strongly than positive ones. Even when positive and negative events are equally intense, the negative ones have a greater impact on our emotions, memory, and decision-making. This is why we remember negative things more quickly. From an evolutionary standpoint, this bias had survival value because you needed to run from that lion, but today it can distort our perspectives.

If a leader receives ten compliments and one criticism, that criticism often dominates their thinking. In healthcare, a single negative patient interaction can outweigh multiple positives. Leaders and clinicians must be mindful, as unchecked bias increases stress and burnout. However, by intentionally noticing positive feedback and balancing our perspective, we can protect our teams. Incorporating positive feedback into your everyday routine helps calm that negativity bias. The key principles of testing assumptions are to ensure you have all the information and to avoid the either-or trap. We want to go for both, because most of the time things aren't either-or. We want to look for creative solutions and check our connection.

Instead of assuming a colleague is being careless about a delay, ask yourself whether a medication safety issue is being verified. Instead of assuming a patient’s non-attendance is due to a lack of motivation, consider whether cost or scheduling is the barrier. This concludes the CONNECT model. While it is a comprehensive model, it becomes easier to incorporate once you see how the pieces flow together. Let us revisit our earlier scenarios to see how different they look when using these skills.

Back at the hospital at 4:45 pm, Sarah, the nurse practitioner, feels frustration rising when Jamal says the documentation isn't finished. Before she speaks, Sarah takes a breath to control her emotions, reminding herself that her goal is a safe discharge. Her tone softens as she offers respect, acknowledging how hectic Jamal's day has been. Jamal relaxes and explains he hasn't had a chance to finish his notes because he wants them to be accurate. Sarah names the facts by stating that the chart shows incomplete documentation, which is holding up the discharge. She notes the response and validates his desire for accuracy. Sarah then explains her position regarding the family's long wait and shifts to common goals, suggesting they document the essentials now and finish the rest later. Jamal agrees. Finally, Sarah tests assumptions by asking if anything else is preventing discharge. Jamal mentions a pharmacy verification, which Sarah handles immediately. Within twenty minutes, the patient leaves safely, and both providers feel respected.

In the scenario with Mrs. Lopez, Alex takes a deep breath to control his emotions and reminds himself that her frustration is a sign of discouragement. When she says therapy isn't helping, Alex offers respect by empathizing with her feelings. He names the facts of her hard work over six weeks and notes the response by giving her space to speak. When she admits the pain makes her stop her exercises, Alex validates her and explains his position that stopping entirely might increase stiffness. They find a common goal: getting her back to cooking, and decide to adjust the exercises. Alex tests assumptions by clarifying the difference between soreness and harmful pain. The session ends with mutual motivation.

Even with the CONNECT model, we will face challenging cases. Unexpected conversations, sensitive subject matter, or defensive individuals can tempt us to abandon our structure and react impulsively. However, research shows that sticking to a structured model is most effective for decreasing burnout and improving safety. You can use an in-the-moment reframe to stay on track. First, notice your irritation. Second, catch your automatic thought, such as the thought that a doctor never listens. Third, step back and ask what else could be true. Perhaps the doctor is rushing because of an emergency. Finally, choose a constructive action.

It is also vital to recognize destructive responses, such as blaming or withdrawing. This awareness is not about blame but about recognizing warning signs so you can de-escalate. On the other hand, productive responses will become more automatic as you practice the CONNECT skills. In challenging cases, manage your emotional flood, assume your share of responsibility, and if necessary, remove yourself from the situation momentarily to regroup. The most important thing is to practice. If we do not actively use these skills, we will not improve our communication—practice, practice, practice.

Summary

So you took this training, and now I was hoping you could ask yourself which ones of these you will practice and when. Which parts of the CONNECT skill are you not really good at yet, and where do you have to work harder? Make sure you are making time in your everyday life to practice these skills. The process becomes automatic because of your practice. We know that a habit takes 28 to 30 days to form. Perhaps you cannot do everything at once, so pick one part of the CONNECT skill to work on for the next month.

When you do this, you model the behavior for others. Your colleagues or family members may not have taken transformative communication training, but they will start noticing your communication changing. You can tell them where you learned these skills, and hopefully, they will pick them up from you as well. Keep in mind that good dialogue promotes trust, and we are always looking to build confidence in healthcare. I applaud you for taking the time to learn this. I continually take training in communication myself because I believe it is something we should improve throughout our lives.

As we close, I want to say that communication in healthcare is not just about information; it is about connection. That is often just as important, if not more so, than the actual data. Every interaction you have with a patient, a family, or a colleague is an opportunity to build trust and reduce stress. The CONNECT model is more than a framework; it is a discipline. It is a way to pause, respect, validate, and collaborate, even in the most challenging moments. When we practice it, we change the culture of our workplaces.

Think of the stories you have lived in your own practices: the moments when a patient needed you to listen, a colleague needed your respect, or you stayed calm and changed the direction of a conversation. These are not small victories; they are the building blocks of safer, healthier teams. Remember what Maya Angelou said about how people will never forget how you made them feel. As you leave today, I encourage you to take these skills with you and try focusing on one a month. Practice a validation phrase with a patient, a colleague, or at home. When we connect with respect and validation, our communication stops being a task and becomes a tool that transforms us and our care. Thank you again for the work that you do every single day. Healthcare is a challenging environment, but it is also enriching, and we can transform our conversations and our future. Thank you for being here with me today.

References

See additional handout.