case study of poor communication

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5 Business Communication Failure Examples and How to Avoid Them

If you watched Kerry Washington as crisis management expert Olivia Pope on Scandal , then you know that a public relations crisis can be a messy affair for a company. One misstep can quickly spiral into a PR disaster that wreaks havoc on a brand’s reputation. A business communication failure example can be found in every industry, but following internal communication best practices can help your company avoid them. 

Learn how the right software can help your company avoid common business communication pitfalls.

What Are Business Communication Failures?

When an organization’s internal stakeholders are aligned on their mission and clearly understand objectives and strategy, it results in positive business outcomes. 

Successful business communication relies on several key factors:

• Transparent communication
• Authentic leadership
• The inclusion of every employee in communication for a bottom-up leadership style
• Silo-free platforms for seamless information exchange and workflows

The two must-haves of effective crisis management are a plan and a team . But even the best-laid plans can fail. Business communication breakdowns can happen within any organization that stray from internal communication best practices. 

The results might just create a small glitch in operations, but sometimes they can have more serious repercussions, such as:

• Disrupted workflows
• Negatively impacted brand reputation
• Drive down value proposition

Whether it’s a product recall, a data breach, or a customer interaction that went viral (think of the infamous video of a man getting dragged off a United flight when they overbooked the plane), companies big and small alike are vulnerable to a controversial communication crisis. As Warren Buffet said, “It takes twenty years to build a reputation and five minutes to ruin it.”

Here are five examples of business communication gone wrong and how the companies involved responded.

1) Nike: Business Communication Failure at the Top

Since 1971, when the Swoosh logo was officially unveiled, Nike has been one of the biggest names in the sneaker world. With endorsement deals with some of the most famous names in sports, Nike solidified its place as the leader of the pack in the footwear industry and has an annual profit of $36 billion .

But despite its spot as one of the world’s most profitable apparel brands, Nike has had a few PR crises that required major repair.

In 2018, female employees spoke out about the male-dominated culture that fostered harassment and discrimination in the workplace. It started as an anonymous survey by a group of women at the company’s Beaverton, Oregon headquarters about their experiences. The disturbing results were delivered to CEO Mark Parker.

Some examples of internal communication problems that went wrong here include:

• It took a renegade survey by a group of employees to reveal this toxic culture 
• Lack of trust in HR
• A leader who says he was unaware of the problems
• Inefficient methods of bottom-up communication

Nike took dramatic steps to fix these issues by firing C-Suite executives, including the head of diversity and inclusion, implementing mandatory management training, a commitment to a more inclusive culture, and an overhaul of their HR procedures and internal reporting processes. 

Pro tip: Be proactive and get ahead of the narrative through authentic, transparent communication.

2) Wells Fargo: Learn to Accept Responsibility 

In any business, it’s always good to be agile and ready to pivot to a crisis communication plan when the time comes. When it happened to Wells Fargo, the second-largest bank in the United States, they only seemed to dig themselves into a deeper hole that made it harder to bounce back. 

It started in 2016 when authorities, like the Consumer Financial Protection Bureau, were alerted to potential fraud. Responding to a top-down demand for aggressive customer quotas, employees at local branches created upwards of two million fake bank accounts in customers’ names but without their consent. The bank was fined $185 million.

Wells Fargo’s leadership response potentially hurt the banks’ image as much as the initial scandal.

• The company’s early public statements neglected to accept any responsibility, nor did they contain apologies. Instead, they downplayed the fraud. An apology only came from the CEO when he was brought to testify before the U.S. Senate Banking Committee.
• Leadership blamed, then fired, 5,300 low-level employees.
• The CEO sold $61 million of his Wells Fargo stock the month before the investigation began.

How to handle a situation like this? An immediate, proactive response.

• Thoughtful, authentic, direct communication to both internal stakeholders to rebuild trust and establish an open culture
• Apologies to the public for what happened
• Accept responsibility
• Take high-profile actions that change policies and procedures to ensure this will never happen again

Wells Fargo is still in business, but their reputation remains scarred.  

3) Starbucks: Align Every Employee to Core Values

In April 2018, two men went to a Philadelphia Starbucks to meet a friend. They sat at a table waiting to order and asked to use the restroom. The result? The manager on duty called the police and the two African American men were—wrongfully—arrested for trespassing. 

The video of the arrest went viral and by the next day, #boycottStarbucks was trending on social media. What might have started as a store manager attempting to follow a company policy turned into a racially-biased encounter that even the Starbucks CEO called a “reprehensible outcome.”

That CEO, Kevin Johnson, instantly released a statement that included a direct apology to the two men. To employees and customers, he said, “You can and should expect more from us.  We will learn from this and be better.”

He also outlined a list of internal actions the company would take. A month later, Starbucks closed 8,000 stores to train 175,000 employees on racial bias and how to make every customer feel like they belong. 

• Realign the entire organization to the company’s core values and mission.
• Encourage bottom-up feedback from partners on how the company was doing from their perspective.
• Adopt best practices and review policies that create a culture of inclusion and equality. 

Recognizing the major failure in their internal communication procedures and how their “practices and training led to a bad outcome”, Starbucks did an internal investigation into their policies. It was widely seen as a transparent, authentic response. 

Pro tip: Don’t just pay lip service to your employees and your customers. Learn from your mistakes and take action to revise your policies. 

4) Yahoo: A Deafening Silence Amplifies a Crisis

In September 2016, Yahoo leadership acknowledged a 2014 data breach that exposed the accounts of 500 million users to hackers. Three months later in December, the company then announced that there was another breach from 2013 that affected one billion accounts. Nearly a year later, in October 2017, Yahoo announced that, in fact, the data breach affected all 3 billion of its customers.

Yahoo’s business communication failure? Not communicating. It turned out that company insiders actually knew about the breach when it happened years earlier but kept it under wraps. 

Not only was this extremely poor business communication, but poor risk management. Running a company means running a gauntlet of risks. Companies need to have a risk management framework in place to prepare for any number of threats. Data breaches happen every 39 seconds . They are a risk a tech company like Yahoo was aware of and should have been prepared for. 

An internal investigation found that “failures in communication, management, inquiry, and internal reporting contributed to the lack of proper comprehension and handling of the 2014 Security Incident.” By not addressing a crisis with internal stakeholders and customers, companies with communication issues face:

• Decrease in valuation: In this case, Yahoo was in the process of selling a piece of their company to Verizon who shaved $350 million off the asking price due to this mistake.
• Damaged brand reputation: People are less willing to trust a company who not only mishandles their personal information, but doesn’t let them know their names, phone numbers, and passwords were stolen. With plenty of alternative search engines and email providers, Yahoo’s failure to communicate most likely resulted in a loss of users.
• Loss of employee trust: Trust is a big-ticket item that delivers high employee confidence and engagement. A moment like this makes employees question the cultures and values of the organization they work for. 

5) IHOP: A Communication Failure Turns Into a Feeding Frenzy

Not every business communication failure turns into a scandal. Sometimes they turn into great PR opportunities. 

When IHOP announced it was changing its name to IHOB, the social media stunt to plug its new menu item (burgers) turned into an unlikely crisis. Its loyal customers were thrown into a frenzy, upset that their favorite pancake place was changing.

IHOP took the communication failure and ran with it, using humor to address the ensuing chaos. What could have put the company in the spotlight for the first time in decades, attracted new customers, and quadrupled burger sales? IHOP took hold of the communication and flipped the narrative, made it fun, and, most importantly, reassured customers that it was still the same brand they had grown to love. 

Business communication failures can lead to a serious PR crisis for any company. But business communication done right can also save a company’s reputation without any need to call Olivia Pope.

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Most frequently asked questions.

Miscommunication occurs when communication is not effective. This is the case when the intent of a message conveyed to someone is misunderstood.

This blog post covers miscommunication examples from Nike, Wells Fargo, Starbucks, Yahoo, and IHOP.

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1. WHAT IS TECHNICAL COMMUNICATION?

1.4 Case Study: The Cost of Poor Communication

No one knows exactly how much poor communication costs business, industry and government each year, but estimates suggest billions.  In fact, a recent estimate claims that the cost in the U.S. alone are close to $4 billion annually! [1] Poorly-worded or inefficient emails, careless reading or listening to instructions, documents that go unread due to poor design, hastily presenting inaccurate information, sloppy proofreading — all of these examples result in inevitable costs. The problem is that these costs aren’t usually included on the corporate balance sheet at the end of each year; if they are not properly or clearly defined, the problems remain unsolved.

You may have seen the Project Management Tree Cartoon before ( Figure 1.4.1 ); it has been used and adapted widely to illustrate the perils of poor communication during a project.

The waste caused by imprecisely worded regulations or instructions, confusing emails, long-winded memos, ambiguously written contracts, and other examples of poor communication is not as easily identified as the losses caused by a bridge collapse or a flood. But the losses are just as real—in reduced productivity, inefficiency, and lost business. In more personal terms, the losses are measured in wasted time, work, money, and ultimately, professional recognition. In extreme cases, losses can be measured in property damage, injuries, and even deaths.

The following “case studies” show how poor communications can have real world costs and consequences. For example, consider the “ Comma Quirk ” in the Rogers Contract that cost $2 million. [3]   A small error in spelling a company name cost £8.8 million. [4]   Examine Edward Tufte’s discussion of the failed PowerPoint presentation that attempted to prevent the Columbia Space Shuttle disaster. [5] The failure of project managers and engineers to communicate effectively resulted in the deadly Hyatt Regency walkway collapse. [6]   The case studies below offer a few more examples that might be less extreme, but much more common.

In small groups, examine each “case” and determine the following:

• Define the rhetorical situation : Who is communicating to whom about what, how, and why? What was the goal of the communication in each case?
• Identify the communication error (poor task or audience analysis? Use of inappropriate language or style? Poor organization or formatting of information? Other?)
• Explain what costs/losses were incurred by this problem.
• Identify possible solution s or strategies that would have prevented the problem, and what benefits would be derived from implementing solutions or preventing the problem.

Present your findings in a brief, informal presentation to the class.

Exercises adapted from T.M Georges’ Analytical Writing for Science and Technology. [7]

CASE 1: The promising chemist who buried his results

Bruce, a research chemist for a major petro-chemical company, wrote a dense report about some new compounds he had synthesized in the laboratory from oil-refining by-products. The bulk of the report consisted of tables listing their chemical and physical properties, diagrams of their molecular structure, chemical formulas and data from toxicity tests. Buried at the end of the report was a casual speculation that one of the compounds might be a particularly safe and effective insecticide.

Seven years later, the same oil company launched a major research program to find more effective but environmentally safe insecticides. After six months of research, someone uncovered Bruce’s report and his toxicity tests. A few hours of further testing confirmed that one of Bruce’s compounds was the safe, economical insecticide they had been looking for.

Bruce had since left the company, because he felt that the importance of his research was not being appreciated.

CASE 2: The rejected current regulator proposal

The Acme Electric Company worked day and night to develop a new current regulator designed to cut the electric power consumption in aluminum plants by 35%. They knew that, although the competition was fierce, their regulator could be produced more affordably, was more reliable, and worked more efficiently than the competitors’ products.

The owner, eager to capture the market, personally but somewhat hastily put together a 120-page proposal to the three major aluminum manufacturers, recommending that the new Acme regulators be installed at all company plants.

She devoted the first 87 pages of the proposal to the mathematical theory and engineering design behind his new regulator, and the next 32 to descriptions of the new assembly line she planned to set up to produce regulators quickly. Buried in an appendix were the test results that compared her regulator’s performance with present models, and a poorly drawn graph showed the potential cost savings over 3 years.

The proposals did not receive any response. Acme Electric didn’t get the contracts, despite having the best product. Six months later, the company filed for bankruptcy.

CASE 3: The instruction manual the scared customers away

As one of the first to enter the field of office automation, Sagatec Software, Inc. had built a reputation for designing high-quality and user-friendly database and accounting programs for business and industry. When they decided to enter the word-processing market, their engineers designed an effective, versatile, and powerful program that Sagatec felt sure would outperform any competitor.

To be sure that their new word-processing program was accurately documented, Sagatec asked the senior program designer to supervise writing the instruction manual. The result was a thorough, accurate and precise description of every detail of the program’s operation.

When Sagatec began marketing its new word processor, cries for help flooded in from office workers who were so confused by the massive manual that they couldn’t even find out how to get started. Then several business journals reviewed the program and judged it “too complicated” and “difficult to learn.” After an impressive start, sales of the new word processing program plummeted.

Sagatec eventually put out a new, clearly written training guide that led new users step by step through introductory exercises and told them how to find commands quickly. But the rewrite cost Sagatec $350,000, a year’s lead in the market, and its reputation for producing easy-to-use business software.

CASE 4: One garbled memo – 26 baffled phone calls

Joanne supervised 36 professionals in 6 city libraries. To cut the costs of unnecessary overtime, she issued this one-sentence memo to her staff:

After the 36 copies were sent out, Joanne’s office received 26 phone calls asking what the memo meant. What the 10 people who didn’t call about the memo thought is uncertain. It took a week to clarify the new policy.

CASE 5: Big science — Little rhetoric

The following excerpt is from Carl Sagan’s book, The Demon-Haunted World: Science as a Candle in the Dark, [8] itself both a plea for and an excellent example of clear scientific communication:

The Superconducting Supercollider (SSC) would have been the preeminent instrument on the planet for probing the fine structure of matter and the nature of the early Universe. Its price tag was $10 to $15 billion. It was cancelled by Congress in 1993 after about $2 billion had been spent — a worst of both worlds outcome. But this debate was not, I think, mainly about declining interest in the support of science. Few in Congress understood what modern high-energy accelerators are for. They are not for weapons. They have no practical applications. They are for something that is, worrisomely from the point of view of many, called “the theory of everything.” Explanations that involve entities called quarks, charm, flavor, color, etc., sound as if physicists are being cute. The whole thing has an aura, in the view of at least some Congresspeople I’ve talked to, of “nerds gone wild” — which I suppose is an uncharitable way of describing curiosity-based science. No one asked to pay for this had the foggiest idea of what a Higgs boson is. I’ve read some of the material intended to justify the SSC. At the very end, some of it wasn’t too bad, but there was nothing that really addressed what the project was about on a level accessible to bright but skeptical non-physicists. If physicists are asking for 10 or 15 billion dollars to build a machine that has no practical value, at the very least they should make an extremely serious effort, with dazzling graphics, metaphors, and capable use of the English language, to justify their proposal. More than financial mismanagement, budgetary constraints, and political incompetence, I think this is the key to the failure of the SSC.

CASE 6: The co-op student who mixed up genres

Chris was simultaneously enrolled in a university writing course and working as a co-op student at the Widget Manufacturing plant. As part of his co-op work experience, Chris shadowed his supervisor/mentor on a safety inspection of the plant, and was asked to write up the results of the inspection in a compliance memo . In the same week, Chris’s writing instructor assigned the class to write a narrative essay based on some personal experience. Chris, trying to be efficient, thought that the plant visit experience could provide the basis for his essay assignment as well.

He wrote the essay first, because he was used to writing essays and was pretty good at it. He had never even seen a compliance memo, much less written one, so was not as confident about that task. He began the essay like this:

On June 1, 2018, I conducted a safety audit of the Widget Manufacturing plant in New City. The purpose of the audit was to ensure that all processes and activities in the plant adhere to safety and handling rules and policies outlined in the Workplace Safety Handbook and relevant government regulations. I was escorted on a 3-hour tour of the facility by…

Chris finished the essay and submitted it to his writing instructor. He then revised the essay slightly, keeping the introduction the same, and submitted it to his co-op supervisor. He “aced” the essay, getting an A grade, but his supervisor told him that the report was unacceptable and would have to be rewritten – especially the beginning, which should have clearly indicated whether or not the plant was in compliance with safety regulations. Chris was aghast! He had never heard of putting the “conclusion” at the beginning . He missed the company softball game that Saturday so he could rewrite the report to the satisfaction of his supervisor.

• J. Bernoff, "Bad writing costs business billions," Daily Beast , Oct. 16, 2016 [Online]. Available:  https://www.thedailybeast.com/bad-writing-costs-businesses-billions?ref=scroll ↵
• J. Reiter, "The 'Project Cartoon' root cause," Medium, 2 July 2019. Available: https://medium.com/@thx2001r/the-project-cartoon-root-cause-5e82e404ec8a ↵
• G. Robertson, “Comma quirk irks Rogers,” Globe and Mail , Aug. 6, 2006 [Online]. Available: https://www.theglobeandmail.com/report-on-business/comma-quirk-irks-rogers/article1101686/ ↵
• “The £8.8m typo: How one mistake killed a family business,” (28 Jan. 2015). The Guardian [online]. Available: https://www.theguardian.com/law/shortcuts/2015/jan/28/typo-how-one-mistake-killed-a-family-business-taylor-and-sons ↵
• E. Tufte, The Cognitive Style of PowerPoint , 2001 [Online]. Available: https://www.inf.ed.ac.uk/teaching/courses/pi/2016_2017/phil/tufte-powerpoint.pdf ↵
• C. McFadden, "Understanding the tragic Hyatt Regency walkway collapse," Interesting Engineering , July 4, 2017 [Online]: https://interestingengineering.com/understanding-hyatt-regency-walkway-collapse ↵
• T.M. Goerges (1996), Analytical Writing for Science and Technology [Online], Available: https://www.scribd.com/document/96822930/Analytical-Writing ↵
• C. Sagan, The Demon-Haunted World: Science as a Candle in the Dark, New York, NY: Random House, 1995. ↵

Technical Writing Essentials Copyright © 2019 by Suzan Last is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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1.10 Case Studies: The Cost of Poor Communication

This chapter is adapted from Technical Writing Essentials – H5P Edition by Suzan Last licensed under a Creative Commons Attribution 4.0 International License.

Learning Objectives

• Apply your understanding of context, purpose, audience, and channel in case studies.

No one knows exactly how much poor communication costs business, industry and government each year, but estimates suggest billions.  In 2017, Josh Bernoff claimed that the cost of poor communication was nearly $4 billion per year: “American workers spend 22 percent of their work time reading; higher compensated workers read more… America is spending 6 percent of total wages on time wasted attempting to get meaning out of poorly written material. Every company, every manager, every professional pays this tax, which consumes $396 billion of our national income” (Meier, 2017).

Poorly-worded or inefficient emails, careless reading or listening to instructions, documents that go unread due to poor design, hastily presenting inaccurate information, sloppy proofreading — all of these examples result in inevitable costs. In one tragic case, a lack of communication between contractors and engineers resulted in a walkway collapse that killed 114 people at the Hyatt Regency .

The waste caused by imprecisely worded regulations or instructions, confusing emails, long-winded memos, ambiguously written contracts, and other examples of poor communication is not as easily identified as the losses caused by a bridge collapse. But the losses are just as real—in reduced productivity, inefficiency, and lost business. In more personal terms, the losses are measured in wasted time, work, money, and ultimately, professional recognition. In extreme cases, losses can be measured in property damage, injuries, and even deaths.

The following cases show how poor communications can have real world costs and consequences.

A .  Read “Case 1: The Unaccepted Current Regulator Proposal”. Then, answer the 5 questions in the quiz set.

CASE 1:  Acme Electric Company

The Acme Electric Company worked day and night to develop a new current regulator designed to cut the electric power consumption in aluminum plants by 35%. They knew that, although the competition was fierce, their regulator could be produced more cheaply, was more reliable, and worked more efficiently than the competitors’ products.

The owner, eager to capture the market, personally but somewhat hastily put together a 120-page proposal to the three major aluminum manufacturers, recommending that their regulators be installed at all company plants.

The first 87 pages of the proposal were devoted to the mathematical theory and engineering design behind the new regulator, and the next 32 pages to descriptions of a new assembly line to produce regulators quickly. Buried in an appendix were the test results that compared her regulator’s performance with present models and a poorly drawn graph showed how much the dollar savings would be.

Acme Electric didn’t get the contracts, despite having the best product. Six months later, the company filed for bankruptcy.

B .  In small groups, examine one of the following cases and complete the following :

• Define the rhetorical situation : Who is communicating to whom about what, how, and why? What was the goal of the communication in each case?
• Identify the communication error (poor task or audience analysis? Use of inappropriate language or style? Poor organization or formatting of information? Other?)
• Explain what costs/losses were incurred by this problem.
• Identify possible solution s or strategies that would have prevented the problem, and what benefits would be derived from implementing solutions or preventing the problem.

Present your findings in a brief, informal presentation to the class.

CASE 2: Petro-chemical company report

Cameron (he/him), a research chemist for a major petro-chemical company, wrote a dense report about some new compounds he had synthesized in the laboratory from oil-refining by-products. The bulk of the report consisted of tables listing their chemical and physical properties, diagrams of their molecular structure, chemical formulas and computer printouts of toxicity tests. Buried at the end of the report was a casual speculation that one of the compounds might be a particularly effective insecticide.

Seven years later, the same oil company launched a major research program to find more effective but environmentally safe insecticides. After six months of research, someone uncovered Cameron’s report and his toxicity tests. A few hours of further testing confirmed that one of Cameron’s compounds was the safe, economical insecticide they had been looking for.

Cameron had since left the company because he felt that the importance of his research was not being appreciated.

CASE 3: Novaware instruction manual

As one of the first to enter the field of office automation, Novaware, Inc. had built a reputation for designing high-quality and user-friendly database and accounting programs for business and industry. When they decided to enter the word-processing market, their engineers designed an effective, versatile, and powerful program that Novaware felt sure would outperform any competitor.

To be sure that their new word-processing program was accurately documented, Novaware asked the senior program designer to supervise writing the instruction manual. The result was a thorough, accurate and precise description of every detail of the program’s operation.

When Novaware began marketing its new word processor, cries for help flooded in from office workers who were so confused by the massive manual that they couldn’t even find out how to get started. Then several business journals reviewed the program and judged it “too complicated” and “difficult to learn.” After an impressive start, sales of the new word processing program plummeted.

Novaware eventually put out a new, clearly written training guide that led new users step by step through introductory exercises and told them how to find commands quickly. But the rewrite cost Novaware $350,000, a year’s lead in the market, and its reputation for producing easy-to-use business software.

CASE 4: Policy memo

Nhi (they/them) supervised 36 professionals in 6 city libraries. To cut the costs of unnecessary overtime, they issued this one-sentence memo to their staff:

After the 36 copies were sent out, Nhi’s office received 26 phone calls asking what the memo meant. What the 10 people who didn’t call about the memo thought is uncertain. It took a week to clarify the new policy.

CASE 5: “Nerds gone wild”

The following excerpt is from Carl Sagan’s book, The Demon-Haunted World: Science as a Candle in the Dark, itself both a plea for and an excellent example of clear scientific communication:

The Superconducting Supercollider (SSC) would have been the preeminent instrument on the planet for probing the fine structure of matter and the nature of the early Universe. Its price tag was $10 to $15 billion. It was cancelled by Congress in 1993 after about $2 billion had been spent — a worst of both worlds outcome. But this debate was not, I think, mainly about declining interest in the support of science. Few in Congress understood what modern high-energy accelerators are for. They are not for weapons. They have no practical applications. They are for something that is, worrisomely from the point of view of many, called “the theory of everything.” Explanations that involve entities called quarks, charm, flavor, color, etc., sound as if physicists are being cute. The whole thing has an aura, in the view of at least some Congresspeople I’ve talked to, of “nerds gone wild” — which I suppose is an uncharitable way of describing curiosity-based science. No one asked to pay for this had the foggiest idea of what a Higgs boson is. I’ve read some of the material intended to justify the SSC. At the very end, some of it wasn’t too bad, but there was nothing that really addressed what the project was about on a level accessible to bright but skeptical non-physicists. If physicists are asking for 10 or 15 billion dollars to build a machine that has no practical value, at the very least they should make an extremely serious effort, with dazzling graphics, metaphors, and capable use of the English language, to justify their proposal. More than financial mismanagement, budgetary constraints, and political incompetence, I think this is the key to the failure of the SSC.

CASE 6: Same topic, different genres

Rowan (she/her) was simultaneously enrolled in a university writing course and working as a co-op student at the New Minas Boat Manufacturing plant. As part of her co-op work experience, Rowan shadowed her supervisor/mentor on a safety inspection of the plant, and was asked to write up the results of the inspection in a compliance memo . In the same week, Rowan’s writing instructor assigned the class to write a narrative essay based on some personal experience. Rowan, trying to be efficient, thought that the plant visit experience could provide the basis for her essay assignment as well.

She wrote the essay first because she was used to writing essays and was pretty good at it. She had never even seen a compliance memo, much less written one, so was not as confident about that task. She began the essay like this:

On June 1, 2018, I conducted a safety audit of the New Minas Boat Manufacturing plant. The purpose of the audit was to ensure that all processes and activities in the plant adhere to safety and handling rules and policies outlined in the Workplace Safety Handbook and relevant government regulations. I was escorted on a 3-hour tour of the facility by…

Rowan finished the essay and submitted it to her writing instructor. She then revised the essay slightly, keeping the introduction the same, and submitted it to her co-op supervisor. She “aced” the essay, getting an A grade, but her co-op supervisor told her that the report was unacceptable and would have to be rewritten – especially the beginning, which should have clearly indicated whether or not the plant was in compliance with safety regulations. Rowan was aghast! She had never heard of putting the “conclusion” at the beginning . She missed the company softball game that Saturday so she could rewrite the report to the satisfaction of her supervisor.

Meier, C. (2017, January 14). The Exorbitant Cost of Poor Writing (About $400 Billion). Medium . https://medium.com/@MeierMarketing/the-exorbitant-cost-of-poor-writing-about-400-billion-973b5a4f0096

Sagan, C. (1995). The Demon-Haunted World: Science as a Candle in the Dark. Random House.

Exercises adapted from T.M Georges’ Analytical Writing for Science and Technology. T.M. Goerges (1996), Analytical Writing for Science and Technology [Online], Available: https://www.scribd.com/document/96822930/Analytical-Writing

1.10 Case Studies: The Cost of Poor Communication Copyright © 2021 by Suzan Last is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Managing Organizational Change

Communication failure in the workplace: case study.

What happens when communication fails in the workplace?

What are the common problems in communication and what can we do to fix communication issues at work?

In this case study we will try to understand how things can go wrong and what should be done to avoid the catastrophic consequences of bad communication .

Let’s take a look at small projects that you have to work on daily. Projects or activities that somehow you were expecting would improve your job, increase efficiency, productivity or improve relationships.

In this post, I want to analyse what brings people to fail in communicating .

I want to analyse a real event happened in the company I work for when a new project had to be planned and executed to improve scheduling of the machining and tooling department.

Creation of a new project

Our Head of quality (that we will call Mr L.) suggested that the company needed to improve the planning and scheduling of the machining and tooling department.

All companies that have machine production do this, and we already had someone scheduling this department (Mr M.), but we needed someone that could do it much more in detail and ahead of time.

• Eventually, the supervisor of the machining department (Mr S.) was elected to be the best person for this job, so the CEO of the company decided that Mr M. had to train Mr S. and explain the method he followed for the planning.
• Mr M. is known to be someone that likes to work the way he wants to work! In other words, he is not known for being someone that listens to other people’s opinion, so Mr S. (much younger) had some difficulty getting information out of Mr M.
• This problem had been planned. In fact, before this project started there had been at least two separate meetings, one together with Mr M. in which the steps of the projects were planned and agreed upon, and one meeting without Mr M. where the relationship issue was discussed with the CEO.

Starting the project

Mr S. was not satisfied with the training received by Mr M. and more than once explained that he could not start scheduling the machines if he had not received more information from Mr M.

After he explained this simple point to the CEO, he almost lost his job and was told that “there are other people out there that can do your job!”.

Mr S. almost left the company, but eventually decided to continue and asked help to other members of the company and understood that there were important elements missing.

He had very poor tools that could not help him understand what had to be scheduled, there was no method and the MRP (Material Requirement Planning) was missing most BOMs.

Without this basic information there was no way that he could receive the correct data from the MRP and start planning.

Where is the communication issue?

Mr. M. was cut out without notice.

The first and maybe the most important mistake was performed by the CEO. He did not understand why there was a need to increase efficiency in the planning and did not communicate properly this need to Mr M. which had been doing it for over 10 years.

How to communicate with Mr M?

The communication issue with Mr M. was not sufficiently taken into consideration by the CEO nor by the head of quality. Given the younger age of Mr S. it was given for granted that there would have been communication differences between the two, but clearly, this cannot be a reason for not facilitating communication.

Age difference in today’s companies is a very important topic that has been studied for decades and needs to be understood deeply by HR managers, CEO’s and middle management in organizations.

What should have been done?

First, the communication problem with Mr M. should have risen at the beginning , in the very first meeting, and should have been faced directly explaining what everyone expected from him .

Second, there had to be a better role definition and goal setting . Who does what and when!

If everyone had a clear idea of the steps required before Mr S. could take ownership of his new task, probably they would have learned from the very beginning that there were important information missing.

They would have saved a lot of time and probably Mr S. wouldn’t have almost lost his job for no reason.

What everyone did was concentrate on the relationship with Mr M. and believed that the project could not continue because of him and not because of the lack of tools to properly schedule the machines.

How did things go?

It ended with Mr S. losing almost 3 months without planning.

The company lost a lot of time and money on something that would have taken a few days to figure out.

Mr M. and Mr S. did not improve their communication skills.

The head of quality stopped following the project and did not facilitate the cooperation between the two.

Communication continued to fail and other projects did not meet the results expected.

The CEO believed that Mr S. was not right for the job and probably never changed idea.

Production efficiency decreased.

All of these “catastrophic” consequences were caused by a simple communication issue.

Common communication issues

These are some common communication difficulties :

• Not explaining goals and priorities properly
• Not asking questions
• Preconceived ideas
• Not understand the actual problem and where the project is aiming to
• Jumping to conclusions
• Not exploring alternatives

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“Poor Communication” Is Often a Symptom of a Different Problem

• Art Markman

It’s a common organizational scapegoat.

Do employees complain that your company suffers from a lack of communication? That the left hand doesn’t know what the right hand is doing? Maybe the one doing the complaining is you. Or perhaps, as many companies do, you conducted an employee engagement survey and “lack of communication” emerged as a top gripe.

• Art Markman , PhD, is the Annabel Irion Worsham Centennial Professor of Psychology and Marketing at the University of Texas at Austin and founding director of the program in the  Human Dimensions of Organizations . He has written over 150 scholarly papers on topics including reasoning, decision-making, and motivation. His most recent book is Bring Your Brain to Work: Using Cognitive Science to Get a Job, Do it Well, and Advance Your Career (HBR Press).

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Introduction to Professional Communication

The cost of poor communication.

The following examples [1] show both personal and organizational costs of poor communication.  As you read through them, consider the following:

• What was the intended goal of the communication?
• What are some communication errors that were made?
• What strategies might have helped participants avoid problematic outcomes?

CASE 1: The promising chemist who buried his results

Bruce, a research chemist for a major petro-chemical company, wrote a dense report about some new compounds he had synthesized in the laboratory from oil-refining by-products. The bulk of the report consisted of tables listing their chemical and physical properties, diagrams of their molecular structure, chemical formulas and computer printouts of toxicity tests. Buried at the end of the report was a casual speculation that one of the compounds might be a particularly effective insecticide.

Seven years later, the same oil company launched a major research program to find more effective but environmentally safe insecticides. After six months of research, someone uncovered Bruce’s report and his toxicity tests. A few hours of further testing confirmed that one of Bruce’s compounds was the safe, economical insecticide they had been looking for.

Bruce had since left the company, because he felt that the importance of his research was not being appreciated.

CASE 2: The unaccepted current regulator proposal

The Acme Electric Company worked day and night to develop a new current regulator designed to cut the electric power consumption in aluminum plants by 35%. They knew that, although the competition was fierce, their regulator could be produced more cheaply, was more reliable, and worked more efficiently than the competitors’ products.

The owner, eager to capture the market, personally, but somewhat hastily, put together a 120-page proposal to the three major aluminum manufacturers recommending that their regulators be installed at all company plants.

She devoted the first 87 pages of the proposal to the mathematical theory and engineering design behind this new regulator, and the next 32 to descriptions of the new assembly line she planned to set up to produce regulators quickly. Buried in an appendix were the test results that compared her regulator’s performance with present models, and a poorly drawn graph showed how much the dollar savings would be.

Acme Electric didn’t get the contracts, despite having the best product. Six months later, the company filed for bankruptcy.

CASE 3: The instruction manual that scared customers away

As one of the first to enter the field of office automation, Sagatec Software, Inc. had built a reputation for designing high-quality and user-friendly database and accounting programs for business and industry. When they decided to enter the word-processing market, their engineers designed an effective, versatile, and powerful program that Sagatec felt sure would outperform any competitor.

To be sure that their new word-processing program was accurately documented, Sagatec asked the senior program designer to supervise writing the instruction manual. The result was a thorough, accurate and precise description of every detail of the program’s operation.

When Sagatec began marketing its new word processor, cries for help flooded in from office workers who were so confused by the massive manual that they couldn’t even find out how to get started. Then several business journals reviewed the program and judged it “too complicated” and “difficult to learn.” After an impressive start, sales of the new word processing program plummeted.

Sagatec eventually put out a new, clearly written training guide that led new users step by step through introductory exercises and told them how to find commands quickly. But the rewrite cost Sagatec $350,000, a year’s lead in the market, and its reputation for producing easy-to-use business software.

In a comprehensive study, “David Grossman reported in ‘The Cost of Poor Communications’ that a survey of 400 companies with 100,000 employees each cited an average loss per company of $62.4 million per year because of inadequate communication to and between employees. Debra Hamilton asserted, in her article ‘Top Ten Email Blunders that Cost Companies Money,’ that miscommunication cost even smaller companies of 100 employees an average of $420,000 per year.” [2]

Poor communication costs both the organization and the individual, which is why good communication is such a consistently-needed skill.

[1] Adapted from T.M Georges’  Analytical Writing for Science and Technology.

[2] The Cost of Poor Communication: A Business Rationale for the Communications Competency. (n.d.). Retrieved February 15, 2019, from https://www.shrm.org/resourcesandtools/hr-topics/behavioral-competencies/communication/pages/the-cost-of-poor-communications.aspx Excerpted from Patricia M. Buhler and Joel D. Worden,  Up, Down, and Sideways: High-Impact Verbal Communication for HR Professionals  (SHRM, 2013).

• The Cost of Poor Communication; edited version of 1.4 Case Study: The Cost of Poor Communication. Authored by : Suzan Last. Provided by : BCcampus. Located at : https://pressbooks.bccampus.ca/technicalwriting/chapter/casestudy-costpoorcommunication/ . Project : Technical Writing Essentials: Introduction to Professional Communiations in the Technical Fields. License : CC BY: Attribution
• image of broken computer screen. Authored by : mediamodifier. Provided by : Pixabay. Located at : https://pixabay.com/en/broken-business-monitor-2237920/ . License : Public Domain: No Known Copyright

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Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports

Abhishek Tiwary Roles: Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Ajwani Rimal Roles: Conceptualization, Methodology, Writing – Original Draft Preparation Buddhi Paudyal Roles: Conceptualization, Supervision, Writing – Review & Editing Keshav Raj Sigdel Roles: Conceptualization, Supervision, Writing – Review & Editing Buddha Basnyat Roles: Conceptualization, Methodology, Resources, Writing – Review & Editing

This article is included in the Oxford University Clinical Research Unit (OUCRU) gateway.

Communication, methotrexate, tuberculosis

Introduction

Communication refers to exchanging information with the help of different mediums, such as speaking, writing or body language 1 . It is of great importance in the field of medicine. Effective physician-patient communication is vital as it is related with favourable health outcomes such as increased patients satisfaction, compliance and overall health status 2 . A study in 2008 by Bartlett G et al. concluded that communication problems with patients lead to increased preventable adverse effects which were mostly drug-related 3 . It has been estimated that 27% of medical malpractice is the result of the communication failures. Better communication can reduce medical errors and patient injury 4 . Poor communication can result in various negative outcomes, such as decreased adherence to treatment, patients dissatisfaction and inefficient use of resources 5 . The cases discussed here highlight the importance of proper communication, how such unfortunate events could have been prevented with good communication skills. The traditional medical education curriculum in South Asia usually focuses more on technical expertise than teaching communication skills. This fact has hindered the capacity of technically expert health professionals to effectively communicate with their patients regarding the disease and treatment approach 6 , 7 . Thus, a concerted effort needs to be made to improve the communication skills of health professionals in South Asia.

Case reports

A 50-year-old woman diagnosed with rheumatoid arthritis (RA) 3 weeks previously presented to Emergency Department of Patan Hospital in June of 2018 with complaints of multiple episodes of vomiting and oral ulcers for 5 days. She had a history of multiple joint pain for a year, for which she sought medical attention in New Delhi, India as her son used to work there. She visited New Delhi with her neighbour, and there was diagnosed with RA. As per the standard treatment of RA, her treating rheumatologist prescribed her 15 mg methotrexate once weekly and 5 mg folic acid twice weekly without emphasizing that methotrexate is to be taken weekly and not daily. The pharmacist also failed to stress the weekly dose schedule. Unfortunately, she consumed methotrexate 15 mg daily for 11 days. At 11th day, she presented with those above complaints to the National Medical College and Teaching Hospital near her home in Birgunj, in the southern plains of Nepal. There she was managed conservatively with folic acid and fluids for 2 days, then referred to our centre for further management. She had ongoing vomiting and her examination of the oral cavity revealed multiple erythematous and ulcerative lesions. Her total white blood cell count (WBC) was 2400/µl (normal range, 4000–11000/µl), with an absolute neutrophil count (ANC) of 1200/µl (normal range, 1500–8000/µl), haemoglobin of 9 g/dl (12–15 g/dl) and platelets of 84000/µl (150,000–450,000/µl). She was immediately admitted to the intensive care unit (ICU) for methotrexate toxicity (myelosuppression and mucositis). Her methotrexate was stopped and she was managed with leucovorin (15 mg once daily), GM-CSF (300 µg once daily) and nasogastric feeding as she was unable to eat anything because of the oral ulcers.

After 3 days in the ICU, she was transferred to the ward, where treatment with leucovorin and GM-CSF was continued at the same dose. She was discharged after a total of 11 days of hospital stay when her blood counts came back to within the normal range (WBC, 12300/µl; ANC, 6888/µl). Her haemoglobin increased to 13 g/dl and her platelet reached 340,000/µl. Her oral lesions subsided, and she was able to feed orally. She was started back on the correct dosage of methotrexate (15 mg once weekly) and counselled about the disease, medications (dosage and adverse effects) and was advised to follow up in rheumatology clinic. She has been followed-up every 3 months since then, is in remission and is taking medications properly.

A 40-year-old man from hills of Nepal presented to the emergency department of Patan Hospital in August 2018 with complaints of weakness in the right half of the body, deviation of the left side of the face and slurring of speech for 4 days. At 3 weeks prior to this, he had visited another tertiary level hospital in Kathmandu for pain in the lower abdomen and fever, where he was diagnosed as having ileo-cecal tuberculosis based on colonoscopy and biopsy with positive Ziehl-Neelson staining. He was then prescribed with antitubercular therapy (ATT) that included 3 tablets of Fixed dose combination consisting of isoniazid 75 mg, rifampicin 150 mg, pyrazinamide 400 mg and ethambutol 275 mg once daily and prednisolone 40 mg once daily. He was advised to take ATT from a health centre near his residence, whereas prednisolone was dispensed from the hospital pharmacy. Unfortunately, he just took prednisolone, but no ATT. As a result, he ended up in emergency with the aforementioned complaints. On evaluation, his chest x-ray showed features of pulmonary tuberculosis. Cerebral spinal Fluid (CSF) analysis was done which showed red blood cells (RBC) 200/µl (normal value, 0/µl), WBC 64/µl (normal range, 0–5/ µl), neutrophil 24%, lymphocytes 64%, protein 294 mg/dl (normal range, 15–45 mg/dl) and sugar 49 mg/dl (normal range, 50–80 mg/dl). Cerebrospinal fluid GeneXpert testing was positive for Mycobacterium tuberculosis . He was then diagnosed as disseminated tuberculosis with meningeal involvement and was admitted to Patan Hospital with ATT (3 tablets of fixed-dose combination consisting of Isoniazid 75mg, Rifampicin 150 mg, Pyrazinamide 400 mg and Ethambutol 275mg once daily) and dexamethasone (6 mg three times a day) for 3 days. He was then discharged with ATT (same dose as above) and prednisolone (40 mg once daily) after proper counselling about the nature of the disease and site of availability of anti-tubercular drugs. He came in for follow-up after 2 weeks with improvement in the symptoms and has been taking all medications properly.

In the discussed cases, the treating physicians had used the standard treatment protocol to best serve their patients. They used their medical knowledge in an appropriate manner to treat the disease condition, but proper communication with clear-cut emphasis on how and when to take the therapy, which is of utmost importance in achieving an overall positive health impact, was lacking. Had the doctors properly counselled and educated the patients regarding the disease, treatment options and the correct way of taking medications, these mishaps could have been prevented. Another major part of the communication involves the judgment of the doctor in figuring out how much the patient understood. As our patients were not literate, they could have explained about the disease and especially the weekly dosing of methotrexate and the availability and importance of ATT very clearly to the patient family. In South Asian countries like Nepal, the patient seldom is alone and therefore making things clear to the patient’s family is obviously a very important option that needs to be utilized to improve communication against the background of rampant illiteracy. In Nepal, only 48.6% of the population is literate; hence this fact needs to be kept in mind when explaining about diseases and prescribing drugs, especially regarding medicines that have dangerous side-effects 8 .

In Nepal, 25.2% population fall below the poverty line and 3.2% population are unemployed 9 . The young working generation have to leave their house for better employment opportunities, meaning they aren’t able to take care of their parents. In one of our cases, the son had to work in India for better employment opportunities and the patient came with her neighbour with whom the treating physician did not spend any time. It is possible that if the son had been there, he may well have been more concerned and asked more questions to the doctor. However, it is the responsibility of the health care professional to try to make sure the patient and their family have understood the matter clearly. There was also no caution mentioned by the pharmacy where the patient bought the medicine explaining the weekly (and not daily) dosing schedule of methotrexate. Hence there was failure of clear communication at various levels that led to this mishap.

Problems in doctor‐patient communication have received little attention as a potential but a remediable cause of health hazards, especially in a setting like this one in South Asia. Communication during the medical interaction among the health practitioner and the patient has a pivotal role in creating a positive health impact that includes drug adherence, future decision making on the interventions and modifying the health behaviours of the patient. We consider the cost and the negative impact on the outcome of the health from poor communication, which includes non-adherence to drugs regimens that will increase the burden of the cost of the total drug therapy, poor health outcomes, and unnecessary treatment and investigations. Different measures need to be considered to improve the communication between doctors and patients which would improve the overall health outcome. The measures include providing communication skills training to health care professionals and regular evaluation of communication skills of these professionals by interviewing the patients after a consultation.

Clear communication is vital in the proper treatment of the patient especially against the background of rampant illiteracy in countries such as Nepal in South Asia. Poor Communication may lead to life-threatening complications, as in our patients. For better communication practice, proper communication training to health care professionals including pharmacists is paramount.

Informed consent for publication of their clinical details, in the form of a fingerprint, was obtained from the patients.

Data availability

All data underlying the results are available as part of the article and no additional source data are required.

Grant information

This study was supported by the Wellcome Trust (106680).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

• 1.   Hornby A, Deuter M: Oxford advanced learner's dictionary of current English. Oxford: Oxford University Press, 2015. Reference Source
• 2.   Ong LM, de Haes JC, Hoos AM, et al. : Doctor-patient communication: a review of the literature. Soc Sci Med. 1995; 40 (7): 903–918. PubMed Abstract | Publisher Full Text
• 3.   Bartlett G, Blais R, Tamblyn R, et al. : Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ. 2008; 178 (12): 1555–1562. PubMed Abstract | Publisher Full Text | Free Full Text
• 4.   The Doctor Weighs In: The Impact of Poor Communication on Medical Errors. [online]. 2018. [Accessed 26 Oct. 2018]. Reference Source
• 5.   Vermeir P, Vandijck D, Degroote S, et al. : Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract. 2015; 69 (11): 1257–67. PubMed Abstract | Publisher Full Text | Free Full Text
• 6.   Choudhary A, Gupta V: Teaching communications skills to medical students: Introducing the fine art of medical practice. Int J Appl Basic Med Res. 2015; 5 (Suppl 1): S41–4. PubMed Abstract | Publisher Full Text | Free Full Text
• 7.   Feinmann J: Brushing up on doctors' communication skills. Lancet. 2002; 360 (9345): 1572. PubMed Abstract | Publisher Full Text
• 8.   Worldpopulationreview.com. [online]. 2018. [Accessed 26 Oct. 2018]. Reference Source
• 9.   Anon. [online]. 2018. [Accessed 26 Oct. 2018]. Reference Source

Comments on this article Comments (0)

Open peer review.

• This article provides two cases where a lack of information and clear understanding of prescription medication contributed to morbidity and unnecessary suffering for the patients. The cases are linked to a lack of health professional engagement with the
• This article provides two cases where a lack of information and clear understanding of prescription medication contributed to morbidity and unnecessary suffering for the patients. The cases are linked to a lack of health professional engagement with the patient and failure to ensure full understanding of medication instructions. The cases and events surrounding are clearly described. The outcomes are also clearly described.  
• The clinical scenario is well described but it would be helpful to know what steps were taken with these two patients to prevent similar circumstances. There is no mention of what was done to educate and inform the patient or their families on discharge. Was there an interdisciplinary team involved to try to ensure the patient got sufficient information and how was their level of comprehension assessed?  
• There is a bit of repetition in the discussion and not many concrete suggestions for improving the skills of physicians in this area. Continuing medical education? Cultural competency teaching?  
• There are a few grammatical errors that could be corrected to improve the paper.   
• Overall, an important concept for discussion and excellent examples of why the discussion must happen. 

Is the background of the cases’ history and progression described in sufficient detail?

Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Is the conclusion balanced and justified on the basis of the findings?

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I teach in a Faculty of medicine and focus on issues related to patient engagement.

• Respond or Comment
• COMMENT ON THIS REPORT
• This section should focus on contextual facts about the central issue of the manuscript, communication in clinical practice in the present context. It is better to avoid assessment of the contents of the cases and
• This section should focus on contextual facts about the central issue of the manuscript, communication in clinical practice in the present context. It is better to avoid assessment of the contents of the cases and conclusion with recommendation.   
• The statement “ The cases discussed here highlight the importance of proper communication, how such unfortunate events could have been prevented with good communication skills” indicates to the assessment of upcoming contents of the manuscript. It seems inappropriate in the introduction. (It better fits in the discussion).  
• The last phrase of this section “ Thus, a concerted effort needs to be made to improve the communication skills of health professionals in South Asia” carries a notion of recommendation, which seems premature for this section of the manuscript. (It can be moved to the conclusion).  
• It will be better to highlight the objective and rationale of presenting cases in this section. It provides the space for the authors to justify importance of communication in clinical practice.  
• Adequate exploration of the facts as the evidence of poor communication in health service/clinical practices and highlights of these facts (findings) are necessary in presentation of the cases for justification of explanations narrated in the section of discussion. The cases in the manuscript look weak, as the communication aspects are not adequately elaborated on. Elaboration of communication dimension in the case presentation is desirable and, hence, suggested.  
• As emphasized in the discussion section, and in the conclusion, of the manuscript, socio-economic characteristics of the service seekers are not clearly mentioned in the cases. Therefore, rationalization of importance of communication in the basis of these attributes is not well justifiable.  
• The discussion should further attempt to establish credible links between doctor-patient communication and implications seen in the discussed cases. Other potential causes for such implications should be excluded to the best possible extent. Few examples:  
• In case 1 – it should be explored in depth whether the attitude and faith of patients to recover earlier by getting medicine in more (frequently) quantity than prescribed dose could be the reason for this situation.  
• In case 2 – role of poor communication is not established clearly. Other possible reasons for not taking ATT like unavailability of medicines, distance to the health centres, and so on should be excluded to establish the role of communication. If prednisolone was the underlying cause of complication of the case, it should be analyzed, whether dispensing prednisolone alone without AT medicines to the patient was a right practice/protocol and correlate with the communication.
• In case 1 – name of the referring hospital as National Medical College and Teaching Hospital is mentioned whereas in the case 2 – it is mentioned as another tertiary level hospital in Kathmandu . It is better to maintain the consistency.
• The conclusion is not well based in facts of cases. The manuscript has justified the importance of communication (in Nepal) in the background of rampant illiteracy . However, literacy and other socio-economic status of the patients in both cases are not known.
• Language could be improved.
• Manuscript has addressed very relevant and useful issues. It should be considered for indexing after improvement incorporating all comments. 

Reviewer Expertise: My research area is public health policy

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Reviewer Reports

• Sharad Onta , Tribhuvan University, Kathmandu, Nepal; Nepal Public Health Foundation, Kathmandu, Nepal
• Jill Allison , Memorial University of Newfoundland, St. John's, Canada

Comments on this article

All Comments (0)

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Internal Communication Case Studies: The Terrible & The Terrific

It’s a question that often comes up: ‘How do other businesses do this?’. Whether you’re implementing a new sales structure or updating your software systems, it’s always helpful to consider how similar companies approached the issue. This is particularly relevant for internal communications , where there is no one-size-fits-all solution. Each organisation has its own unique set of challenges and needs to tailor its internal communication strategy accordingly. Internal communication case studies can help you evaluate your approach, by exploring comparable situations and their outcomes.

In this blog, we’ve selected some of the best internal communication examples from the world of business. Not all were successful. In fact, some were complete disasters. But these failures, along with the success stories, are great examples of internal communication in action. When you’re looking for the answers to effective internal communication , nothing speaks more clearly than real-life examples.

We have grouped the following internal communication case study examples under the ‘seven golden rules’. These rules were proposed by Fitzpatrick in his ground-breaking  publication  Internal Communications: A Manual for Practitioners. These fundamental rules of internal communication best practices help us to categorise the relative successes and failures of these examples.

Rule 1: Activity means nothing without results

The starting point for every IC has to be: “What do we want people to do?” Being busy and generating a constant stream of campaigns, videos and newsletters is a waste of time if nothing changes as a result. When you’re looking at improving internal communications , always keep track of the outcome as well as the action. This is where the true significance lies.

Case Study 1 - Nationwide Building Society

Background: Nationwide Building Society ran an award-winning five-week BIG Conversation, gathering ideas from all its 18,000 employees in a company-wide collaboration. The aim was directed to reinvigorating Nationwide’s sense of purpose.

Approach: The activity included TalkBack events, online surveys and a huge listening exercise to give staff and members the chance to contribute to its future. By implementing a company-wide internal communications survey , Nationwide opened up a free-flowing conversation with its workforce.

Outcome: The result has been a refreshed strategy and a marketing campaign based on the new concept of ‘building society, nationwide’ – helping people improve the quality of their lives. This business communication case study demonstrates the power of actively listening and acting on employee’s suggestions. 

Verdict: Success

Rule 2: Value benefits the business

You will only be adding real value if your employee communication links directly to the business needs of your organisation and helps to achieve a defined strategy or a specific project. The benefits of good internal communication only become apparent when you define your desired outcomes and set actual targets.

Case Study 2 – XPO Transport and Logistics

Background: XPO wanted to leverage great ideas from its colleagues across its 104 UK sites to help its customers improve productivity and reduce costs. Its large, flexible and hard-to-reach workforce (from drivers for Asda to B&Q warehouse contractors) don’t usually have a company phone or laptop. Of all the case studies on communication in the workplace, this large-scale exercise is remarkable in its scope.

Approach: To spark engagement, Talkfreely developed the Ideas Matter App, which every employee was able to download to their personal phone. An internal communications app is the ideal way to connect with remote workers and hard-to-reach employees.

Outcome: Linked directly to business needs, the internal communications platform proved to be exceptional value. The generation of ideas has been significant; 1 in 4 of all ideas submitted are being put into practice. In addition, it showed a remarkable return on investment of 6.5:1 with £156,000 of savings in the first year alone.

Rule 3: In the thick of it

When you’re looking for new ideas, trying to work out what your employees are really thinking or wondering why a previous internal communications plan went wrong, don't sit pondering at your desk or researching online. Leave your office and start talking. Once you talk and listen to your employees, you will begin to understand what motivates them, what concerns them and how they feel about the company. Of all the internal communication ideas , this one is key if you want to keep track of engagement levels.

Case Study 3 – AOL

Background: AOL announced it was slashing its Patch local news network by a third. This was a large-scale change affecting many employees across the company and required careful handling in its communication.

Approach: CEO Tim Armstrong set up a conference call with 1,000 employees with the aim of boosting morale across the workforce. As Armstrong talked, Patch Creative Director Abel Lenz began taking pictures of him. He was immediately sacked, in front of the 1,000 staff on the conference call.

Outcome: Perhaps Armstrong did not know that Lenz’s job included photographing meetings with key leaders for the Patch intranet, for the benefit of remote workers. But he should have. If he had been in touch with his workforce, he would have been fully aware of the roles of individual employees. This employee communication case study gives a clear indication of the importance of understanding your employee’s job roles.

Verdict: Failure

Rule 4: Shut up and listen

Communicating with employees should be a two-way street. The megaphone approach is never going to work best because people only feel connected and motivated if they are part of a conversation. It’s vital to put internal communication channels in place that allow employees to comment on the messages coming down from the top. Listen to what they have to say … and learn.

Case Study 4 – PayPal

Background: The digital payment company needed to address an internal report that revealed not all their employees were not using the PayPal app. The President, David Marcus, wrote a company-wide memo to all staff regarding the problem.

Approach: David Marcus took a heavy-handed approach to the matter. He told his staff to use the product or quit: “If you are one of the folks who refused to install the PayPal app or if you can’t remember your PayPal password, do yourself a favor, go find something that will connect with your heart and mind elsewhere”.

A better policy would have been to find out why his employees weren’t using the payment app, whether they felt competitor products had better features and ask for their suggestions.

Outcome: The memo was leaked to the press. It generated widespread coverage across the media and left customers wondering what was wrong with an app that PayPal’s own staff wouldn't use. Internal communications best practice case studies demonstrate that opening a two-way channel for feedback will improve both internal and external communication .

Rule 5 – I did it their way

Understand the working methods of those you need to convince. If leaders seem bound up in stats and spreadsheets, give them what they want. Gather data to prove your ideas work, show them a process, outline a clear outcome and they’ll soon be on your side. Measuring internal communications will help to provide the rationale behind your ideas. Equally, if the types of internal communication you are using don’t seem to be connecting with your employees, don’t be afraid to try a different approach.

Case Study 5 – Seymour House

Background: Seymour House runs ten outstanding childcare nurseries and wanted to get staff across the group engaging better with each other to share great practice. They needed to identify the best methods of internal communication that would resonate with their unique team-based workforce.

Approach: Talkfreely innovated with an internal communications app called Community. Community replaces static web pages and posts with highly personalised, bite-sized chunks of information presented on boards displaying relevant cards. These communicate quick stories and are far better at connecting people across teams. 

Outcome: The Seymour House teams instantly connected with the Community app. Engagement levels took an immediate uplift as the communication and understanding between teams and individuals improved. This internal communications case study shows how crucial it is to connect with employees in a way that suits their style of interaction.

Rule 6: Make the most of managers

Your leadership team are crucial to the success of your strategy. However big or small your organisation, line managers and local leaders are your allies. They are essential to motivating employees and getting them on board: through discussion, allaying fears and leading by example. When you’re pulling together your internal communication definition , make sure leadership is one of the key points.

Case Study 6 – Yahoo

Background: The tech pioneer defined a need for remote workers return to the office environment. There was no longer a role for staff working from home and all employees needed to be office-based moving forward. The job of communicating this message was handed to the HR department.

Approach: Yahoo’s Head of HR sent out a motivational memo full of praise for the company’s “positive momentum”, “the buzz and energy in our offices”, “remarkable progress” and promising “the best is yet to come”. At the end of this message was the directive that all staff working from home must move back into the office or quit.

Outcome: A communication of this importance should have come from the head of the business. By trying to hide the order as a motivational HR message, it failed to provide a strategic business rationale. This is where the CEO needed to be a visible presence, sharing the reasoning behind this unpopular decision. Internal communication case study examples show time after time that leadership visibility is an essential element, especially when communicating change .

Rule 7: There is no silver bullet

We’d love to be able to reveal the secret to implementing that perfect internal communication strategy. Social media, the employee intranet , digital screens, email – they have all at some stage promised to revolutionise internal communications and make everything else redundant. But it hasn’t happened, which means the role of the internal communicator remains absolutely pivotal. Cut yourself slack in how you judge success, because every organisation has a different set of challenges and issues to overcome.

Case Study 7 – West Sussex County Council

Background: West Sussex Country Council has a workforce of over 6,000 staff spread across a wide geographic area in a variety of locations. In addition, around 25% of staff members have limited access to IT equipment and/or limited IT knowledge. The channels of internal communication in operation were outmoded and ineffective, leading to misinterpretation and inconsistencies.

Approach: Talkfreely developed a bespoke internal communications app designed to connect the disparate council workforce. Called ‘The Big Exchange’, the app allowed for real-time communication over a variety of digital platforms. Available 24 hours a day, 365 days a year, it allowed for flexibility in work patterns, increasing its appeal for all employees.

Outcome: By the end of the first quarter, a third of the employee base were actively using the app. In some sectors, 33% would be a pretty modest engagement score. For West Sussex Country Council however, it has connected with those hard-to-reach employees for the very first time. In addition, it proved that there is a real council workforce appetite to get involved. For example - there were 25,200 page views in the first month which means on average, each active user visited over 25 pages of content per month. Read the full case study .

“The TalkFreely app has helped improve, beyond recognition, the way we communicate with our 6000 strong workforce, many of whom are hard to reach. This has become even more evident over the last few weeks in our local response to the coronavirus crisis, helping us to get critical, time-sensitive information out to staff quickly and easily wherever they are across the county.” William Hackett, Communications & Engagement Lead, West Sussex County Council

Final thoughts

It’s clear, when looking at this selection of communication case studies, that not every internal communication is destined for success. And, if handled incorrectly, a poorly targeted message can actually do more harm than good. Internal communication mistakes are very costly, to both morale and the bottom line. However, if you take the time to plan carefully, the positive impact of a good internal communication exchange can be considerable. When assessing internal communications case studies, it’s also vital to consider the arena in which the company is operating before judging the relative success of the campaign. Ultimately, every organisation will need to take a different approach, tailored to suit their unique set of circumstances.

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Internal Communications Metrics: Five Steps To Success

Internal Communication Examples: Update Your Strategy for 2024

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When Poor Communication Does and Does Not Matter: The Moderating Role of Stress

Teresa p. nguyen.

Sonoma State University

Benjamin R. Karney

University of California, Los Angeles

Thomas N. Bradbury

Associated data.

Although a number of theoretical perspectives in relationship science argue that variability in couples’ relationship satisfaction over time is driven by changes in their communication, tests of this hypothesis have been limited to single assessments of behavior. To address this gap, we examine within-couple, across-time changes in communication, and we argue further that couples’ external circumstances might combine with these behavioral changes to generate changes in relationship satisfaction. Using self-reports of satisfaction and in-home observational data collected four times at 9-month intervals from 414 newlywed couples, we show that fluctuations in dyadic behavior and spousal stress covary with fluctuations in spousal satisfaction. Tests of the interaction between fluctuations in stress and behavior reveal that husbands who experience upward fluctuations in stress and negativity also experience decreases in relationship satisfaction at the same wave. Downward fluctuations in problem-solving effectiveness are associated with lower relationship satisfaction, but only among spouses who had chronically high levels of cumulative stress; when chronic stress is low, reduced problem-solving effectiveness is unrelated to satisfaction. Exclusive focus on between-couple variability in couple communication, without regard for the stressors that couples face, will likely restrict the understanding and prevention of relationship distress.

Communication processes define and characterize all committed partnerships, and all major theoretical perspectives in relationship science hypothesize that the quality of couples’ communication will influence the quality and course of their relationships. A wealth of observational data has been brought to bear on this hypothesis, and many correlational studies using middle-class samples establish consistent, small-to-medium associations between the quality of observed communication and relationship satisfaction (for meta-analysis, see Woodin, 2011 ). Longitudinal research, however, yields inconsistent and contradictory findings. For example, observed negativity is sometimes associated with declines in relationship satisfaction (e.g., Markman, Rhoades, Stanley, Ragan, & Whitton, 2010 ), but in other instances higher levels of negativity are associated with higher levels of relationship satisfaction over time (e.g., McNulty & Russell, 2010 ). Moreover, while some studies indicate that wives displaying more positive behavior are less likely to become distressed over time (e.g., Pasch & Bradbury, 1998 ), others indicate that wives’ positivity is associated with lower satisfaction years later (e.g., Gottman & Krokoff, 1989 ). Randomized controlled trials of interventions add to this mixed picture, as increases in satisfaction from pre- to post-treatment are unmediated by changes in observed communication (e.g., Williamson, Altman, Hsueh, & Bradbury, 2016 ).

While there is little doubt that couples communicate with more frustration and less warmth when they are dissatisfied in their relationship, the inconsistent and contradictory findings reviewed above highlight the surprising complexity that underlies the association between communication and changes in relationship outcomes. Thus, despite real progress in describing what is arguably the single most theoretically important element in couple relationships, the manner in which communication operates to affect judgments of satisfaction remains a source of confusion and controversy. In the present study, we argue that expecting a consistent association between couple communication and relationship satisfaction is misguided, because it fails to recognize that any given couple will encounter a range of situations and that these situations can alter such an association. This view is based on Baron and Kenny’s (1986) observation that unexpectedly weak associations can signal the presence of moderation, and on the more specific idea that behavioral performance under certain conditions will carry greater consequences for relationship satisfaction than under other conditions, even when the behavior itself is topographically identical.

As a consequence of conceptualizing behavior-satisfaction effects as trait-like and invariant across circumstances in couples’ lives, study designs have relied upon single assessments of couple communication (even when samples are followed longitudinally) without regard for the ongoing demands that might be influencing partners’ affective states in standard observational paradigms. Critically, such one-time assessments make assumptions about couple interaction and can only test hypotheses regarding between -person differences in communication (i.e., couples’ capacity for constructive communication relative to other couples). This approach fails to align with the assumptions made in major theoretical approaches to relationships— including attachment theory ( Hazan & Shaver, 1987 ), social exchange theory ( Thibaut & Kelley, 1959 ), social learning theory ( Jacobson & Margolin, 1979 ), and the intimacy process model ( Reis & Shaver, 1988 )—which allow for and even emphasize behavioral change . These theories assert that changes in communication are the mechanism by which satisfaction improves: when a couple communicates in a more constructive manner, their satisfaction in the relationship should increase, while moments of poor communication should be associated with downward fluctuations in their relationship satisfaction.

Other theoretical perspectives further argue that the success of a relationship is dependent on partners’ ability to modulate their behavior as circumstances and demands change ( Neff & Karney, 2017 ). Though plausible, this central idea has not been examined and tested directly. That is, the majority of studies do not test whether within-person fluctuations in spouses’ behaviors correspond with within-person fluctuations in their relationship satisfaction. Such within-person analyses control for stable, between-person differences and selection effects, and thereby allow for stronger inferences about the links between communication and relationship satisfaction. These questions relating to change have been touched upon with various versions of self-report studies (e.g., diary studies, telephone assessments; Debrot, Siegler, Klumb, & Schoebi, 2017 ), but such self-report studies fall short of studying actual communication processes. In short, because observational studies almost always include a single assessment of behavior, they permit only a very narrow and perhaps misleading evaluation of models which assert that communication is associated with relationship outcomes. The current study aimed to address this limitation by examining couples’ behavior as it fluctuates over time.

If we allow for the possibility that behavior-satisfaction associations are not uniform across settings for a given couple, what theoretical concepts might be used to account for variability in behavioral effects on satisfaction? Emerging socioecological models that build upon seminal work by Bronfenbrenner (1979) describe how forces arising outside of couples’ interpersonal transactions can impinge upon their relationships ( Bodenmann, 2005 ; Conger, Rueter, & Elder Jr., 1999 ; Schulz, Cowan, Pape Cowan, & Brennan, 2004 ). These external forces can range from more immediate stressors like an argument with a neighbor to less acute but taxing experiences like implicit discrimination in the workplace—all of which may combine to make it more or less likely for couples to sustain rewarding partnerships ( Karney, Story, & Bradbury, 2005 ). Furthermore, it is likely that these adverse influences are heightened among individuals and couples with fewer economic resources and a lower social standing, as, e.g., they will be more reliant on public services, less able to find stable well-paying jobs, or less able to pay for services that could make their lives and their relationships easier. In this way, middle-class samples—used in the majority of couple research—might misrepresent the nature of the association between stress and satisfaction. Thus, more inclusive sampling of stressful experiences is needed to adequately explore the association between stress and relationship satisfaction. Although daily diary studies on stress have begun to shed light on the relationship between changes in stress and satisfaction ( Debrot et al., 2017 ; Totenhagen, Randall, & Lloyd, 2018 ), such fluctuations are likely to be smaller and less qualitatively different on a day-to-day basis, suggesting that studying stress over longer periods of time is necessary in order to sample a wide range of circumstances within a given couple.

Although there may be value in studying effects of distinct forms of stress, stressors do not operate in isolation ( Kraemer, Stice, Kazdin, Offord, & Kupfer, 2001 ), and emerging research suggests that the accumulation of stressors across domains—cumulative stress—is uniquely costly to relationship satisfaction above and beyond the effects of the individual components ( Rauer, Karney, Garvan, & Hou, 2008 ). We therefore test whether the association between observed couple communication and relationship satisfaction is dependent on the extent to which spouses experience stress across multiple domains. Specifically, we examine the cooccurrence and buildup of stress from work, discrimination, and finances, in light of evidence that low-income, ethnically diverse individuals are more likely to work non-standard hours with little paid sick or vacation leave (e.g., Heymann, 2000 ), to experience discrimination ( Lincoln & Chae, 2010 ), and to report financial strain as a concern in the relationship ( Jackson et al., 2016 ).

Although well-developed literatures examine how couple communication and stress might affect relationships, much of this work overlooks how they combine to affect relationships, thus limiting our understanding of how extradyadic influences combine with intradyadic processes to predict change in relationship satisfaction. Frameworks such as the Vulnerability-Stress-Adaptation model ( Karney & Bradbury, 1995 ) explicitly argue for the integration of behavioral and contextual influences on relationship satisfaction. According to this view, the quality and longevity of relationships is determined by the interplay between partners’ experiences of stress, their adaptive (i.e., communication) processes, and the stable and enduring vulnerabilities that partners would bring to any relationship. In this paper, we examine whether the association between couples’ communication and relationship satisfaction is altered as a function of the external demands that spouses face, insofar as poor communication and high degrees of stress might both need to be present before there are any associated changes in relationship satisfaction; poor communication in the absence of high levels of stress may be less likely to cooccur with decreases in satisfaction.

While various indices of stress have been shown to covary with divorce and relationship satisfaction ( Cohan & Cole, 2002 ; Randall & Bodenmann, 2009 ), few studies directly address the combined contributions of stress and observed behavior (cf. Bodenmann et al., 2015 ). Nonetheless, self-reported dyadic coping has been shown to attenuate the adverse effects of stress on verbal aggression ( Bodenmann, Meuwly, Bradbury, Gmelch, & Ledermann, 2010 ) and the adverse effects of posttraumatic stress on relationship quality ( Lambert, Hasbun, Engh, & Holzer, 2015 ). Studies employing observational coding of behavior also indicate that the effects of couples’ communication on relationship satisfaction are dependent on couples’ socioeconomic risk ( Ross, Karney, Nguyen, & Bradbury, 2019 ) and changes in their neighborhood environment (see Nguyen, Williamson, Karney, & Bradbury, 2017 for another paper using the same sample). Furthermore, to our knowledge no study has addressed whether the association between behavior and satisfaction is altered by fluctuations in spouses’ stress or their level of chronic stress relative to other spouses. Thus, as we outline below, we aim to close the gap between leading explanations for relationship change and the data available to test those explanations.

We address two main aims. First, building from theoretical assertions that interpersonal processes ( Jacobson & Margolin, 1979 ; Thibaut & Kelley, 1959 ) and stress ( Bodenmann, 2005 ; Conger et al., 1999 ; Karney & Bradbury, 2005 ) will predict changes in relationship satisfaction, we examine whether fluctuations in key facets of widely-studied communication behaviors—including positivity, negativity, and problem-solving effectiveness—and fluctuations in cumulative stress covary separately with fluctuations in relationship satisfaction. We also test the effects of communication and cumulative stress simultaneously to examine whether the effects overlap or remain uniquely predictive of changes in relationship satisfaction.

With our second aim we test whether the association between behavior and satisfaction is dependent on spouses’ experiences of stress. We do this in two ways. First, we ask whether fluctuations in behavioral processes operate differently on satisfaction when spouses experience acute upward fluctuations in cumulative stress relative to their norm (i.e., within-person interaction between behavior fluctuations and stress fluctuations ). Second, we test whether fluctuations in behavioral process operate differently among spouses who vary in their across-time levels of chronic stress accumulated across domains in the first three years of marriage (i.e., between-person interaction between behavior fluctuations and chronic stress levels). We predict that stress will moderate behavioral effects on satisfaction in light of other work suggesting that couples are more reactive to relationship experiences when faced with high demands ( Neff & Karney, 2009 ). Existing studies provide no basis for predicting how our three sets of behavioral codes will perform when interacting with within-person fluctuations in stress versus between-person differences in chronic stress. To the extent that differences do emerge, within-person change effects could favor behavioral codes that have the potential to be more labile, particularly positivity and negativity, which are more affect-laden and thus potentially responsive to circumstantial influences. Between-person level effects, in contrast, might favor codes that fluctuate less and are more trait-like in couples’ behavioral repertoires, such as problem-solving effectiveness. Nevertheless, because few prior studies examine natural fluctuations in couple communication, our position is necessarily speculative.

We test these two aims using a sample of couples varying widely in socioeconomic status but disproportionately living with low incomes, in recognition of evidence that relationship distress and contextual stressors are overrepresented among economically disadvantaged and culturally diverse populations ( Copen, Daniels, Vespa, & Mosher, 2012 ). We employ a relatively large sample of 414 couples living with low incomes, focusing specifically on first-time newlywed couples to ensure analysis of married couples before they have self-selected out of the sample due to separation or divorce. Couples are assessed in-home at four time points with direct behavioral observation of couples’ communication to reduce shared-method variance when predicting relationship satisfaction.

Sampling was undertaken to yield first-married newlywed couples in which partners were of the same ethnicity, living in low neighborhoods in Los Angeles County. Recently married couples were identified through names and addresses on marriage license applications. Addresses were matched with census data to identify applicants living in low-income communities, defined as census block groups wherein the median household income is less than 160% of the 1999 federal poverty level for a 4-person family and thereby oversampling an understudied and rarer population of couples living in low-income neighborhoods. Next, names on the licenses were weighted using data from a Bayesian Census Surname Combination, which integrates census and surname information to produce a multinomial probability of membership in each of four racial/ethnic categories (Hispanic, African American, Asian, and Caucasian/other). Couples were chosen using probabilities proportionate to the ratio of target prevalences to the population prevalences, weighted by the couple’s average estimated probability of being Hispanic, African American, or Caucasian, which are the three largest groups of people living in poverty in Los Angeles County ( United States Census Bureau, 2002 ).

Participants

The 431 identified couples participated in data collection four times over 36 months. At baseline, marriages averaged 4.8 months in duration ( SD = 2.5) and 0.6 children ( SD = 1.0). Mean age for husbands was 27.9 ( SD = 5.8) and 26.3 ( SD = 5.0) for wives. Mean income was $34,153 ( SD = $27,094) for husbands and $28,672 ( SD = $24,549) for wives. Twelve percent of couples were African American, 12% were Caucasian, and 76% were Hispanic, consistent with proportions of people living in poverty in Los Angeles County (12.9% African American, 14.7% Caucasian, and 60.5% Hispanic; U.S. Census Bureau, 2002). Of the Hispanic couples, 33% spoke Spanish in their interactions; all African American and Caucasian couples spoke English.

At T1 couples were visited in their homes by two interviewers who took spouses to separate areas to ensure privacy and orally administered self-report measures. Partners were then reunited for three 8-min videotaped discussions—a problem solving discussion, husband social support discussion, and wife social support discussion. Interviewers returned 9 months (T2; n = 375), 18 months (T3; n = 359), and 27 months after baseline (T4; n = 336) and administered the same interview protocol. Couples were debriefed and paid $75 for T1, $100 for T2, $125 for T3 and $150 for T4. The RAND Corporation Institutional Review Board approved all procedures.

Behavioral Observation

Videotapes were scored by 16 trained coders using the Iowa Family Interaction Rating Scales (IFIRS; Melby et al., 1998 ). Unlike microcoding systems, the IFIRS gives each spouse a single score for each code at the end of the task rather than for multiple short time segments. Coders—five of whom were native Spanish speakers—coded only in their native language. Coders participated in 10 hours of training per week for 3 months and were required to pass written and viewing tests at an 80% accuracy level before coding tapes. Coders also participated in weekly 2-hour training meetings consisting of a variety of structured activities (e.g., watching examples of specific codes) designed to minimize drift and ensure fidelity to the IFIRS codes. Coders viewed each of the interaction tasks three to four times using the Noldus Observer XT coding software, using the built-in capabilities to note behaviors of both spouses. Coders then used their recorded notations to assign a single score for each spouse for each code, using the criteria from the IFIRS coding manual ( Melby et al., 1998 ). The possible scores range from 1–9, with a score of 1 indicating that the behavior did not occur and a score of 9 indicating that “the behavior occurs frequently or with significant intensity” ( Melby et al., 1998 , pp. 7–8). To assess reliability, 20% of the videos were randomly assigned to be coded by two coders chosen at random from the pool of 16 coders. The scores of the two coders were compared, and any scores discrepant by more than one point were resolved by both coders working together. The final set of scores used in analyses included scores that matched across the two coders during their initial individual coding (when codes were off by 1 point, the score from the randomly designated “primary coder” was used), and discrepant scores were replaced by the scores from the second joint coding. Factor analysis reduced the IFIRS codes to positivity, negativity, and effectiveness.

Relationship satisfaction.

Satisfaction was assessed by summing responses on an 8-item questionnaire. The measure was adapted from Rauer et al. (2008) and included items from the General Social Survey ( Davis, Smith, & Marsden, 2006 ). It has been used in large surveys with low-income couples Rauer et al. (2008) and racially diverse couples ( Trail, Goff, Bradbury, & Karney, 2012 ), and has been shown to covary systematically with observed communication ( Williamson, Karney, & Bradbury, 2013 ), thus lending support to its validity as an indicator of relationship functioning. Five items asked how satisfied the respondent was with certain areas of their relationship (e.g., “amount of time spent together”), and were scored on a 5-point scale (ranging from 1 = very dissatisfied to 5 = very satisfied ). Three items asked the degree to which the participant agreed with a statement about their relationship, (e.g., “How much do you trust your partner?”) and were scored on a 4-point scale (1 = not at all , 2 = not that much , 3 = somewhat, 4 = completely ). Scores are a summation of the item responses, with scores ranging from 8 (very dissatisfied) to 37 (very satisfied). Coefficient α exceeded .70 for husbands and wives across all waves of the study.

Observed dyadic communication behavior.

Using the IFIRS, positivity, negativity, and effectiveness scores were calculated for each partner at each of the four assessments and then averaged across spouses to create dyadic indicators of positivity, negativity, and effectiveness. A positivity behavioral scale, accounting for expressions of warmth and closeness within the interaction, was created by averaging an individual’s scores on the group enjoyment, positive mood, warmth/support, physical affection, humor/laugh, endearment, and listener responsiveness codes. Coefficient α for positivity ranged from .65 to .74 for husbands and wives across all waves of the study. A negativity behavioral scale, accounting for anger and divisive behaviors within the interaction, was created by averaging an individual’s scores on the angry coercion, contempt, denial, disruptive process, dominance, hostility, interrogation, and verbal attack codes. Coefficient α for negativity ranged from .76 to .82 for husbands and wives across all waves of the study. An effectiveness behavioral scale, accounting for the couple’s problem-solving skills in resolving an issue, was created by averaging an individual’s scores on the assertiveness, communication, effective process, solution quality, and solution quantity codes. Coefficient α for effectiveness ranged from .65 to .78 across all waves of the study. Possible scores on the measures of observed positivity, negativity, and effectiveness range from 1 to 9. Given the interdependent nature of couples’ behaviors during communication tasks, husbands’ and wives’ scores for positivity, negativity, and effectiveness were averaged to create a dyadic measure for each of the three domains.

Cumulative Stress.

Using three self-report measures, spouses were asked to rate their degree of stress in three domains: work, finances, and discrimination. Work stress was assessed by summing responses on a 5-item questionnaire. Two items assessed the degree of stress of each spouse’s current job over the past month as well as nine months, and three assessed its impact on family. Coefficient α ranged from .58 to .76 for husbands and wives across all waves of the study. Spouses’ perceived experience of day-to-day discrimination was assessed using six questions adapted from the Midlife Development in the U.S. (MIDUS) survey ( Kessler, Mickelson, & Williams, 1999 ). Participants were asked “a series of questions about how people might treat you because of your gender, your ethnicity, or your English speaking ability.” Participants indicated how often they experienced: being treated as inferior, people acting “as if they are afraid of you,” being treated with less respect than others, people acting “as if you are dishonest,” being called names or insulted, and being threatened or harassed. Coefficient α ranged from .69 to .83 for husbands and wives across all waves of the study. The measure of financial stress included five items assessing the degree of difficulty the couple has had fulfilling financial obligations and purchasing necessary items, including food. Coefficient α exceeded .75 for husbands and wives across all waves of the study. To assess the number of domains in which spouses were experiencing significant stress at each wave, three dichotomous values were calculated and summed for each stress domain (i.e., a cumulative stress index; see Evans, 2003 ). Specifically, for each stressor, couples were given a value of 1 if they were in the top 75 th percentile in that stress domain and a value of 0 if below the 75 th percentile. The dichotomous values for the three stress domains were then summed, yielding a score ranging from 0 to 3 for each wave of the study.

Analytic Plan

Data was analyzed using multilevel modeling (MLM). Using Raudenbush, Brennan, and Barnett’s (1995) multivariate approach, analyses were conducted as 2-level models with repeated measures ( Level 1 , within-person) nested within individuals ( Level 2 , between-person). To examine within-person fluctuations from individual means, we used mean/intercept models with no underlying trajectory of change in our study variables. Husbands and wives were included in the same model to account for interdependence in the dyadic data. Analyses were conducted in SAS Studio version 3.7; the variance-covariance matrix was specified as a full, unstructured matrix and the estimation method was specified as Restricted Maximum Likelihood (REML).

Testing Behavioral and Stress Models ( Model 1 and 2 ).

To test covariation between behavior and relationship satisfaction, we use a within-couple model and ask: On waves in which couples display upward fluctuations in positivity, negativity, or effectiveness (i.e., relative to the couple’s own cross-wave average), do spouses report higher or lower relationship satisfaction than usual within that same wave ( Model 1 )? Similarly, to test the Stress Model ( Model 2 ) we use a within-person model and ask: On waves in which individuals experience higher levels of cumulative stress than usual (i.e., relative to their own cross-wave average), do individuals report higher or lower satisfaction than usual? These models allow us to see how fluctuations in behavior and cumulative stress are associated with fluctuations in satisfaction.

We test for within-person effects at Level 1 (repeated observations; see Equations 1 and 2 ) with no predictors at Level 2 (not depicted). Relationship satisfaction at a given wave is modeled as a function of intercept, time, and fluctuations in dyadic positivity, negativity, and effectiveness (Model/ Equation 1 ) or as a function of fluctuations in spousal cumulative stress (Model/ Equation 2 ). We center behavioral variables around the dyad’s mean, and we center cumulative stress around the individual’s mean (creating person-centered variables). Thus, values below zero represent a level lower than average for that dyad or individual and values above zero represent a level higher than average.

Testing Independent Effects of Behavior and Stress ( Model 3 ).

To test whether communication and cumulative stress overlap or remain uniquely predictive of fluctuations in relationship satisfaction, Model 3 includes all three behaviors and the cumulative stress measure simultaneously at Level 1 (see Equation 3 with no predictors at Level 2 ).

Testing Interactive Models ( Model 4 and 5 ).

Two models are estimated to examine multiplicative associations between observed behavior and stress in their prediction of satisfaction. Model 4 tests whether fluctuations in couples’ behavior interact with fluctuations in spousal cumulative stress, allowing us to examine whether upward fluctuations in dyadic positivity/negativity/effectiveness are associated with spouses’ experience of smaller or larger changes in relationship satisfaction when their cumulative stress also fluctuates during the same wave. We test for within-person interaction effects at Level 1 with no predictors at Level 2 ( Equation 4 ).

Model 5 tests whether levels of stress accumulated across the first three years of marriage interact with fluctuations in the three communication behaviors to predict satisfaction, thus allowing us to address whether spouses experiencing consistently high levels of stress also experience smaller or larger changes in satisfaction as observed behaviors fluctuate, as compared to spouses reporting lower levels of accumulated stress. For this analysis we collapsed across time to create a mean rating for each spouse (i.e., T1-T4 average), with higher scores reflecting higher across-time levels of cumulative stress. We now test for between-person effects at Level 2 ( Equation 5 ). At Level 2 , we enter a between-person chronic cumulative stress variable (i.e., T1-T4 mean cumulative stress), thus creating a two-way cross-level interaction.

Descriptive Statistics

Means and standard deviations of all study variables are presented in Table 1 . Dyadic positivity, negativity, and effectiveness were all moderately correlated at baseline ( r = |.18–.32|, p < .01), suggesting that the three dimensions of communication behaviors were related but distinguishable. The correlation between husbands’ and wives’ cumulative stress and intercorrelations between behavior and cumulative stress were all nonsignificant at baseline. A full correlation matrix is presented in Table 1 of the online supplemental materials .

Means and Standard Deviations of Time-Varying Variables

Are Changes in Behavior and Changes in Stress Linked with Changes in Satisfaction?

Model 1: behavior..

Consistent with behavioral conceptions of marriage, fluctuations in communication behavior covaried reliably with fluctuations in relationship satisfaction. When couples were less positive during their interactions relative to their own average, both spouses experienced downward fluctuations in relationship satisfaction within the same wave (husbands’ t = 2.38, p = .017; wives’ t = 2.02, p = .043; see Table 2 , Model 1 ). When couples were more negative than usual during interactions, wives also experienced downward fluctuations in satisfaction ( t = −2.78, p = .005). 1

Hierarchical Linear Modeling Coefficients. Fluctuations in relationship satisfaction as predicted by fluctuations in (1) Behavior, (2) Stress, (3) Behavior and Stress, (4) Behavior * Stress Interactions, and (5) Behavior * Chronic Stress Interactions

Note: Δ = Delta change / fluctuations, Avg. = T1-T4 mean/average. Models also include intercept and time effect (not shown).

Model 2: Stress.

Consistent with socioecological models of relationship functioning, husbands and wives experiencing upward fluctuations in cumulative stress experienced downward fluctuations in satisfaction within the same wave (husbands’ t = −2.02, p = .043; wives’ t = −2.99, p = .002; see Table 2 , Model 2 ). 1

Model 3: Behavior and stress.

To test whether observed communication behaviors and stress account for shared or unique variance in satisfaction, we entered all behavioral and stress variables in the model simultaneously. Results indicate that behavior and stress account for unique variance in predicting satisfaction. Specifically, the three significant effects found for wives’ satisfaction—that is, for positivity, negativity, and for wives’ cumulative stress—remained significant, as did the two significant effects relating positivity and cumulative stress to husbands’ satisfaction (see Table 2 , Model 3 ).

Does Stress Moderate the Association Between Communication and Satisfaction?

Model 4: fluctuations in cumulative stress x fluctuations in behavior..

The association between fluctuations in behavioral negativity and husbands’ changes in relationship satisfaction varied as a function of husbands’ cumulative stress. Specifically, relative increases in observed dyadic negativity were associated with decreases in husbands’ relationship satisfaction when husbands also experienced less cumulative stress, whereas decreases in observed negativity in the presence of less stress were associated with increases in husbands’ satisfaction ( t = −2.00, p = .045, see Figure 1 and Table 2 , Model 4 ).

Interaction between fluctuations in dyadic negativity and fluctuations in husbands’ cumulative stress. When couples were observed communicating more negatively (relative to the couple’s norm) and husbands were concurrently reporting upward fluctuations in cumulative stress, husbands also reported downward fluctuations in relationship satisfaction at the same wave. Note that the simple slope for −1 cumulative stress was not statistically significant ( p = .093). * p < .05.

Model 5: Chronic cumulative stress x fluctuations in behavior.

Finally, we tested whether the association between maladaptive communication and satisfaction would be stronger under conditions of high chronic cumulative stress. The association between fluctuations in observed effectiveness and fluctuations in relationship satisfaction was significantly moderated by spouses’ own chronic cumulative stress (husbands’ t = 1.96, p = .049; wives’ t = 3.32, p < .001; see Table 2 , Model 5 ). Figure 2 depicts the interaction between changes in dyadic effectiveness and average levels of cumulative stress for husbands (left) and wives (right). As Figure 2 shows, decreases in effectiveness were associated with decreases in relationship satisfaction, but only among spouses who had chronically high levels of cumulative stress relative to other spouses. That is, husbands and wives who experienced average or above average levels of cumulative stress over 36 months also experienced downward fluctuations in relationship satisfaction when they displayed less effective communication behaviors during their interactions. Conversely, among individuals experiencing below average levels of chronic stress, fluctuations in observed effectiveness were unrelated to fluctuations in relationship satisfaction.

The interaction between fluctuations in dyadic problem-solving effectiveness and spouses’ chronic level of cumulative stress (i.e., T1-T4 average) is depicted on the left for husbands and on the right for wives. When couples were observed communicating less effectively (relative to the couple’s norm) and spouses reported high chronic cumulative stress (relative to other individuals), spouses reported the greatest downward fluctuations in relationship satisfaction. When chronic stress was low, reduced problem-solving effectiveness was unrelated to satisfaction. †p < .06, *p < .05, **p < .01.

A wealth of theoretical models in relationship science (e.g., attachment, social-exchange, social learning theory) hypothesize that exchanges between partners provide the raw material from which couples evaluate their relationship. Yet empirical tests of these hypotheses—many of which assess communication at one time point—have limited our ability to adequately test whether changes in couples’ behavior predict their satisfaction because reliance on one-time behavioral assessments only permit comparisons between couples rather than behavioral fluctuations within a couple. Moreover, alternative conceptions of relationships (e.g., Bodenmann, 2005 ) hold that spouses’ behaviors, and their global evaluations of relationship quality, are also related to ongoing demands and challenges in their lives. This study examined how couple communication and stress, considered independently and multiplicatively, covary with spouses’ fluctuating evaluations of relationship satisfaction over the early years of marriage.

With tests of our first aim we demonstrated that within-couple fluctuations in communication behaviors and within-person fluctuations in cumulative stress (i.e., the number of stressors individuals accumulated at any given wave) predicted fluctuations in spouses’ own relationship satisfaction. Specifically, when couples expressed less warmth and cooperation (i.e., positivity) and more hostility and sarcasm (i.e., negativity) relative to their own norm, husbands and wives also reported less relationship satisfaction at that same time point ( Table 2 , Model 1 ). Within-person fluctuations in cumulative stress during a given wave were also associated with their own fluctuations in relationship satisfaction. Specifically, upward fluctuations in individuals’ cumulative stress—arising from work, experiences of discrimination, and financial strain—covaried with downward fluctuations in husbands’ and wives’ satisfaction ( Table 2 , Model 2 ). When examining the effects of observed positivity, negativity, and problem-solving effectiveness simultaneously with reports of cumulative stress, results remained consistent ( Table 2 , Model 3 ). Thus we find evidence that fluctuations in communication and in cumulative stress covary with fluctuations in satisfaction, corroborating on the within-person level effects that are familiar at the between-person level. Directions of causation cannot be established with these data, yet we can see that evaluations of relationship quality are reliably linked in predicted directions with changing experiences in dyadic and extradyadic factors.

With the second aim of the study, we integrated behavioral and stress-based views by examining how these elements interacted to predict relationship satisfaction. First, we tested whether the association between fluctuations in behavior and fluctuations in satisfaction were moderated by within-person fluctuations in spouses’ reports of cumulative stress within a given time point. Results depicted in Figure 1 reveal that the simultaneous experience of upward fluctuations in dyadic negativity (relative to that couple’s own norm of negativity) and in husbands’ cumulative stress (relative to his norm in cumulative stress) was associated with downward fluctuations in husbands’ relationship satisfaction. Conversely, husbands’ experiences of upward fluctuations in stress but downward fluctuations in negativity was associated with upward fluctuations in satisfaction. We do not have a ready explanation for this latter effect, though it is possible that relationships improve relative to their own baseline as stress increases to the extent that those stressors are in a manageable range, potentially bringing partners closer together. Outside of this range, higher levels of stress might undermine satisfaction even as negativity remains low (see Tesser & Beach, 1998 ).

Second, we tested whether the same behavior-satisfaction effect was moderated by between-person differences in chronic levels of stress, as averaged across the first three years of marriage. As Figure 2 illustrates, among husbands and wives who reported high chronic cumulative stress from work, discrimination, and finances (relative to other husbands and wives), downward fluctuations in problem-solving effectiveness were associated with downward fluctuations in spouses’ relationship satisfaction. Conversely, among husbands and wives who reported average or below average chronic stress (relative to other husbands and wives), fluctuations in dyadic effectiveness were not associated with spouses’ judgements of satisfaction in the relationship. Although our results were not robust across behavioral codes, obtained findings are not inconsistent with the view that identical forms of observed couple communication—in this case, problem-solving effectiveness—vary in their association with satisfaction as a function of the accumulated demands that spouses are facing. When those demands are high, communication may matter more for relationship satisfaction than when those demands are low (relative to other couples).

Before considering the implications of the study in greater detail, we provide some reasons for caution in interpreting the results. First, given that we studied naturally occurring changes in behavior and stress rather than true experimental manipulation, causal inferences are not possible. Second, although the interacting effects of behavior and stress on relationship satisfaction are statistically reliable, we cannot make strong claims about their magnitude because traditional estimates of effect sizes do not apply to multilevel models ( Holden, Kelley, & Agarwal, 2008 ). Nonetheless, as our figures demonstrate, the scale of changes in our relationship satisfaction variable were not large in magnitude and thus give further reason for caution. Third, our primary dependent variable—relationship satisfaction—may be too broad and undifferentiated to capture outcomes that are crucial to couples living with low incomes. Although they will likely correlate with satisfaction, inclusion of outcomes such as relationship confidence, having a sense of shared purpose, trust, and willingness to maintain the relationship may permit a finer-grained perspective on how couples across the socioeconomic spectrum are managing their partnership. Finally, we remain tentative about the interaction results of the study because, although there is some suggestion that the effects of behavior and cumulative stress are dependent on one another, our evidence is preliminary and results were not always consistent between spouses or across all behavioral codes. Specifically, although acute within-person changes in husbands’ cumulative stress moderated the effect of dyadic negativity on husbands’ satisfaction, we found no evidence for this interaction effect among wives nor for the other domains of communication.

To the extent that we do find interaction results, between-person differences in chronic cumulative stress more consistently interacted with dyadic problem-solving effectiveness in predicting both husbands and wives’ satisfaction. There was no evidence, however, for interactions between chronic stress and the other behavioral codes. Although we had no a priori reason for expecting that the different behavioral codes would interact differently with within-person fluctuations in stress ( Level 1 interaction) versus between-person differences in level of chronic stress ( Level 2 interaction), one possible explanation is that Level 1 , within-person-change interactions may favor behavioral codes that have the potential to be more labile and affect laden, particularly negativity, which are the target of emotion-regulation interventions in skill-based interventions (e.g., communication training in Traditional Behavioral Couple Therapy). It is possible that more frequent assessments of communication tasks (e.g., weekly, monthly) and assessments of stress during interaction tasks would have captured the lability of affect to a greater degree and accordingly detect interaction effects for wives and/or detect interaction effects for positivity to the extent that positivity is more labile within-person rather than between-person. Thus, future studies are needed to replicate and then clarify whether husbands are uniquely vulnerable to acute accumulation of stress interacting with negativity. Experimental work by Bodenmann et al. (2015) does suggest that stressed husbands, compared to unstressed husbands, may become emotionally flooded and display less positivity and more negativity when responding to a stressed partner, though the longer-term implications of this tendency for relationship quality remain unknown. Between-person differences or Level 2 interaction effects, in contrast, might favor codes that fluctuate less within an individual and are more trait-like in couples’ behavioral repertoires. Thus, codes that capture communication effectiveness (e.g., assertiveness, ability to generate high quality of solutions) might be more likely to yield Level 2 interaction effects, perhaps because chronic rather than acute stress poses a direct problem that necessitates long-term planning skills. Nevertheless, because few prior studies examine natural fluctuations in couple communication and few studies test for interactions between observed behavior and stress, our position is speculative.

Notwithstanding the limitations of this study, the results have theoretical implications regarding the role of behavior and stress in intimate relationship functioning. Although it has been largely assumed that the effects of behavioral processes on relationship satisfaction are fundamental and uniform, this study offers some suggestion that the effects of behavior and stress on satisfaction are profitably viewed as interconnected and interdependent. That is, behavioral linkages with satisfaction are not immutable and may differ as a function of spouses’ experiences of chronic stress, and the opposite view is equally valid: that linkages between stress and satisfaction may differ as a function of the fluctuating quality of couple communication. Continued efforts to establish main effects of communication on satisfaction, without consideration of the contextual forces that might be affecting (or are being affected by) communication, likely oversimplifies a more complex and dynamic portrait of how couples navigate their daily lives. Overall, a full understanding how communication processes influence relationship outcomes requires an appreciation of how those processes are situated within the larger array of settings that couples inhabit.

The results of this study also have practical implications for strengthening couple relationships. Future efforts to help couples via existing communication-based skills training may need to be adapted to account for the effects of stress, and might benefit from identifying low-income couples experiencing high levels of social and economic adversity. Indeed, interventions that transcend simple efforts to change basic communication skills with vulnerable populations are already showing promise by focusing specifically on the contexts in which those skills are being enacted. For example, the Protecting Strong African American Families (ProSAAF) program is designed to directly target couples’ daily burdens and stress (e.g., from work, racism, money, family) using cognitive and behavioral techniques in addition to targeting communication skills ( Barton, Beach, Bryant, Lavner, & Brody, 2018 ; Barton et al., 2017 ; Barton, Beach, Wells, et al., 2018 ; Beach et al., 2016 ). Promising results indicate that the ProSAAF intervention can buffer couples from the effects of financial hardship on partners’ relationship confidence over time ( Barton, Beach, Wells, et al., 2018 ). More generally, growing interest in studying and enhancing the relationships of under-resourced couples is now highlighting how communication processes often operate in the service of anticipating or managing circumstances that might otherwise destabilize those relationships, highlighting the need for deeper analysis of how forces operating within and upon couples can be harnessed to enhance their well-being.

Supplementary Material

Supplemental material, author acknowledgements:.

Preparation of this report was supported by Research Grants HD053825 and HD061366 from the National Institute of Child Health and Human Development awarded to Benjamin R. Karney and a National Science Foundation Graduate Research Fellowship awarded to Teresa P. Nguyen.

A portion of the ideas and data appearing in this manuscript were presented at the 2017 annual conference for Association for Psychological Science (APS) and the 2018 annual conference for Association for Behavioral and Cognitive Therapy (ABCT).

1 The pattern of results remained the same after controlling for baseline/initial levels of the time-varying predictors.

Contributor Information

Teresa P. Nguyen, Sonoma State University.

Benjamin R. Karney, University of California, Los Angeles.

Thomas N. Bradbury, University of California, Los Angeles.

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5 Internal Communication Case Studies and Best Practices To Follow

Alex Cleary

Apr 6, 2022

Internal Communications

From employee engagement to workplace culture to change management, businesses often face similar challenges to each other even if those businesses are radically different. While the specifics of these challenges may differ, how other businesses solve these challenges can give you new insights into addressing your own.

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1. Mettler Toledo Saves Days on their Internal Communications with ContactMonkey

When Kate Kraley began as Mettler Toledo’s Marketing Communications Specialist, she wanted to use internal communications to increase engagement and improve communication with employees.

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Kate came to an internal communications department tasked with reaching employees through a number of channels. Email was the main focus of their approach, but this encompassed many forms of communication based on email like employee newsletters, eNews, and quarterly email updates.

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“We faced challenges with Mailchimp. Since we had to leave Outlook to use Mailchimp, we found it was double the work to maintain distribution lists in both Outlook and Mailchimp. The HTML builder in Mailchimp was also difficult to use as it didn’t work well with older versions of Outlook, compromising the layout.”

Kate also needed a way to determine whether Mettler Toledo employees were actually reading her internal communications. She used Mailchimp to track open rate, but wanted more in-depth measures of engagement. That’s when she switched to ContactMonkey.

Kate found ContactMonkey via the IABC Hub in 2018, and began testing it out. ContactMonkey’s all-in-one internal communications software removed the need to switch from tool to tool. Using our email template builder , Kate now builds visually stunning email newsletters and templates without having to navigate away from Outlook:

She also now has access to her own analytics dashboard . Kate analyzes numerous email metrics like open rate, click-through rate, read time, opens by device and location, and more to see which communications are driving the most engagement. With this new centralized approach, Kate knew she had found the right solution:

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2. BASF Manages Their Remote Workforce with ContactMonkey

Mark Kaplan is the Global Communications Manager at BASF’s Agricultural Group —a department of the German chemical company BASF SE. Because BASF has offices and production sites around the world, Mark coordinates with other internal communicators across the company to drive employee engagement.

With the success of any business comes new challenges, and BASF isn’t any different. While Mark knew he had to keep others informed of the latest news from the BASF Agricultural Group, he was aware employees would be receiving news from other parts of the company as well.

With many different departments sending their own internal communications, Mark faced a difficult task: keeping employees engaged while being careful not to overwhelm them with countless emails and updates.

“We try to be very strategic with what we’re sending out because people are already getting a lot.”

Not only did Mark have to find a solution that made his email communications more engaging, but he also had to prove the value of whatever solution he chose to management. How could Mark show that he was increasing employee engagement while avoiding tuning out from oversaturation?

Mark began using ContactMonkey to create better internal communications for BASF employees. Using our drag-and-drop email template builder, he designs emails that maximized communication and minimized distractions, keeping information to just what his recipients needed to know.

Mark uses ContactMonkey’s email template library to save time on his email design process. He also uses the easy drag-and-drop format of the email template builder to add multimedia into his email communications to save space and increase their effectiveness:

Mark uses the email analytics provided by ContactMonkey to determine the best times to send internal emails . Not only does email analytics help Mark increase engagement on his employee emails, but he now has hard data he can show management to prove the value of his internal communications.

“ContactMonkey has been great in that I can download a report, attach it to an email, and send it to our top leadership and say, ‘Oh, wow. 88% of the organization opened this in the last 24 hours, I think we should do more of this.’ It’s that little extra credibility.”

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3. Alnylam Drives Remote Employee Engagement Using ContactMonkey

Employee engagement is crucial for ongoing productivity and growth, and Alnylam’s Brendon Pires wanted to leverage their internal communications to increase engagement.

Brendon is an internal communications specialist at Alnylam —the world’s leading RNAi therapeutics company—and is tasked with keeping their 2000+ employees engaged and informed. But Brendon’s existing internal communications process was leading to issues all over the place.

Like many companies, Alnylam shifted to remote work when the COVID-19 pandemic hit. Brendon knew that employees would be relying on his emails to stay up-to-date on the latest company news and announcements, but their existing internal communications tool wasn’t up to the task:

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• Email design was a chore with a difficult-to-use email builder.
• Intranet traffic was down and Brendon’s emails weren’t driving traffic to it.
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“We were having consistent issues and it had been going on for like a couple of months. It was one issue after the other, between emails not sending because they were getting caught in our firewall, and then tracking not being consistent. So at the end of the day it was kind of like that’s really important, you know? Obviously if I can’t send that email that’s a problem. So that’s what really drove us to look at other solutions like ContactMonkey”

Brendon and Alnylam use Outlook for their employee emails, so he began looking for alternatives to his current software. That’s when Brendon found ContactMonkey.

Right away Brendon had a much easier time creating internal emails using our email template builder. He can create stellar internal emails and email templates that drive more engagement.

Brendon also uses ContactMonkey’s embedded star ratings to let Alnylam employees rate the emails they’re receiving. This helps Brendon and his team zero-in on their most engaging email content. He also uses our email analytics to measure engagement via open rate and click-through rate. He maximizes his results on these metrics by using ContactMonkey’s scheduled email sending:

Using ContactMonkey, Brendon was able to increase email engagement and drive traffic to Alnylam’s internal intranet . He now sends emails without worry of encountering sending errors that can hinder engagement—like Outlook not rendering HTML emails .

“ContactMonkey is really easy to use and allows me to create really nice content. There’s enough customization so we can do what we really want and have some creative freedom.”

4. Travel Counsellors Ltd. Stays Connected with Remote Employees Using ContactMonkey

In an economy deeply impacted by COVID-19, countless companies had to adapt to new challenges. As Community Manager at Travel Counsellors , Dave Purcell experienced firsthand the effects on morale and engagement his over 1,900 partners experienced as result of the quarantine and resulting societal changes.

Dave wanted to regularly check-in on Travel Counsellors franchisees’ wellbeing, and measure their engagement over time. But Dave’s current method of checking-in on an audience of over 1,900 was not up to the task.

Using their existing email software, Dave encountered all sorts of problems when trying to gauge wellness and drive email engagement. He and his team were unable to create personalized internal communications , as they were told it just wasn’t possible with their existing “solution”. They also experienced numerous tracking issues, as they were receiving tracking numbers that didn’t make any sense.

“The stats we had previously were unusable and that’s the easiest way I can put it. I was getting 200% open rates, which was just impossible.”

Realizing that email tracking and personalization were must-have features for him and his team, Dave sought a new email software that could deliver what he was looking for.

With the aim of sending personalized emails and tracking wellness in his organization, Dave was immediately impressed by ContactMonkey. “I stumbled across ContactMonkey, and everything just screamed: ‘This is the right platform for us’. It’s pretty fantastic.”

Dave uses ContactMonkey’s merge tags to create personalized subject lines and body copy based on the recipient:

He also began using emoji reactions on his weekly employee newsletters , using them as a pulse check survey for his audience.

“Mindset and wellbeing have always been a big part of what we do. It’s even more so now. Our franchisees craved that personal interaction. ‘Welcome to a Brand New Week’ checks in with them on a Monday, sees how they’re feeling with emoji reactions. And we do the same on a Friday.”

In addition to customization and surveys, Dave uses our email template builder’s custom employer branding options to save time on creating his email newsletters. All of this is driven by email analytics that help Dave and his team determine which content is generating the greatest engagement.

“Our commercial team is looking at what people are engaging with in terms of link clicks and what they’re not engaging with and changing our tactic depending on that. We also send an update from our CEO and we can now track this more accurately. We’re getting a 90% open rate within two days.”

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5. Exemplis Boosts Internal Communications Engagement with ContactMonkey

When Corey Kachigan arrived at Exemplis as Engagement and Communications Lead, she knew she had her work cut out for her. Exemplis—the largest volume manufacturer of office seating in North America—was experiencing rapid growth but did not have any sort of internal communications strategy . Corey knew if she wanted to properly manage Exemplis’ ongoing growth, she’d need to make internal communications an indispensable part of the business.

Before Corey arrived, Exemplis’ existing internal communications consisted only of random announcements and update emails. They had no defined approach for sending internal communications, which lead to emails that can cause employees to tune out.

“Our receptionist would email: ‘Hey, whoever left their coffee mug in the sink, please clean it and take it back to your desk.’ And it’s like, okay, that just went to 200 people.”

Corey and her team knew they had to harness their email resources better, and wanted a way to measure what employees actually wanted to see.

“We need some metrics to gauge whether this is working or not. We’re rolling out all these things, but we can’t tell if employees are even clicking these emails. Our team is inundated with hundreds of emails a day. How do we know they are reading these and how do we know they find it valuable? We have no idea.”

They also wanted to use emails to align their ever-growing employee base with Exemplis’ core values and vision. Using Mailchimp—an external marketing email tool—resulted in more problems than solutions. Corey experienced issues with importing and tracking emails within Outlook. She realized that Mailchimp is not for internal communications , and set out to find a new solution to power her employee emails.

So Corey began searching for a new email software for internal communications. Creating a definite approach to internal communications was just one priority of hers; she also wanted to prove the value of internal communications to management using hard data.

What first stood out to Corey about ContactMonkey was the crisp layout and that it worked with Exemplis’ existing Outlook system. ContactMonkey uses your company’s existing email services, and this meant Corey would no longer encounter internal email problems caused by an external tool like Mailchimp.

Corey now uses email metrics and employee feedback to inform her internal communications approach. She features pulse surveys on her internal emails, and uses the results in combination with email metrics to pinpoint what Exemplis employees want to see.

With ContactMonkey’s email analytics, Corey can point to real engagement data to back up her internal communications objectives.

“The thing I love about ContactMonkey is that it allows us to communicate more consistently with our team, but also be able to have the data to back it up. When we used to send out newsletters, we didn’t really have a way to see who did or didn’t open it, who clicked what and they couldn’t interact with the communication besides reply to me, which was super cumbersome.”

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• Volume 8, Issue 1
• Incivility in healthcare: the impact of poor communication
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• http://orcid.org/0000-0002-8295-1138 Joseph H Guppy 1 ,
• http://orcid.org/0000-0003-1387-9707 Hedda Widlund 2 ,
• Ross Munro 1 ,
• Jim Price 1
• 1 Department of Medical Education , Brighton & Sussex Medical School , Brighton , UK
• 2 University Hospitals Sussex NHS Foundation Trust , Worthing , UK
• Correspondence to Dr Ross Munro, University of Brighton, Brighton, UK; r.munro{at}bsms.ac.uk

Incivility is a common issue within healthcare in the UK and internationally. Experienced by at least one-third of staff within the UK National Health Service, incivility has been demonstrated to have significant negative implications on both patient care and healthcare staff. These include contributing to direct medical errors, diagnostic inaccuracy and team communication, with a large associated cost burden, while for staff it has significant negative impacts on retention, productivity and morale. Proposed methods do already exist to both prevent and address incivility, and it is in the interest of healthcare institutions, for their patients and staff, to investigate incivility and adopt these methods. This review explores existing literature on the effects of incivility, researched strategies to address it, as well as the proposed ways of integrating these. Through raising awareness and exploring these issues, our aim is to increase recognition of incivility, as well as inspire healthcare managers and leaders to collectively take efforts to reduce the rates of incivility.

• health policy
• multi-professional

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/leader-2022-000717

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What is incivility?

Communication is an essential aspect of good healthcare. Whether to aid diagnosis through history taking, discuss management options or facilitate difficult conversations, communication is key throughout. 1 The importance of effective communication between patients and healthcare providers (HCPs), has been complemented with the progressive realisation of its importance between HCPs themselves. 2 As medicine moves increasingly towards multidisciplinary patient-centred care, with its coordinated approach shown to reduce medical error and patient harm, effective HCP–HCP communication is ever more relevant. 3

A key component in ensuring effective HCP–HCP communication is civility. 4 Unfortunately, civility can easily be impacted by stressful work environments common within healthcare, in turn adversely affecting teamwork and communication. 4 When unchecked, incivility can propagate throughout a team and gradually become accepted behaviour throughout. 5

Incivility can be defined as ‘rudeness and disregard for others in a manner that violates norms for respect’. 6 It may manifest as dismissive, undermining comments or tone of voice, which creates tension and unease. Examples include making condescending or demeaning remarks, overriding decisions without giving a reason, insulting or shouting at someone. 6 Incivility is distinct from bullying, and while the effects can be similar, incivility is more prevalent, yet many studies and surveys focus on bullying. 4 7 Incivility can be seen as more subtle relative to bullying which is more overt. However, with its potential to affect both patient care and staff well-being, understanding how and why incivility occurs, and how to address it, is essential for a cohesive healthcare system.

This literature review explores the current state of incivility within healthcare, with a particular focus on the United Kingdom’s National Health Service (NHS). Following this, various evidenced effects of incivility on patients, staff and the wider functioning of a healthcare service are explored, together with what already is, and can further be done to address incivility.

What is the current state of incivility within the NHS?

The extent of incivility has been reflected in the annual NHS Staff surveys. Most recently, the survey showed almost 30% of respondents did not feel they worked with colleagues who were polite or treated others with respect. 8 Bradley et al ’s 2015 survey directly studied incivility amongst doctors across three large UK tertiary care centres. 7 They found 31% experienced incivility on a daily or weekly basis, whilst 1%–3% felt they experienced being bullied, and 51% of respondents in the NHS Staff Survey admitted they do not report bullying to begin with.

These percentages have worsened since the NHS Staff survey was first introduced in 2003, and have been largely static since 2019, despite political and managerial recognition of the need to address this in the NHS Long Term Plan. 8 9 However, it seems the need to reframe our mindset of negative workplace behaviours away from primarily ‘bullying’ to more widely inappropriate or uncivil behaviour, is becoming increasingly apparent, with the latest NHS surveys from 2021 highlighting ‘respect and civility’ as a distinct subsection. Such recognition may improve identification, reporting and addressing such behaviours in the future.

Impact of incivility on patient care

The link between workplace incivility and patient care has been evidenced numerously in the literature, including acute patient management, teamwork, prescribing and medication administration errors. 10–12 Riskin et al showed ‘rudeness’ resulted in a 12% reduction in diagnostic and procedural performance, when looking at management of an acutely deteriorating neonate in a simulation scenario. 10 Katz et al later demonstrated a causal association between incivility and a wide range of performance metrics in a similar acute simulated environment, including diagnostic accuracy, responsiveness, effective communication and patient management. 11 Interestingly, while those exposed to incivility performed significantly worse in every assessed domain, more than a third in those groups were unaware of their performance being affected. Therefore, as self-reporting may be insufficient, the added dilemma when trying to address incivility includes how to adequately monitor it.

Second, with regard to the impact of incivility on medication errors, Johnson et al ’s randomised controlled study noted higher error rates in medication prescription and administration during cardiopulmonary resuscitation simulations. 12 In this study, nurses were randomly assigned to ‘rude’ or ‘not rude’ groups with other actors and were assessed on performance and teamwork for cardiopulmonary resuscitation. Six of the 10 ‘rude’ groups made a major error in the cardio-pulmonary resuscitation protocol, while the ‘not rude’ control group made none. These findings were concordant with Bradley et al’s survey, which found 7% of doctors felt that ‘Rude, Dismissive and Aggressive’ communication, directly led to them making errors in their work. 7

In addition, acute stress, such as that resulting from incivility, has been shown to impair working memory, team performance and willingness to help others, while incivility itself can result in the affected staff member becoming aggressive or obstructive themselves. 13 14 Therefore, recognising the need for how staff can manage and address incivility is also essential, to improve effective working and prevent incivility spreading further.

Beyond the immediate impacts of incivility on patient care described above, its effects can propagate throughout the healthcare system. This leads to patient care being affected due to organisational shortcomings. Hutton and Gates found that incivility from both senior team members and patients, has an inverse relationship to staff productivity. 15 Additionally, the Francis Report (2013) highlighted how bullying can affect the organisation-wide delivery of effective and safe patient care. 16 The culture within Mid Staffordshire Hospital at the time allowed for poor team cohesion and incivility to develop, which not only critically impaired patient care, but also delayed the ability to speak out and address issues. 16

Finally, from an even greater macroscopic perspective, bullying has been shown to have a financial cost to the NHS as a whole, through the monetary sequelae of many of the previously described effects above. Kline and Lewis calculated the annual economic impact of bullying and harassment on NHS England to be £2.281 billion in 2018, almost 2% of the total NHS budget at the time. 17 They included factors such as impact on productivity, absentee rates, employee turnover and medicolegal effects of bullying-related errors. However, the authors also noted other costs associated with bullying exist which they were unable to calculate, thus the monetary impact is likely to have been even higher. Six years later, with increased work pressures, recovering from the effects of the COVID-19 pandemic, together with monetary inflation, the importance of reducing the economic impact of incivility to maintain good patient care is even greater. 18

Impact of incivility on healthcare staff

The wide-reaching negative implications of incivility on staff members’ psychology and productivity have been studied. 19 20 Regarding absenteeism, according to the latest NHS Staff Survey, 44.8% of staff reported feeling unwell as a result of work-related stress. 6 This figure lies within the range of other estimates of bullying-related absentee rates in previous years and across different countries. 21–23 Prepandemic data also note growth in healthcare output is significantly outpacing growth in workforce numbers, and so staff retention, well-being and minimising avoidable sick leave is essential for safe staffing levels. 24

Regarding staff turnover rate, a meta-analysis focused outside of healthcare, found that workplace bullying and harassment increased the rate at which staff left their employment, while smaller studies have found similar correlation within healthcare settings. 25–27 According to NHS Workforce Analytics, in 2020, NHS England faced a shortfall of 115 000 full-time equivalent staff, projected to double by 2025 and almost quadruple by 2035. 28 In the context of the NHS’s limited human resources, current staffs’ psychology and work ethic should clearly be prioritised when looking at efficiency, as well as staff retention and morale.

As opposed to staff leaving work, incivility can also lead to ‘negative presenteeism,’ whereby staff may turn up to work, but they lack morale and perform poorly. 17 29 Kabat-Farr et al found workplace incivility can lead to reduced self-esteem and greater work withdrawal. 30 Additionally, the authors of the above study found negative emotional effects were amplified in ‘committed’ staff, as self-assessed using a survey. In other words, more conscientious staff, a desired trait for healthcare workers, are most affected by incivility.

Further to Kabat-Farr et al ’s association of the emotional impacts of incivility, Felblinger described the shame response elicited by some HCPs when subject to incivility. 20 She described how, as a response to bullying, one may develop ‘inner-directed anger’ and subsequently become ‘revictimised’. The psychological effect of incivility can understandably lead to disengagement from work, emotional exhaustion and staff burn-out. Bradley et al again highlight how incivility significantly impacted those affected, with 40% reporting moderate or severe psychological and productivity effects on their working day. 7

Finally, incivility has negative implications for staff learning and development. During busy times, service provision inevitably takes precedence over learning, however, learning is integral to professional development, and so cannot be neglected. 31 Incivility and perceived stressors can both fuel each other and impair memory and learning. 32 Billet argues that staff readiness to learn depends on how ‘invitational’ the workplace learning environment is. 33 If a trainee is overworked or undermined, any chance for self-development and learning will be limited. 32 33

Instigating positive change

Considering the breadth of implications demonstrated, the question remains: ‘why is the situation not improving?’. Difficulties may lie in identifying the sources of incivility, devising sustainable strategies to reduce or prevent it, and challenges in reporting.

In 2005, the nationwide American study, ‘Silence Kills’ observed healthcare staff’s reluctance to speak-out on issues. 34 Incivility (witnessed by 77% of respondents), was one of seven reoccurring areas of clinical concern HCPs found difficult to challenge. Twenty per cent of respondents reported seeing patient harm occur as a direct result of the concerning behaviour, despite only 7% stating they raised concerns, and even fewer when cases involved incivility. Similarly, UK data from the NHS Staff surveys, show that at least half of all staff do not raise concerns. 8 A 2013 cross-sectional analysis of seven NHS trusts found common barriers to speaking out, including a perception nothing would change, and a fear of repercussions. 35 Thus, healthcare staff need to feel the benefits of speaking out and be assured that any perceived harm of doing so will be minimal.

What is currently being done to address incivility in the NHS

The need to address workplace incivility has been recognised within the wider NHS, and despite statistics in the annual NHS surveys not improving, progress has indeed been made in devising strategies to do so.

A significant player in addressing incivility can be seen as the development of the ‘freedom to speak up guardian’ role. Introduced after the 2013 Francis Report, this mandatory role is designed to help support staff to speak up and raise issues and address barriers to doing so. 36 They are responsible for looking into reported concerns, and a key focus is around the learning and reflection process that results from this. The focus is on moving away from a ‘blame culture’, and towards one of learning from mistakes, and ultimately improving patient care. 36 Issues that may be reported and investigated are wide ranging but do, for example, include negative behaviours such as bullying. Incivility naturally falls under the remit of the freedom to speak up guardian in the same manner, and can provide a pathway for staff to report concerns they may be experiencing, including doing so anonymously if desired.

Recently, the NHS brought attention to the issue of incivility through their ‘anti-bullying awareness week’ in 2022. 37 In recognising the prevalence of incivility, as well as the negative effects it can have on staff and patient care, the NHS England Civility and Respect Team hosted a series of events to raise awareness and encourage the raising of issues encountered. In particular, the week’s aim was to encourage staff to ‘reach out’ about incivility issues. Themes such as this work towards addressing the gaps in reporting, for example, as mentioned in the aforementioned ‘Silence Kills’ study. 34 Further to this, the NHS Civility and Respect programme has created resources, including interactive toolkits, posters, a ‘cost of bullying calculator’, among others, for staff and employers to address incivility in their individual workplaces. 37

Several Royal Colleges have also provided insight into their stance on incivility. The Royal College of Physicians, for example, outlines their expectations in their code of conduct, which include for colleagues to act with respect, kindness, and foster collaborative and supportive working, and to recognise our impact on others. 38 Similarly, steps taken by the Royal College of Nursing include publishing a ‘healthy workplace toolkit’, which aims to foster inclusive workplace cultures, by sharing tools and techniques to tackle factors which lead to stress and poor mental health including incivility. 39

More ‘grassroots’ campaigns also highlight the issue around incivility, for example, the ‘Civility Saves Lives’ campaign. 40 Run by several NHS staff members, the collaboration aims to raise awareness of the issues, and the evidence available of the impacts on patient care. Additionally, the now widespread ‘Hello my name is…’ initiative by Dr Kate Granger, although primarily focused around improving compassionate care and communication with patients, also has a knock-on effect for interactions between healthcare professionals. 41 The simple act of wearing a name badge to identify oneself when working with often new and rotating colleagues, takes steps towards improving civility in the workplace, through more personable and civil interactions.

Regarding staff themselves, workplace reviews can provide opportunities for issues to be raised. Looking, for example, at doctors, the Annual Review of Competence and Progression and multisource feedback forms, among others, naturally provide a pathway whereby issues around behaviour and incivility can be picked up. Colleagues and supervisors are able to provide anonymous feedback on a range of aspects, with some specific points related to teamwork and behaviour. 42 Such issues would then be of notice to the trainee’s supervisor or tutor, and able to be addressed accordingly, with the level of action appropriate to the concern raised.

Despite not being an exhaustive list, the above does highlight the recognition of both the issue of incivility, and the need to address it. Why the situation is not improving, therefore remains a challenge. It may be that while the resources are available, how commonly these resources are utilised, or how widespread knowledge of their availability is, could potentially be improved. Perhaps by individual trusts providing information on their own guidelines, policies and pathways, for example, through inductions, bulletins and by educating managers and supervisors around them, it may improve awareness of these resources and help affected staff in accessing them.

Strategies for change

Several successful strategies have been shown to reduce incivility through a comprehensive organisation-wide approach. 43–46 An example is Holloway and Kusy’s Toxic Organisational Change System. 44 This three-tiered approach encourages cultural and policy change at the organisational, team and individual levels, with the overarching themes at each level illustrated in figure 1 .

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Strategies used at each level within the Toxic Organisation Change System (figure adapted from article) 44

Further, an important aspect in addressing incivility is identifying why it has occurred, for example, if the person themselves is overworked or overburdened, and ways of addressing these looked at, rather than purely disciplinary actions considered. In addition, an important point by Bradley et al highlight how attempts to avoid incivility should not impact assertive communication when required, for example, in emergency situations. 7 While self-awareness and recognising incivility is important, the high-pressure environments of healthcare can naturally lead to anyone falling short and acting negatively. It is the ability to recognise this, and respond to those situations, for example, through debriefing or apologising, that are important, and actions to address incivility ought to be proportionate to the scenario it has occurred in. 46

While theoretically ideal, a comprehensive, multilevel strategy may prove difficult to implement in a busy, strained healthcare organisation with competing targets.Felblinger on the other hand, rather than promoting a specific model, proposed five criteria for a successful organisational approach to addressing incivility ( figure 2 ), recognising the individual constraints within each organisation. 45

Key criteria for a successful programme to address incivility. Adapted from Felblinger. 45 .

An alternative approach to address incivility is highlighted through Hickson et al ’s strategy of education and empowering medical staff to challenge incivility themselves. 46 Approaches are graduated depending on the degree of harm or number of incivility events from an informal ‘cup of coffee’ conversation to disciplinary actions. They argue the former should be taught to physicians just as breaking bad news communication is taught. Some organisations might find this staff-focused approach to be more practical than a multilevel organisational model, given their individual circumstances.

Finally, an aspect which should not be overlooked when applying a strategy to reduce incivility and its impact on care, is with regard to those affected by it. Support services for bullied staff and remedial intervention for any patient harm occurred are both important considerations. 44

Going forward

Bringing the above together, and considering the steps taken with the NHS thus far, several areas that could be developed further have been considered in figure 3 . Nationally led initiative should involve continuing to raise awareness of the impacts of incivility. Regional initiative could involve ensuring local guidelines and policies promote civility and address incivility, which could involve incorporating teaching into inductions, having named representatives at senior level to take responsibility for dealing with cases of incivility. Concomitantly, structures should be in place to support both those affected by incivility and those reported to cause incivility such as through occupational health. Within departments, the staff members need to feel comfortable that they can raise any issues with relevant personnel without fear of repercussions and knowing their concerns will be recognised and acted on.

Synthesis of strategies to address incivility within healthcare at different levels of the healthcare system.

Review limitations

The literature search for this article involved a comprehensive search of English language articles available on Google scholar and PubMed as well as independent organisational reports. However, this article did not evaluate grey literature including unpublished material and is therefore susceptible to publication bias.

This article focuses on the impact of incivility on staff and the provision of care within the NHS specifically. This is not an exhaustive evaluation of all the research regarding healthcare focused workplace incivility. In addition, this article discusses incivility within the context of the NHS based on research from multiple different health systems across different countries. This raises the question of applicability of research which the authors have tried to address within the discussion.

In addition, it is recognised that the authors of this paper write from a primarily medical background, and although reference is made to the NHS as a whole, and research looks at varying members of the multi-disciplinary team, insight from specific allied healthcare professionals may be more limited, and further review of these avenues could be useful next steps in addressing the issues raised.

Finally, within the introduction the authors attempt to adequately distinguish the distinct boundaries between incivility and bullying, however, the authors have identified some overlap between the two phenomena within the literature. Consequently, the authors would encourage future research in this field to adequately define and distinguish between incivility and bullying to ensure precision of definitions and the efficacy of strategies to tackle both incivility and bullying in the future.

As demonstrated throughout, incivility has been shown to significantly impair patient care and negatively impact healthcare staff in a plethora of ways. However, untangling incivility from within an institution is not straightforward. This review describes a number of initiatives that currently exist within the NHS, and several further methods evidenced in the literature, to address this issue. Taken together, these involve first highlighting the issue of incivility, ensuring robust recognition and reporting policies are in place, and devising mechanisms to confront incivility. These mechanisms are likely best personalised to fit within the existing infrastructure of a healthcare trust or organisation, with several such mechanisms already evidenced to work in different healthcare institutions around the world. This review, like elsewhere in the literature, once again highlights the importance of tackling incivility and explores some of the successful models evidenced in the literature, for the benefits of not only staff, but patient care and safety.

Ethics statements

Patient consent for publication.

Not applicable.

• Foronda C ,
• MacWilliams B ,
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Contributors JG, HW and RM are junior doctors trained at UK undergraduate medical schools and working within the NHS. JP is director of postgraduate medical and clinical education at Brighton and Sussex Medical School. The authors collaborated on this paper following the PGCert in Medical Education’s module ‘Advanced Communication in Skills and Strategies in Medical Education’ led by JP. JG was the lead writer of the paper, HW supported with the design, review and edits of the paper, RM supported initial conceptualisation, review of the paper and design of figures, JP supervised and provided final edits.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient and public involvement statement Input from patients’ experiences were not sought, however, JG drew on first-hand experiences of incivility and collaborated with the other authors on this.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

ANDY LAZRIS, MD, CMD, Personal Physician Care, Columbia, Maryland

ALAN R. ROTH, DO, FAAFP, FAAHPM, Jamaica Hospital Medical Center, Jamaica, New York

HELEN HASKELL, AND JOHN JAMES

Am Fam Physician. 2021;103(12):757-759

Author disclosure: No relevant financial affiliations.

Case Scenario

A 48-year-old patient presented with a history of major depressive disorder and mildly elevated blood pressure. After two separate blood pressure measurements of 155/90 mm Hg, the patient's physician prescribed daily hydrochlorothiazide (HCTZ) to lower blood pressure. The patient asked if there was anything important to know about the medication, and the physician said the patient should eat a banana daily to keep potassium levels up. The patient was advised to follow up in the future. The physician did not ask about any other medications the patient was taking or other health habits, and additional blood tests were not ordered.

The patient was taking escitalopram (Lexapro), which a psychiatrist prescribed, was an avid runner, and often fasted one day per week for health reasons. The patient took the HCTZ as prescribed and, over the next few weeks, began to feel weak and dizzy. The patient called his physician, who diagnosed acute labyrinthitis over the phone and prescribed meclizine for vertigo. The patient's symptoms worsened despite the new medication, and the patient passed out during a run one week later, on a day of fasting. At the emergency department, the patient's blood pressure was 75/50 mm Hg, potassium was 2.3 mEq per L (2.30 mmol per L), and sodium was 117 mEq per L (117.00 mmol per L). The patient was admitted to the hospital, and the HCTZ was immediately discontinued.

Clinical Commentary

Good communication between physicians and patients is essential to enable good outcomes and avoid medical errors. Sometimes patients cannot express their concerns and needs clearly. Conversely, physicians often overestimate their communication skills, and such skills have been shown to decline during a physician's career. 1 Breakdown in communication can lead to harm and suboptimal treatment. A previous article in American Family Physician highlighted the importance of involving the patient as a partner in the diagnostic process, 2 something that can only occur with good physician-patient discourse.

Poor communication can lead to a medical error when a patient does not report their allergies or health history to a physician, or when a physician does not correctly or thoroughly record a medical history or medication list, as in this patient's case. When clinicians do not communicate well with each other, errors can occur because of incorrect or missing information. 3 But harm may also occur when patients do not follow a prescribed course of care or physicians do not inform patients of potential risks of treatment.

Studies have shown that ineffective clinician communication can reduce patient adherence to care. One study found that when patients believed communication was optimal, 70% followed recommendations, whereas when communication was deemed poor quality, only 50% did. Patients with lower adherence had worse outcomes and a substantially higher cost of care. 4 In 71% of cases in which patients did not follow a physician's care plan, they did not agree with what the physician recommended, or they did not fully understand the physician's instructions. This can occur when a physician does not explain the recommendations adequately and does not allow patients to ask questions or voice their beliefs or concerns. 5 When patients are allowed to tell their story and physicians explain information in a way that patients understand, adherence and quality of care improve without increasing the patient visit time. 6 Good communication has been associated with higher patient satisfaction, increased adherence to therapy, better control of blood glucose and blood pressure, fewer medical mistakes, and increased symptom resolution. 7

What constitutes effective physician-patient communication? Often it is spending time listening to a patient's needs and wants and understanding each patient's circumstances. A short discussion of the patient's health habits would have impacted medication choice for this patient. Studies suggest that listening, explaining, and having empathy are the three most important factors in increasing patient satisfaction and outcome. 5 Studies show that poor communication leads to a poor sense of physical and mental health compared with more optimal communication. 4 When physicians do not sufficiently explain interventions, do not respect the health beliefs of their patients, and do not try to reach consensus, the likelihood of therapeutic failure and error increases.

Poor communication can lead to a nocebo response, in which patients feel they are not being heard, do not convey all their health information to the physician, and tend to ignore advice. 8 For this patient, the physician's limited questioning created a breach where the patient did not convey important information to the physician and impeded the physician from recognizing symptoms that were caused by a medication the physician prescribed.

Physician-patient discourse should occur in a language and at a health literacy level that patients understand. Using relative numbers (e.g., 50% reduction in stroke, as in this patient's case) is confusing to patients and does not help them understand actual risks and benefits. The use of absolute numbers or the number needed to treat is more comprehensible and accurate.

Good communication does not take more time; it only requires a physician to consider it important and be adequately trained. Good communication has been shown to be as important as many prescribed therapies, possibly contributing to the beneficial effects of antidepressants and dementia drugs. 7

Patient Perspective

Good communication and good patient care are closely intertwined in primary care, as this patient's case illustrates. The physician presumably had access to the patient's medication list and possibly to information about the patient's dietary and exercise habits. That the physician did not take these factors into account suggests that the patient's electronic health record had not been reviewed or that the physician was unaware of the documented interaction between escitalopram and diuretics. The patient's subsequent phone report of a well-known adverse effect was attributed to a new and unrelated disease process (labyrinthitis), which suggests the same casual attitude toward the patient's history. Did the physician not remember the prescription for HCTZ? Should the physician have asked about the patient's current blood pressure readings? In both instances, asking the patient a couple of simple questions would have elicited the necessary information even if it were unavailable from other sources .

To say that the patient did not convey important information to the physician misses the point. The patient's actions indicate that the patient was a health-conscious and conscientious individual. The patient exercised regularly, paid attention to diet, followed the physician's recommendations, and called about new symptoms when they appeared. The patient asked the physician the key question that should have opened up the shared decision-making process: “Is there anything I need to know about this medication?” The physician deflected the question with a suggestion to eat bananas .

A patient would rarely persist in light of such a response. Patients have been acculturated to believe that physicians should not be questioned, and most patients might assume there is nothing to be concerned about if a physician does not mention it. This patient had probably filled out forms documenting medications and health habits and reasonably assumed these were considered. It is incumbent on clinicians to be familiar with the possible adverse effects and interactions of the medications they prescribe and share that knowledge with their patients .

The interactions between this patient and physician raise further concerns. It may be premature to prescribe an antihypertensive medication after only two blood pressure measurements without considering the possibility of white coat hypertension. Asking the patient to take their blood pressure at home would have provided a layer of protection against adverse events and would, in all likelihood, have prevented the alarming experience of passing out and going to the emergency department .

The misdiagnosis of labyrinthitis is troubling because it was made without the patient being examined. This is a serious diagnostic error mediated by poor communication that may be replicated many times as medical care shifts to more virtual visits. It is the physician's responsibility to know when a virtual assessment is sufficient and when it is not .

Resolution of Case

By not taking time to thoroughly discuss the patient's medications, health habits, and exercise routine, the physician prescribed a medication that was not optimal and potentially dangerous. The physician did not arrange a follow-up appointment and laboratory tests, adequately discuss the possible risks of the medication they prescribed, or take the correct actions when the patient called and reported dizziness.

Before discharge, the hospital team contacted the patient's physician to determine a blood pressure medication that would work well based on the patient's lifestyle and comorbidities. They chose low-dose lisinopril. The physician spoke with the patient at the time of discharge to discuss why the previous medication caused a severe reaction and possible adverse effects of the new medicine. They both agreed to be more forthright in their communication. A follow-up appointment was arranged for one week after discharge.

Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.

Ely JW, Graber ML. Preventing diagnostic errors in primary care. Am Fam Physician. 2016;94(6):426-432. Accessed April 1, 2021. https://www.aafp.org/afp/2016/0915/p426.html

Dingley C, Daugherty K, Derieg MK, et al. Improving patient safety through provider communication strategy enhancements. In: Henriksen K, ed. Advances in Patient Safety: New Directions and Alternative Approaches . Agency for Healthcare Research and Quality; 2008.

Okunrintemi V, Spatz ES, Di Capua P, et al. Patient-provider communication and health outcomes among individuals with atherosclerotic cardiovascular disease in the United States: medical expenditure panel survey 2010 to 2013 [published correction appears in Circ Cardiovasc Qual Outcomes . 2017;10(8):e000031]. Circ Cardiovasc Qual Outcomes. 2017;10(4):e003635.

Institute for Healthcare Communication. Impact of communication in healthcare. July 201 1. Accessed August 1, 2020. https://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

Riedl D, Schüßler G. The influence of doctor-patient communication on health outcomes: a systemic review. Z Psychosom Med Psychother. 2017;63(2):131-150.

Travaline JM, Ruchinskas R, D'Alonzo JE. Patient-physician communication: why and how. J Am Osteopath Assoc. 2005;105(1):13-18.

Greville-Harris M, Dieppe P. Bad is more powerful than good: the nocebo response in medical consultations. Am J Med. 2015;128(2):126-129.

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at https://www.aafp.org/afp/rightcare .

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3.1: Case Study- The Cost of Poor Communication

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No one knows exactly how much poor communication costs business, industry and government each year, but estimates suggest billions. In fact, a recent estimate claims that the cost in the U.S. alone are close to $4 billion annually! [1] Poorly-worded or inefficient emails, careless reading or listening to instructions, documents that go unread due to poor design, hastily presenting inaccurate information, sloppy proofreading — all of these examples result in inevitable costs. The problem is that these costs aren’t usually included on the corporate balance sheet at the end of each year, so often the problem remains unsolved.

You may have seen the Project Management Tree Cartoon before ( Figure 1.4.1 ); it has been used and adapted widely to illustrate the perils of poor communication during a project.

The waste caused by imprecisely worded regulations or instructions, confusing emails, long-winded memos, ambiguously written contracts, and other examples of poor communication is not as easily identified as the losses caused by a bridge collapse or a flood. But the losses are just as real—in reduced productivity, inefficiency, and lost business. In more personal terms, the losses are measured in wasted time, work, money, and ultimately, professional recognition. In extreme cases, losses can be measured in property damage, injuries, and even deaths.

The following “case studies” show how poor communications can have real world costs and consequences. For example, consider the “ Comma Quirk ” in the Rogers Contract that cost $2 million. [3] A small error in spelling a company name cost £8.8 million. [4] Examine Edward Tufte’s discussion of of the failed PowerPoint presentation that attempted to prevent the Columbia Space Shuttle disaster. [5] The failure of project managers and engineers to communicate effectively resulted in the deadly Hyatt Regency walkway collapse. [6] The case studies below offer a few more examples that might be less extreme, but much more common.

In small groups, examine each “case” and determine the following:

• Define the rhetorical situation : Who is communicating to whom about what, how, and why? What was the goal of the communication in each case?
• Identify the communication error (poor task or audience analysis? Use of inappropriate language or style? Poor organization or formatting of information? Other?)
• Explain what costs/losses were incurred by this problem.
• Identify possible solution s or strategies that would have prevented the problem, and what benefits would be derived from implementing solutions or preventing the problem.

Present your findings in a brief, informal presentation to the class.

Exercises adapted from T.M Georges’ Analytical Writing for Science and Technology. [7]

CASE 1: The promising chemist who buried his results

Bruce, a research chemist for a major petro-chemical company, wrote a dense report about some new compounds he had synthesized in the laboratory from oil-refining by-products. The bulk of the report consisted of tables listing their chemical and physical properties, diagrams of their molecular structure, chemical formulas and computer printouts of toxicity tests. Buried at the end of the report was a casual speculation that one of the compounds might be a particularly effective insecticide.

Seven years later, the same oil company launched a major research program to find more effective but environmentally safe insecticides. After six months of research, someone uncovered Bruce’s report and his toxicity tests. A few hours of further testing confirmed that one of Bruce’s compounds was the safe, economical insecticide they had been looking for.

Bruce had since left the company, because he felt that the importance of his research was not being appreciated.

CASE 2: The rejected current regulator proposal

The Acme Electric Company worked day and night to develop a new current regulator designed to cut the electric power consumption in aluminum plants by 35%. They knew that, although the competition was fierce, their regulator could be produced more cheaply, was more reliable, and worked more efficiently than the competitors’ products.

The owner, eager to capture the market, personally but somewhat hastily put together a 120-page proposal to the three major aluminum manufacturers, recommending that their regulators be installed at all company plants.

She devoted the first 87 pages of the proposal to the mathematical theory and engineering design behind his new regulator, and the next 32 to descriptions of the new assembly line she planned to set up to produce regulators quickly. Buried in an appendix were the test results that compared her regulator’s performance with present models, and a poorly drawn graph showed how much the dollar savings would be.

Acme Electric didn’t get the contracts, despite having the best product. Six months later, the company filed for bankruptcy.

CASE 3: The instruction manual the scared customers away

As one of the first to enter the field of office automation, Sagatec Software, Inc. had built a reputation for designing high-quality and user-friendly database and accounting programs for business and industry. When they decided to enter the word-processing market, their engineers designed an effective, versatile, and powerful program that Sagatec felt sure would outperform any competitor.

To be sure that their new word-processing program was accurately documented, Sagatec asked the senior program designer to supervise writing the instruction manual. The result was a thorough, accurate and precise description of every detail of the program’s operation.

When Sagatec began marketing its new word processor, cries for help flooded in from office workers who were so confused by the massive manual that they couldn’t even find out how to get started. Then several business journals reviewed the program and judged it “too complicated” and “difficult to learn.” After an impressive start, sales of the new word processing program plummeted.

Sagatec eventually put out a new, clearly written training guide that led new users step by step through introductory exercises and told them how to find commands quickly. But the rewrite cost Sagatec $350,000, a year’s lead in the market, and its reputation for producing easy-to-use business software.

CASE 4: One garbled memo – 26 baffled phone calls

Joanne supervised 36 professionals in 6 city libraries. To cut the costs of unnecessary overtime, she issued this one-sentence memo to her staff:

After the 36 copies were sent out, Joanne’s office received 26 phone calls asking what the memo meant. What the 10 people who didn’t call about the memo thought is uncertain. It took a week to clarify the new policy.

CASE 5: Big science — Little rhetoric

The following excerpt is from Carl Sagan’s book, The Demon-Haunted World: Science as a Candle in the Dark, [8] itself both a plea for and an excellent example of clear scientific communication:

The Superconducting Supercollider (SSC) would have been the preeminent instrument on the planet for probing the fine structure of matter and the nature of the early Universe. Its price tag was $10 to $15 billion. It was cancelled by Congress in 1993 after about $2 billion had been spent — a worst of both worlds outcome. But this debate was not, I think, mainly about declining interest in the support of science. Few in Congress understood what modern high-energy accelerators are for. They are not for weapons. They have no practical applications. They are for something that is, worrisomely from the point of view of many, called “the theory of everything.” Explanations that involve entities called quarks, charm, flavor, color, etc., sound as if physicists are being cute. The whole thing has an aura, in the view of at least some Congresspeople I’ve talked to, of “nerds gone wild” — which I suppose is an uncharitable way of describing curiosity-based science. No one asked to pay for this had the foggiest idea of what a Higgs boson is. I’ve read some of the material intended to justify the SSC. At the very end, some of it wasn’t too bad, but there was nothing that really addressed what the project was about on a level accessible to bright but skeptical non-physicists. If physicists are asking for 10 or 15 billion dollars to build a machine that has no practical value, at the very least they should make an extremely serious effort, with dazzling graphics, metaphors, and capable use of the English language, to justify their proposal. More than financial mismanagement, budgetary constraints, and political incompetence, I think this is the key to the failure of the SSC.

CASE 6: The co-op student who mixed up genres

Chris was simultaneously enrolled in a university writing course and working as a co-op student at the Widget Manufacturing plant. As part of his co-op work experience, Chris shadowed his supervisor/mentor on a safety inspection of the plant, and was asked to write up the results of the inspection in a compliance memo . In the same week, Chris’s writing instructor assigned the class to write a narrative essay based on some personal experience. Chris, trying to be efficient, thought that the plant visit experience could provide the basis for his essay assignment as well.

He wrote the essay first, because he was used to writing essays and was pretty good at it. He had never even seen a compliance memo, much less written one, so was not as confident about that task. He began the essay like this:

On June 1, 2018, I conducted a safety audit of the Widget Manufacturing plant in New City. The purpose of the audit was to ensure that all processes and activities in the plant adhere to safety and handling rules and policies outlined in the Workplace Safety Handbook and relevant government regulations. I was escorted on a 3-hour tour of the facility by…

Chris finished the essay and submitted it to his writing instructor. He then revised the essay slightly, keeping the introduction the same, and submitted it to his co-op supervisor. He “aced” the essay, getting an A grade, but his supervisor told him that the report was unacceptable and would have to be rewritten – especially the beginning, which should have clearly indicated whether or not the plant was in compliance with safety regulations. Chris was aghast! He had never heard of putting the “conclusion” at the beginning . He missed the company softball game that Saturday so he could rewrite the report to the satisfaction of his supervisor.

• J. Bernoff, "Bad writing costs business billions," Daily Beast , Oct. 16, 2016 [Online]. Available: https://www.thedailybeast.com/bad-writing-costs-businesses-billions?ref=scroll ↵
• J. Ward, "The project management tree swing cartoon, past and present," TamingData, July 8, 2019 [Online] Available: https://www.tamingdata.com/2010/07/08/the-project-management-tree-swing-cartoon-past-and-present/ . CC-BY-ND 4.0 . ↵
• G. Robertson, “Comma quirk irks Rogers,” Globe and Mail , Aug. 6, 2006 [Online]. Available: https://www.theglobeandmail.com/report-on-business/comma-quirk-irks-rogers/article1101686/ ↵
• “The £8.8m typo: How one mistake killed a family business,” (28 Jan. 2015). The Guardian [online]. Available: https://www.theguardian.com/law/shortcuts/2015/jan/28/typo-how-one-mistake-killed-a-family-business-taylor-and-sons ↵
• E. Tufte, The Cognitive Style of PowerPoint , 2001 [Online]. Available: https://www.inf.ed.ac.uk/teaching/courses/pi/2016_2017/phil/tufte-powerpoint.pdf ↵
• C. McFadden, "Understanding the tragic Hyatt Regency walkway collapse," Interesting Engineering , July 4, 2017 [Online]: https://interestingengineering.com/understanding-hyatt-regency-walkway-collapse ↵
• T.M. Goerges (1996), Analytical Writing for Science and Technology [Online], Available: https://www.scribd.com/document/96822930/Analytical-Writing ↵
• C. Sagan, The Demon-Haunted World: Science as a Candle in the Dark, New York, NY: Random House, 1995. ↵

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Examples of good and bad communication via a case study

Good communication may be invisible, as we do not always notice when things go right, rather we tend to notice when things go wrong. This case study demonstrates the use of core communication skills and shows what good communication, written and in person, looks like in practice.

In this video case study , Marie receives an invitation to attend a breast screening mammography appointment, which leads to her receiving a breast cancer diagnosis. As she moves along the diagnostic pathway, she is likely to become more anxious and concerned as to what the results of the mammogram will lead to, and staff need to be able to respond to her unspoken and spoken messages.

Other case studies and information useful for all staff can be found at:

Homeward Bound , Educational play and workbook, Seth’s Legacy. Hospice UK, the national charity for hospice care, supporting over 200 hospices in the UK.

How to talk end of life care with a dying patient , Atul Gawande (You tube)

Care Opinion UK  - Real experiences of UK health and care services, good or bad.

RCN First Steps for health care assistants,  listening and attending

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Studying the relationship between causes and effects of poor communication in construction projects using PLS-SEM approach

Journal of Facilities Management

ISSN : 1472-5967

Article publication date: 25 October 2021

Issue publication date: 11 January 2023

The purpose of this paper is to develop a structural relationship model to study the relationship between causes and effects of poor communication and information exchange in construction projects using Smart-PLS.

Design/methodology/approach

The first method of this research is to identify the causes and effects factors of poor communication in construction projects from the extant of literature. The data used to develop the model was collected using a questionnaire survey, which targeted construction practitioners in the Malaysian construction industry. A five-point Likert type scale was used to rate the significance of the factors. The factors were classified under their relevant construct/group using exploratory factor analysis. A hypothetical model was developed and then transformed into Smart-PLS in which the hypothetical model suggested that each group of the cause factors has a direct impact on the effect groups. The hypothesis was tested using t -values and p -values. The model was assessed for its inner and outer components and achieved the threshold criterion. Further, the model was verified by engaging 14 construction experts to verify its applicability in the construction project setting.

The study developed a structural equation model to clarify the relationships between causes and effects of poor communication in construction projects. The model explained the degree of relationships among causes and effects of poor communication in construction projects.

Originality/value

The published academic and non-academic literature introduced many studies on the issue of communication including the definitions, importance, barriers to effective communication and means of poor communication. However, these studies ended up only on the general issue of communication lacking an in-depth investigation of the causes and effects of poor communication in the construction industry. The study implemented advanced structural modeling to study the causes and effects. The questionnaire, the data and concluding results fill the identified research gap of this study. The addressed issue is also of interest because communication is considered one of the main knowledge areas in construction management.

• Construction projects
• Poor communication

Gamil, Y. and Abd Rahman, I. (2023), "Studying the relationship between causes and effects of poor communication in construction projects using PLS-SEM approach", Journal of Facilities Management , Vol. 21 No. 1, pp. 102-148. https://doi.org/10.1108/JFM-04-2021-0039

Emerald Publishing Limited

Copyright © 2021, Yaser Gamil and Ismail Abd Rahman.

Published by Emerald Publishing Limited. This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

1. Introduction

The success of communication in the construction project is essential to produce a successful collaboration and understanding between project parties, which eventually leads to satisfying project completion ( Dainty et al. , 2007 ; Hair et al. , 2021 ). It is also required to ensure better quality and performance of the project execution ( Günhan et al. , 2012 ). The project management body of knowledge ( Guide, 2001 ) considers communication as a significant component of the project, which plays an essential role in information exchange and mutual collaboration among construction parties.

On the contrary, ineffective, poor and substandard communication among construction parties leads to many undesirable sequences, such as dispute and failure of the project ( Hossain, 2009 ). It is also a significant source of many other negative impacts to project performance and quality ( Henderson et al. , 2016 ). The term poor communication is described as the phenomenon of unsuccessful exchange of project information (PI) throughout the lifecycle of the project ( Loosemore and Lee, 2002 ). There are many causes and effects of poor communication, which have been uncovered previously through investigations of literature and exploratory interviews with construction experts. The cause-and-effect factors of poor communication have been classified into their corresponding groups/construct using factor analysis. This article aimed to use the data to develop a structural equation model (SEM) to study the relationships between causes and effects of poor communication in construction projects.

2. Literature review

In recent years, the construction industry has expanded significantly and become one of the leading industrial sectors for the development of the society and economy and one of the primary sectors for job generation ( Isa et al. , 2013 ). Therefore, its sustainable growth and progress is an indicator of the development of the countries ( Dainty et al. , 2007 ). The construction industry has unique characteristics in comparison with other industrial sectors where it is dynamic, multifaceted, complex, multidisciplinary and expandable ( Chen, 1998 ; Dubois and Gadde, 2002 ; Senaratne and Ruwanpura, 2016 ). Consequently, these characters are accompanied by many challenges and problems, such as poor quality of construction, poor performance, cost and time overruns, accidents, poor communication and project failure ( Abd El-Razek et al. , 2008 ; Alaghbari et al. , 2007 ).

Effective communication in the construction project lifecycle is an indispensable element for the success of the projects because it involves in all the project stages as a method of imparting and exchanging PI ( Dainty et al. , 2007 ). For that reason, maintaining a proper process of communication and effective flow of information can be a significant challenge due to the vast amount of information and the number of parties engaging in a single project ( Loosemore and Lee, 2002 ). On that account, poor communication develops and becomes a detrimental phenomenon in construction projects ( Zulch, 2012 ). It is also considered as one of the hindrances to maintaining a steady execution process and effective project delivery ( Senaratne and Ruwanpura, 2016 ).

Poor communication is the term used to describe the unsuccessful delivery of PI, the wrong selection of channeling and improper timing of information distribution ( Dainty et al. , 2007 ). In a corresponding finding, a report released by the Project Management Institute ( PMI, 2013 ) revealed that more than half of all project budget risk is due to ineffective communications, improper channeling and inaccurate time management of information dissemination. The report further elaborated, inferior and substandard communications are the primary cause of project failure. Furthermore, the British Standards Institution ( BSI, 2003 ) estimated the cost required to correct defects due to ineffective communication of PI is valued at approximately £20bn annually in the UK construction industry. It also emphasized that for better communication and sharing information between designers, engineers and contractors would likely to be essential to complete the project on time and budget.

Poor communication in the construction workplace leads to many other negative impacts. Frustration, friction, tense environment and demotivation are among the negative impacts of poor communication ( Zulch, 2012 ). These issues result in poor productivity and efficiency whereby employees tend to overreact upon any matter. Hence, effective communication is necessary to produce a more understandable workplace and facilitate the interaction between employees to ensure successful completion of the project.

Regarding the situation of the Malaysian construction industry, which is the study area of this research, it has a multicultural and multilingual society where different languages are used and different interpretations are developed during the PI exchange ( Kuang et al. , 2010 ). Malaysia is one of the most diverse countries due to its multicultural and multilingual societies comprising different ethnic groups and backgrounds whereby the most dominant ethnic groups are Malays, Chinese, Indian and others in which they speak more than one language and bounded to different cultures ( Kuang et al. , 2010 ). Malaysian construction sectors involve all the races in the country alongside with international investors and workforce. The workforce is mainly from Bangladesh, Indonesia, Pakistan, Myanmar and other ASEAN countries ( Adnan, 2004 ). Therefore, communication in the industry experiences challenges and barriers to be performed effectively.

Several studies have been introduced on the topic of communication in the Malaysian industry. A study by Valitherm and Rahman (2014) on the communication barrier in Malaysia construction sites found that language barrier is the most severe challenge in construction site whereby supervisors face difficulties to converse and deliver the information and that lead to a safety violation and wrong execution of the project activities. Furthermore, a study by Salleh et al. (2012) on the language problem among foreign workers in the Malaysian construction industry and concluded that the language barrier has led to many accidents. In another perspective by Taleb et al. (2017) , investigated the communication management between architects and clients during the design phase and found that it is essential to improve communication management among the architects as a demanding matter to obtain effective performance. Moreover, Pozin et al. (2018) explored the usage of the virtual communication practices in the industrialized building system in the Malaysian construction industry and found that most of the team members are using virtual communication during project implementation due to modern organization reform. Unfortunately, this study is unable to find any research work related to poor communication in the Malaysian construction industry. Hence, more effort and research are required to investigate the issue of communication in the construction industry especially on identifying the causes and effects of poor communication on construction projects success, which is expected to benefit the construction community to understand the issue of poor communication in their respective organizations.

2.1 Communication in construction projects

In the construction industry context, communication can be defined as the mutual exchange of PI with the assurance of creating an understandable platform between construction parties ( Dainty et al. , 2007 ; Fichet and Giraud, 2007 ). According to Pérez Gómez-Ferrer (2017) , communication is the process of sending and receiving technical and non-technical information through different means and channels and among different managerial and non-managerial levels. PMBOK ( Guide, 2001 ) defined project communication management as “one of the main knowledge areas in project management, which include the processes requires to ensure timely and appropriate generation, collection, distribution, storage, retrieval, and ultimate disposition of project information.” Communication covers all tasks related to producing, compiling, sending, storing, distributing and managing project records above and beyond it also necessitates an accurate report on the project status, performance, change and earned value ( Crowe, 2005 ). On another side, Emmitt and Gorse (2006) described effective communication as a key management competency to effective leadership and decision-making. Correspondingly, Dingsdag et al. (2006) defined effective communication as the ability to communicate with employees. Emuze and James (2013) described communication as one of the fundamental components of the construction industry, and it is the crucial component to project success.

2.2 Concept of poor communication in construction projects

Communication in the construction industry exhibits complexity, heterogeneity and challenges due to the huge amount of PI and the number of parties involved in a single project ( Emmitt and Gorse, 2006 ). Communication in construction projects is arguably one of the most important aspects in project management that supersede others and effective communication is a significant factor for the successful accomplishment of construction projects ( Dainty et al. , 2007 ). However, poor communication in construction is a global problem that requires attention to explore solutions and mitigation measures.

The term poor is used by many researchers to describe the phenomenon of ineffective communication in construction projects. Hoezen et al. (2006) used the term to describe the improper and lack of communication among construction stakeholders. BSI (2003) used the term poor as a general concept to describe the inefficient communication and inappropriate exchange of PI in the construction industry. Similarly, Dainty et al. (2007) used the term poor to articulate the concept of improper, inadequate communication and ineffective project communication among construction teams.

Poor communication practices have been recognized as a severe delimiting factor to the success of construction projects ( Loosemore and Lee, 2002 ). Rostami and Oduoza (2017) classified lack of communication as a key risk in the Italian construction industry and Thunberg et al. (2017) categorized the failure of internal communication and external communication as a key problem in the supply chain management in construction projects. From another point of view, poor communication leads to many undesirable effects, such as conflicts, frustrations among construction parties, which subsequently cause tremendous problems, such as unexpected cost loss, delay and litigation between construction teams ( Arnorsson, 2012 ; Tipili and Ojeba, 2014 ). It also causes errors and reworks in construction projects, which then incur an extra cost for restorations ( Arnorsson, 2012 ; Love and Li, 2000 ).

On that account, ensuring the right information and instructions are disseminated from all levels of management requires effective communication skills among construction practitioners ( Guide, 2001 ). Hence, keeping adequate communication among all project participants is a key factor in project success ( Sinesilassie et al. , 2018 ). For these motives, avoiding the phenomenon of poor communication in the construction industry requires more investigations and research on the cause and consequences ( Dainty et al. , 2007 ; Loosemore and Lee, 2002 ; Rostami and Oduoza, 2017 ).

In the construction industry, it is a considerable challenge to maintain the effectiveness of communication due to the complex nature of projects and the massive amount of information exerted on a daily basis ( Dainty et al. , 2007 ). According to Quill (1995) , the most dominant barriers to effective communication are background diversity, different levels of experience and personal barriers. Furthermore, Jureddi and Brahmaiah (2016) classified the most common barriers to effective communication, which include, but are not limited to language barriers, psychological barriers, physical barriers and attitudinal barriers. According to Torrington and Hall (1998) , the common barriers to effective communication are the individual’s frame of reference, which refers to the interpretation of an individual based on his/her reference, stereotyping, which means people may stereotype others according to their own perceptions and cognitive dissonance, which means if someone receives information which is not in line with their beliefs then that will cause a barrier to understand or respond in a positive way which consequently creates communication barriers. Additionally, Ross and Dewdney (1998) identified the barriers to effective communication, which include selective perception: listener only picks the message that supports his or her ideas or opinions, making assumptions: misinterpreting the meaning or feeling rather than listening to the details, giving unsolicited advice: listener gives information before listening to the problem, being judgmental: listener becomes critical of others opinions or point of views in a way that creates a barrier or gap that can not be comprehended from the transmitter’s perspectives, acting defensively: the listener defending a position rather than listening to the opinion of another person and failing to understand cultural differences. From another perspective, Buchanan and Huczynski (2019) and Othman and Mydin (2014) outlined the barriers of effective communication as power differences, which happens due to the fact that employees distort communication upward and believe that superiors have a limited understanding of subordinate’s needs, gender differences : men tend to talk more, whereas women tend to listen and reflect more, physical surroundings : issues such as room layout, noisy equipment and physical proximity, which affect communication effectiveness, language : variations in language and dialect can affect communication and cultural diversity : different cultures harbor dissimilar expectations as regard formal and informal expectations. Furthermore, Loosemore and Lee (2002) added, the main barriers to effective communication in the construction industry are culture, poor control of diversity, language, poor technical skills and different levels of education among the project team.

2.3 Importance of communication to project success

Communication is an essential component for the success of construction projects ( Dainty et al. , 2007 ). The success of the construction industry is wholly reliant upon effective communication between individuals, teams and organizations ( Pérez Gómez-Ferrer, 2017 ). Therefore, leveraging efficient communication methodologies has positively impacted project quality, scope clarity and business benefits ( Coopers, 2012 ). According to Zulch (2014) , effective communication minimizes the cost, time overruns and improves the quality of work. Furthermore, using proper communication methods and medium help to resolve any design problems and associated conflicts ( Tipili and Ojeba, 2014 ). Also, effective communication smoothens the project implementation from the inception stage to the handover stage and it is essential to understand its important role in the success of the construction industry ( Zulch, 2012 ).

In the context of the organizational project, communication is considered as a core competency, and if it is not executed correctly and connected every member of the project team to a set of consistent strategies and procedures then project outcomes are jeopardized, and the budget incurs unnecessary risk ( Dainty et al. , 2007 ). A report developed by Coopers (2012) on the role of communication in project outcomes revealed that effective communication plays an essential role to the success of projects and the report investigated the opinions of executive and project managers in which 9 out of 10 chief executive officers agreed that communication is critical to the success of strategic initiatives and considered communication as an integral component of strategic planning and execution process.

Several studies discussed the importance of effective communication in the construction industry. A survey by Fichet and Giraud (2007) on the role of communication toward the improvement of performance found that quality performance depends upon effective communication. Further, the effective change of information and ideas between members of the design team can simplify the design process and provide an efficient outcome ( Best and De Valence, 2007 ). From another viewpoint, Liao et al. (2014) investigated the relationship between communication execution and safety in China and found that communication is a very pivotal factor to manage safety and produces a safe workplace and easy dissemination of safety information.

Achieving coordinated results : effective communication assists to smoothly organize the collective actions of team members and the vast amount of information, which further avoids independent actions that lead to incompatibility and mismatched with project objectives and coordinated outcomes.

Managing change : frequent change is a standard in construction projects, but the presence of effective communication supports to avoid conflict during change and variations.

Motivating employees : quality of communication from managers can effectively improve the degree of motivation and produce self-initiative individuals among construction teams.

Understanding the needs of the workforce : effective channeling of communication can facilitate and accelerate the response of the organization to any alert in the workplace.

2.4 Causes of poor communication in construction projects

An investigation of several articles on poor communication was carried out to identify the causative factors of poor communication from different literature a total of 35 causes factors were identified and tabulated ( Gamil and Rahman, 2017 ).

One of the common causes of poor communication is the lack of timely communication among project parties. It is one of the leading causes of poor communication in the construction industry, which has significantly resulted in many negative consequences to the construction project and further has been confirmed that the less rate of communication among parties during the project can cause time and cost overruns ( Badu et al. , 2010 ; Chan and Kumaraswamy, 1997 ; Hoezen et al. , 2006 ; Sambasivan and Soon, 2007 ). Additionally, lack of communication can cause rework and a range of other construction performance deficiency (PER) ( Emuze and James, 2013 ). A comparative study on causes and effects of delay in Nigerian and Iranian construction projects by Oshodi Olalekan and Rimaka (2013) ranked lack of communication between construction parties from the contractor’s perspective based on its importance as the 11th and 12th factors of delay for Nigeria and Iran, respectively, however, the ranks from the consultant perspective were 20th and 13th for Nigeria and Iran, respectively. From another viewpoint, a study conducted by Darvik and Larsson (2010) on the impact of material delivery deviations on costs and performance in construction projects showed that quality defects and delivery deviation of materials occurred due to lack of communication among relevant parties and communication failure. Therefore, it was suggested, stakeholders must put more concern in the enhancement of communication regularity, means and methods. PMI (2013) investigated the importance of frequent communication on the overall performance of organizations. It was found that high performing organizations are better at communicating key project areas, including objectives, budget, schedules, scope, outcomes and business benefits. It was also added, frequent and sustained communication is essential to maintain the project activities flow over the stipulated schedule assigned for the whole project; therefore, a delay is diminished and quality is improved.

Another reason for poor communication is the lack of a communication system, which is defined as the complete structured platform of the communication process in the whole organization. If the communication system is established, then the information dissemination will be easily managed ( Ballan, 2011 ). A communication system is also called an information management system and is used to manage information flow and dissemination time in the construction industry and a complete reporting system to administer the communication and feedbacks that can keep the process in balance by reacting to any deviation during construction projects ( Affare, 2012 ). In a qualitative study by Nguyen and Chileshe (2013) , it was found that lack of effective communication system in the implementation of projects ranks number 12 as 1 of the critical factors ranking causing failure of construction projects in Vietnam. Therefore, the lack of an effective communication system hampers the process of communication in the construction industry ( Olanrewaju et al. , 2017 ). For that reason, a complete system needs to be implemented to manage information of the project from the planning stage to the completion stage of construction projects ( Dainty et al. , 2007 ).

Communication skills are essential for effective communication and lack of communication skills is a reason for poor communication, especially in construction projects where skills required, are technical, interpersonal and social skills. Everyone in the construction project is expected to have these skills to provide quality work and one of the interpersonal skills is effective communication ( Dainty et al. , 2007 ). Interpersonal skills include communication skills play an indispensable role in the success of the project ( Günhan et al. , 2012 ). Typically, parties involved in construction possess different communication skills, which also depend on their qualification and cultural background. These differences cause concurrent misunderstandings in the construction and delivery stages of the project ( Cheng et al. , 2001 ).

Language barrier is also one of the main causes of poor communication in construction projects because the construction industry with a unique characteristic is diversified and comprising many people of different backgrounds, cultures and languages ( Abd El-Razek et al. , 2008 ; Zhang, 2010 ). Construction parties speak different languages and have different cultural backgrounds; these differences if not well-managed can cause communication failure in a construction site ( Dainty et al. , 2007 ). Most of the time, misunderstanding among construction practitioners may occur and that could lead to poor workmanship and productivity ( Othman and Mydin, 2014 ). PMI (2013) reported that the organizations have difficulties in communicating with appropriate levels of clarity and details are likely to be caused by the difference in languages to understand project-specific technical terminologies. The data confirms that an average of four out of five projects that are communicated with sufficient clarity and details expressed in the language of the audience meet their original goals and intent in comparison to just over half of projects when communication is not sufficiently clear and detailed. An investigation conducted by Tipili and Ojeba (2014) on the effects of communication in construction project delivery in Nigeria, which focused on 40 professionals working in the construction industry in Bauchi, Nigeria and were asked to evaluate based on the low, medium and large scale on how language can hinder communication on construction. The study has shown that 33% answered medium, which means that the language used by operatives is essential for effective communication on site.

Not forgetting that, poor communication channeling is one of the causes of poor information dissemination where communication is managed by channels in all the organizations, hence each department or section in the organization is responsible for disseminating the related information to formulate a complete communication system. However, due to the complexity in the construction industry, several concurrent communication problems occur because no proper channeling is adopted to manage the communication process ( Fichet and Giraud, 2007 ). Communication in construction is seriously obstructed due to a lack of appropriate data channels, inappropriate channels and inaccurate data transfers ( Lee and Bernold, 2008 ). Also, unclear channels of communication cause project delays ( Tipili and Ojeba, 2014 ). It is, therefore, essential to standardize the channels of communication in the construction industry to expedite and ease the communication process. In reality, the selection of the correct channel in communicating PI is delicate and intricate due to the fragmentation and complexity features of the construction industry. Fichet and Giraud (2007) explained the criteria for selecting an appropriate medium and channel for successful communication, which includes the possibility to get feedback immediately, the potential offers by the mean of communication to express different elements of communication, such as body language, facial expressions and tone of voice, and the option offers by the medium to focus on a particular person. Furthermore, the selection of inappropriate medium or channels can also create communication breakdown. It can occur when a receiver is expected to select the wrong medium and happens on a construction site, which leads to poor communication ( Khahro and Ali, 2014 ). Therefore, to avoid miscommunication the selection of an appropriate channel is essential for the success of communication.

In different prospective possessing different levels of education and experience can cause difficulty in communication, it can create a misunderstanding environment whereby the receiver or sender lacks the appropriate methods of communication. Communication is basically a vertical process in which top management has to communicate with lower therefore if they possess different levels of education then poor communication and misinterpretation are resulted ( Dainty et al. , 2007 ). Further, lack of communication procedures and training refers to the shortage of sponsored training for employees on the communication process and method. Hence, it creates difficulty in conducting information exchange and communication ( Khahro and Ali, 2014 ).

In the aspect of lack of support for advanced communication technology, companies tend to downgrade the impact of improper communication and do not allocate a budget to support the use of advanced technology in facilitating communication, which may contribute to the deficiency of the communication process ( Ahuja, 2007 ). However, then again malfunction of technology is an issue in the construction site, it is basically common to face during the project execution whereby the location of construction sites maybe faces short in supply of electricity and network coverage and these cause malfunctioning communication technology ( Tai et al. , 2009 ).

Concerning the diversity of culture, construction companies involve many people from different cultures and backgrounds, which creates an improper interpretation of communication. Hence, it creates a tense environment and requires more concern to resolve this issue ( Loosemore and Lee, 2002 ). It is also the same with diversity in ethnical groups in the project whereby the receiver or the sender limits the frame of communication to his/her ethnics, which outweighs the concern of creating successful communication ( Günhan et al. , 2012 ). Additionally, individual barriers can also create miscommunication, which is meant the communicator is creating his own barriers and lack of confidence can also be a personal barrier of being shy or undetermined cause poor communication ( Dainty et al. , 2007 ). Gender difference can be a hindrance to effective communication, it refers in this context to the cultural barriers in which men prefer to seek information only from men and the same from women and that creates miscommunication ( Waziri and Khalfan, 2014 ).

Essentially, lack of communication plan is one of the causes of poor communication, which refers to the plan of communication which has to explain the details of information flow in terms of the time of communication, type of information and person in charge of disseminating the information and without prior communication plan, communication on construction site is improperly managed and administered therefore it causes poor communication ( Lee and Bernold, 2008 ). Improper communication time management is the main cause of poor communication, which is referred to as the improper plan of time which causes pressure when it comes to the construction site on a sudden basis. It is also referred to as the equivalence of selecting the right information at the right time ( Dainty et al. , 2007 ). Poor planning and coordination point to the overall plan and coordination of the project in terms of scheduling and monitoring of construction activities. Hence, improper planning results in poor communication ( Bandulahewa, 2015 ), poor communication management refers to the deficiencies of managing the huge amount of information in terms of archiving, storage and dissemination. It also causes hassle to answer what type of information is needed when it is needed and how it is transferred ( Dainty et al. , 2007 ).

Inaccessibility of PI also causes miscommunication and refers to the restrictions between construction teams involved in the construction can hinder the communication process, which also creates a shortage of information especially in emergency communication, which then leads to augment the miscommunication among the parties ( Thorpe and Mead, 2001 ).

Frequent change of project contract can also cause poor communication, which is common to the construction industry in which the terms change due to the nature of the project or the requirement of the client and need of modification due to encounters during the execution of the project on the construction site. These changes of contract or design or methods can cause poor communication ( Bandulahewa, 2015 ; Enshassi et al. , 2006 ). Lack of clear communication objective denotes that the person in charge of communication is not aware of the targeted goals of communication, which then causes wrong selection of information and creates misunderstanding ( Olanrewaju et al. , 2017 ). Also, without a clear purpose of communication, it leads to uncertainty of the message and confusion between the transmitter and receiver ( Baguley, 1994 ), Apart that, lack of mutual trust among construction parties is implied by less transparency and credibility, which may be caused by cultural and ethical diversity. Trust among parties is a key to successful communication and understanding ( Dainty et al. , 2007 ).

From another point of view, weak organizational structure refers to the limited authority of personal in terms of communication, which resembles the characteristics of functional organization structure and improper definition of activities and task allocation can cause poor communication. Hence, a good organizational structure provides a firm foundation for the standards procedures and communication process ( Tai et al. , 2009 ).

Contractual barriers refer to the restrictions of obtaining the PI due to the terms in the contract in which the contract may assign certain tasks to a certain party, thus it restricts others from interferences and results in miscommunication occurrence ( Dainty et al. , 2007 ). Also, lack of representation for project stakeholders refers to the absenteeism of construction meetings and that is interpreted by lack of being accountable, which can cause poor communication ( Thomas et al. , 1998 ).

From the technical prospective, poorly detailed drawing refers to the lack of clarity and specifics that explain the technical drawing especially to personnel with less experience in translating the drawing into practice ( Aulich, 2013 ). Also, incorrect instructions or technical information can generate miscommunication and that results to cause reworks due to the wrong execution of certain project activities ( Aulich, 2013 ).

2.5 Effects of poor communication to construction projects

Poor communication has many negative impacts on the project. It is one of the main factors triggering the failure of construction projects ( Tipili and Ojeba, 2014 ). As a result of poor communication, many undesirable effects and consequences caused, which mainly includes, but not limited to cost overruns, time overruns, dispute and others. Furthermore, ineffective communication leads to unproductive outcomes ( Gamil et al. , 2019 ). According to PMI (2013) report on the investigation of communication in organizational perspectives, which shows the differences between highly effective communicators and minimally effective communicators in meeting original goals, on-time delivery and within budget. It is shown that highly effective communication results in 80% of meeting initial goals, 71% achieving on-time project delivery and 76% within budget planned. However, minimally effective communication results in declination of meeting goals, time and cost outlined. Figure 2.6 illustrates the relationship between the frequency of effective communication and project success components. It is shown that highly effective communicators achieve better results in meeting original goals, on-time delivery and within the stipulated budget.

Late and slow dissemination of information: if communication is not active, then the flow of information is slow, which contributes to cause time overrun. Slow response to inquiries also causes a delay in progress ( Guide, 2001 ).

Lack of communication during the early stage of the contract causes continuous changes of the contract ( Shehu et al. , 2014 ).

Inadequate communication among construction teams during execution leads to cumulative communication and causes poor management of information, which consequently causes a delay in the work process ( Shehu et al. , 2014 ).

Communication is not correctly carried out due to the weak organizational structure of construction ( Dainty et al. , 2007 ).

Ineffective or unprepared reporting systems can cause poor communication, which leads to more time in managing the PI ( Tipili and Ojeba, 2014 ).

Improper channels of communication, especially during emergency calls or during reporting of any work process can cause a delay in work progress ( Tipili and Ojeba, 2014 ). Faulty transmission of the message via an inappropriate medium or channel. It is happening when the receiver engages in too much information from different channels and mediums that consequently causes poor communication ( Dainty et al. , 2007 ).

Technology malfunction causes poor communication, which subsequently triggers the delay of the project ( Dainty et al. , 2007 ).

Following that, a dispute, which is a phenomenon of disagreement on a specific set of terms and in the construction industry is commonly known as an endemic and chronic issue ( Sinha and Wayal, 2007 ). It occurs when project parties disagree or misinterpret the contractual terms and, thus results in continuous dispute and that significantly have an impact on the main project components, such as cost, time and quality of construction projects and in some cases results in the failure of the project as a whole ( Gebken and Gibson, 2006 ). Poor communication among the construction parties is one of the main causative factors of dispute. It is, therefore, the main consequence of ineffective communication ( Adnan, 2004 ; Adnan et al. , 2012 ). Effective communication is vital to improve the relationship between the project team ( Adnan et al. , 2012 ). Khahro and Ali (2014) studied the indirect causes of dispute in the Pakistan construction industry and found that poor feedback system and negligence are ranked as the first and second indirect causes of the conflicts with an average mean value of 2.7 and 2.65, respectively, whereas the lack of communication procedures and non-adherence of communication procedure set are classified as number 5 and 6 with an average value of 2.38 and 2.34, respectively, as the trivial or indirect cause of the dispute in the construction projects.

Effective communication is the most powerful motive to strengthen the relationship and understanding among the parties of the project ( Adnan et al. , 2012 ). On the contrary, ineffective communication is one of the main causative factors of dispute existence in the construction industry ( Sinha and Wayal, 2007 ). According to Malleson (2013) , the potential source of conflict varies depending on the project type and most likely arises from the lack of communication and the absence of transparency among construction parties. A study by Cakmak and Cakmak (2013) on the identification of causes of disputes in the construction industry considered lack of communication among construction parties as the leading cause of dispute occurrence.

Consequently, collaboration among construction parties is essential to produce successful projects through the concept of integrated project delivery ( Kent and Becerik-Gerber, 2010 ). Nevertheless, it has been a hindrance due to the existence of a dispute and it becomes challenging to maintain a good relationship and cooperation among project parties ( Kassab et al. , 2006 ).

In regard to cost overrun, it refers to the project failed financially to achieve its objective ( Abdullah et al. , 2009 ; Rahman et al. , 2013 ). Cost overrun occurs when a project’s cost exceeds the estimated cost and causing major conflict and litigation, which remarkably lead to project failure ( Shehu et al. , 2014 ). There are several causing factors of cost overrun issue in the construction industry. Poor communication among construction parties is one of the leading causes of cost overrun in the construction industry ( Rahman et al. , 2013 ). A study by Alhomidan (2013) in Saudi Arabia had identified 41 cost overrun factors in several road construction projects and found that most of the critical factors causing cost overruns are internal administrative difficulties, poor communication among construction parties, payments deferment and delays in decision-making. In another investigation by Bassioni et al. (2013) uncovered that lack of communication and coordination between design participants of different backgrounds documented a higher relative impact to cost overrun in the design phase of the Egyptian construction industry. It was also indicated that communication difficulties during the execution of the project could directly lead to an increase in unnecessary expenditures ( Sinesilassie et al. , 2018 ). As in time overrun factors, again poor communication is regarded as an essential factor, which leads to cost overrun. However, not many research studies on factors causing cost overrun as compared to time overrun.

Rework : in construction work, some changes of design are reported after the execution of specific jobs due to poor management of communication, the instructions are delivered late then demolishing has to take place to restructure the work as instructed, which requires new materials and labor ( Love and Li, 2000 ).

Poor details of construction drawing : basically, detailing is meant by the process in which the designer conveyed to a contractor by the mean of technical documentation. Poor detailing causes cost overrun if the drawing is misinterpreted or transferred wrongly due to improper communication among designers and engineers on-site ( Dainty et al. , 2007 ).

Lack of communication among construction parties : it can cause adverse outcomes in terms of cost by creating a delay, which subsequently causes cost overrun due to incomplete tasks on schedule ( Dainty et al. , 2007 ).

Regarding rework, which is a common issue in the construction industry ( Nagapan, 2014 ). It is defined as the unnecessary work or activities of redoing or replenishing a job that was essentially executed incorrectly for the first time ( Love and Li, 2000 ). Several descriptions of rework in construction can vary depending on the type of project. Fayek et al. (2003) classified the form of rework as quality deviations, non-conformance, defects and quality failures. Rework was described as the process of doing activities more than once in the field with no prior change of scope, which has been set by relevant parties ( Fayek et al. , 2003 ). As a result, rework is a source of other problems, such as waste generation and cost overruns ( Nagapan, 2014 ).

Rework in general, requires an additional budget to repeat the work to satisfy the quality and set of standards. According to research conducted by Nylén (1996) to investigate the significant causes of rework in the construction of highway projects and found that a total of 23 failure factors during the production phases were identified, which accounts for 10% of the whole production cost and 51% of these failures were originated from communication problems between consultant and clients. Another study on quality failure in the construction industry was introduced by Hammarlund and Josephson (1991) specified that 13% of quality failures are induced by poor communication among construction parties. It was also identified that in the UK, more than 30% of construction cost overrun is caused by rework occurrence ( Ofori and Ekanayake, 2000 ). Furthermore, in Australia, it was reported to be up to 35% of the total cost of the project and contributed as 50% of the total cost overruns in construction projects ( Aziz and Hafez, 2013 ). Therefore, it was suggested, proper communication platforms must be implied and proper identification of client requirements to minimize rework occurrence ( Nagapan, 2014 ). A case study by Abdul-Rahman (1995) investigated the cost of non-conformance during a highway project and found that poor communication is classified as one of the main factors to non-conformance in which it causes poor quality in construction projects requires the extra cost to rectify non-conformance.

Another study conducted on causes of defects in the South African housing construction industry: perceptions of built-environment stakeholder, which introduced 17 causes of errors in the construction industry and lack of communication between designer and contractors was ranked 11th in respect to its importance caused to the occurrence of defects and required a rework process to rehabilitate the defects ( Buys and Le Roux, 2013 ).

Subsequently, accident on the construction project site. It remains a critical challenge to the industry due to the nature of work in a construction site, the improper practice by labors, safety standards violation and incorrect delivery of PI ( Chong and Low, 2014 ; Dingsdag et al. , 2006 ). Inappropriate communication and wrong delivery of technical information cause accidents in the project site ( Chan and Kumaraswamy, 1997 ). According to Haslam et al. (2005) , Salleh et al. (2012) , most of the accidents are caused by ineffective communication between the workforce and technical expertise accompanied by poor supervision and inconsiderate adherence to safety regulations.

Referring to the effect of poor communication in creating demotivated workforce, it has been discussed by many researchers that an agitated workforce and negative impact on creativity are the result of poor communication and have negatively impacted the overall performance of the project. The way instructions are being disseminated can affect the workforce negatively if not properly communicated with effective skills. Hence, it requires more attention to improve communication in terms of process and mediums ( Dainty et al. , 2007 ; Emuze and James, 2013 ).

Poor teamwork is also a negative impact of poor communication whereby the individual tends to rely on others to do his own job rather than prominently participating to accomplish the task ( Aiyewalehinmi, 2013 ; Salleh et al. , 2012 ).

Poor communication also leads to a late response to the disaster, whereby during emergency time more information is required to respond to the situation. If there is no clear system of communication, in the time of disaster or accidents time is wasted to decide on the right party before actions are taken ( Apolot, 2011 ; Liao et al. , 2014 ).

Poor productivity is also an effect of poor communication between the project team in the form of deficiency in work in terms of changes of contract or drawing details. The workforce also faces situations where the task is incomplete and of poor quality, which, consequently, resulted in cost and time overrun ( Ali and Wen, 2011 ).

Misunderstanding refers to a factual situation whereby the receiver misreads the information, which leads to mislead due to poor communication. Misunderstanding also leads to misinterpretation and misuse of the information, which leads to an agitated communication environment ( Cheng et al. , 2001 ; Emuze and James, 2013 ).

Design errors are also caused by poor communication whereby the designer receives wrong information and leads to design wrongly, which then creates an undesirable situation that requires rehabilitation and correction ( Oluwaseun Sunday and Olumide Afolarin, 2013 ; Sambasivan and Soon, 2007 ).

Low satisfaction among construction party is also caused by poor communication. If the project parties are not happy with the outcome then affects the collaboration and cooperation to accomplish the project ( Hoezen et al. , 2006 ).

Frequent remedies in design and plan are also the sequence of poor communication between project parties. The remedies required to achieve conformance on the requirement are incurred with extra cost and that leads to other negative sequences ( Dainty et al. , 2007 ).

Similarly, waste generation is also caused by improper communication and information exchange and that also incurred extra cost and time to perform rehabilitation ( Alwi et al. , 2002 ). Poor communication also results in the unclear selection of channels, poor risk management, poor project documentation, poor planning and affects the design and execution process. These causes and effects of poor communication need to be correlated to introduce a clear understanding of the relationship and a global view of the issue of poor communication as well.

3. Contribution of the study to body of knowledge

The published academic and non-academic literature introduced many studies on the issue of communication includes the definitions, importance, barriers to effective communication and means of poor communication. However, these studies ended up only on the general issue of communication lacking an in-depth investigation of the causes and effects of poor communication in the construction industry. Hence, this study developed an SEM model to explain and uncover the relationships among causes and consequences of poor communication in construction projects, which have been identified from previous literature ( Gamil and Rahman, 2017 ). The model helps to better understand the phenomenon of poor communication and its impact on project failure.

Furthermore, the model helps to visualize and comprehend the issue addressed in a complete approach. The study filled the knowledge gap related to cause-and-effect factors of poor communication in the construction industry by establishing the relationships between the factors using advanced multivariate analysis. The model is expected to be used to quantify the impact of poor communication on the construction project failure and evaluating the health status of communication and information exchange in the project’s settings.

4. Concept of partial least square-structural equation model

SEM is developed using the approach of partial least square (PLS) ( Bowen and Guo, 2011 ). These combinations of methods result in producing a basic technique called PLS-SEM ( Rigdon et al. , 2010 ; Wong, 2013 ). It is a common approach used to analyze multi-variables ( Garson, 2012 ; Hair et al. , 2021 ). There are two common approaches in SEM known as CB-SEM and PLS-SEM ( Hair et al. , 2021 ). Covariance Based structural equation modeling (CB-SEM) is the covariance-based approach and is used to confirm or reject theories. However, Partial Least square structural equation modeling (PLS-SEM) is used to develop theory in exploratory research ( Astrachan et al. , 2014 ; Garson, 2012 ; Hair et al. , 2021 ). In this research, poor communication cause and effect factors are a form of an exploratory study, therefore, PLS-SEM is suitable to be adopted in this research. Generally, SEM comprises two models, which are an outer model and an inner model. The outer model is also called a measurement model or manifests or items and inner models are also called a structural model ( Bowen and Guo, 2011 ; Hair et al. , 2021 ). The outer model shows the relationships between the items and the constructs, whereas the inner model depicts the relationship between independent variables (IV) and dependent variables (DV) ( Hair et al. , 2021 ; Rigdon et al. , 2010 ).

5. Adequacy of sample size

To develop SEM, it is imperative to confirm the adequacy of the sample size used to develop the model ( Iacobucci, 2010 ). According to Hair et al. (2021) , the sample size is an essential element in improving the reliability of the model. There have been many types of research on defining the number of sample sizes. According to Kock and Hadaya (2018) , the adopted rule of thumb is the 10-time rule as a method to simplify the process of size estimations. However, it is considered an imprecise estimation ( Hair et al. , 2021 ). Furthermore, researchers over the past decade used different sample sizes, which depends on the number of variables, the possibility of attaining data and the nature of the research. In construction industry research, PLS-SEM has been extensively used by many researchers. Memon and Rahman (2014) used PLS-SEM to model the causes of cost overrun in the construction industry and the total sample used was 231. Nagapan (2014) developed SEM to study the causes and effects of construction waste generation in the construction industry and collected 277 responses. About the adequacy of sample size in this research, there is no specific size of the sample, however, it was suggested by Hair et al. (2021) , the sample size is estimated to be 10 times the number of structural paths to the DV, which are 10 in this study and the total minimum size is 100 accordingly. As the valid sample size collected for this study is 262 which is more than what is suggested by Hair et al. (2021) , therefore, the sample size is adequate to develop SEM and the more sample size improves the goodness-of-fit for the model ( Coughlan, 2008 ; Iacobucci, 2010 ).

6. Model development and assessment process

This section presents the development and assessment procedures adopted in generating and assessing the structural model.

Figure 1 shows the overall process involving the development and assessment of SEM. It consists of five major steps, which include hypotheses development and assigning path model, data inputs, running algorithms, assessment of measurement and structural model and testing hypotheses and validation of the results.

6.1 Hypothetical model

The first step toward developing SEM is to create a hypothetical model by assuming the path model to predict the relationship between constructs. To initiate that, the previous findings serve as a baseline of the start. According to a study by Nagapan (2014) on the causes and effects of construction waste, the model was an integral between causes and effects. Furthermore, Abusafiya and Suliman (2017) , developed PLS-SEM to study the relationships among causes and effects of cost overrun in a construction project in Bahrain and considered the cost overrun as a dependent variable, however, the causes and effects are IV. In this study, the hypothetical model is developed based on the group established by factor analysis. Figure 2 presents the proposed path model and its hypotheses.

According to Figure 2 , a total of 12 hypotheses are proposed for the model. These hypotheses represent the independent latent variables which are the causes, however, the effects depict the dependent variable. To accept or reject these hypotheses, the structural model must go through the assessment process in the following subsections. The next step is to transform the hypothetical model into Smart-PLS to represent the relationships among the variables.

6.2 Sampling for the survey

The targeted respondents for this study are construction practitioners from all the management levels and different project parties, which include contractors, clients and consultants in Malaysia. Construction practitioners in this study are referred to as company directors, project managers, architects, project engineers, site engineers and quantity surveyors ( Enshassi and Al Swaity, 2015 ).

Random sampling technique is widely used in construction research where the sample is randomly selected from the population based on non-zero probability. This technique is considered effective because it produces a sampling representative of the population by avoiding any voluntary response bias ( Sandelowski, 2000 ). All population has the probability of equal chance of being selected as the sample and provide accurate representation for the broader population ( Sharma, 2017 ). Therefore, this technique is adopted to select the participants for this study. The method to determine the sample size of an unlimited population is adopted from Al-Najjar (2008) and Enshassi and Al Swaity (2015) to calculate the sample size: (1) SS =   Z 2   ×  P   ( 1 − P ) C 2 Where:

SS = sample size;

Z = Z value (1.96 for 95% confidence level);

P = percentage picking a choice, expressed as a decimal (0.5 used for sample size needed);

C = margin of error (9%), maximum error of estimation, which can be 9% or 8% ( Memon and Rahman, 2014 ); and

SS = 1.96 2   ×   0.5    ( 1 − 0.5 ) 0.09 2 = 118.57   ≅   ≈ 119 (As the minimum SS).

To check the marginal error value, the following formula is being used ( Enshassi and Al Swaity, 2015 ). The maximum margin of error for a 95% confidence level ≈ 1.96 SS = 1.96 119 = 0.18 > 0.09. Hence, the margin is acceptable. In this study, the final sample size obtained is 262 respondents.

6.3 Data input

The study finalized 262 respondents as core data for generating the model. The respondents are construction practitioners who are working in the Malaysian construction sector. A five-point Likert type scale was used to assess the significance and severity of cause-and-effect factors of poor communication. The final numbers of cause-and-effect factors are 30 and 17, respectively, which makes a total of 47 manifests and this yields 262 × 47 = 12,314 data used to develop the SEM. These data were keyed into SPSS and then saved in a new file as CSV to be compatible with Smart-PLS. The data is then imported into Smart-PLS for further analysis.

6.4 Path model creation in Smart-PLS

After drafting the hypothetical model, the items/manifests are then assigned to the relevant independent variable by importing the related data. Figure 3 shows the screenshot of the model after assigning the manifest.

Figure 3 illustrates the model after assigning the manifests to their corresponding latent variables. The color of the LVs turned to blue after assigning the manifests and this shows all the LVs are active for further analysis. The total number of manifests is 47 items.

6.5 Model execution process

After assigning all the manifests to their associated latent variable, the following step is to perform the modeling process. The primary step is to run the PLS algorithm to calculate the loadings in each manifest. The main parameters calculated from the algorithm are the assessment criteria, which include both the outer model (measurement model) and the inner model (structural model) ( Memon and Rahman, 2014 ; Nagapan, 2014 ).

Figure 4 shows the screenshot extracted from Smart-PLS software to exhibit the process of running the PLS algorithm. The following step is to perform the assessment process of the model regarding its reliability and adequacy of the relationship among the manifests. The next section explains the criteria of model assessments.

6.6 Criterions of model assessment

To assess the model’s reliability and validity, there are several guidelines and standards developed by the previous researcher for both the model’s inner and outer models. Table 1 summarizes the standard model assessment guidelines.

Table 1 presents the criteria used to assess the model for its components’ measurement and structural models. These criteria must be achieved to consider the model’s adequate representation to study the structural relationships among causes and effects of poor communication.

7. Assessment of measurement model

It is essential in developing PLS-SEM to check the reliability and validity of the measurement before generating the study results to ensure the methods and data are valid. The essential step is to check the internal consistency of the model; the correlation between the items is adequate for further analysis. The standard procedures consist of two conditions to be achieved: the first one is a model performance using individual item reliability and convergent validity and the second procedure is the discriminant validity, which is assessed after meeting the criterion in the first step. This involves a few iterations of the analysis by omitting factors that behold low loading ( Henseler et al. , 2016 ).

7.1 Convergent validity (testing model’s performance)

Running of the PLS algorithm has to be associated with testing the measurement model to check its convergent validity and individual item reliability and those two criteria are related to each other ( Henseler et al. , 2015 ). Convergent validity is defined as the extent to which a measure relates positively to another measure of the same constructs ( Hair et al. , 2021 ). To check the convergent validity, three parameters have to be achieved average variance extracted (AVE) which has to be more than 0.5, composite reliability (CR) which has to be more than 0.7 ( Hair et al. , 2021 ; Memon and Rahman, 2014 ; Nagapan, 2014 ) and internal consistency (Cronbach’s alpha) which has to be more than 0.7 and in the case of exploratory research, 0.60 to 0.70 is acceptable ( Hair et al. , 2021 ; Mohamad et al. , 2015 ). However, Peterson and Kim (2013) criticized that Cronbach’s α is considered as a lower bound and inaccurate estimator of true reliability, nevertheless, CR is a more accurate estimator of internal reliability and ( Wong, 2013 ), recommended not to use Cronbach’s alpha to assess the internal consistency in PLS-SEM. The criterion of individual item reliability is described by Hair et al. (2021) which states that each item/manifest has to attain more than 0.5 and any factor that holds a value less than 0.5 has to be deleted and restart of the iteration process and model performance till achieving the minimum requirement described beforehand. In this study, the iteration process was performed until the validity and reliability criterions completed. Figure 5 shows the detailed parameters obtained from iteration 1.

Figure 5 shows the parameters of measurement model assessment, which is obtained from running the PLS algorithm for the first iteration. Tables 2 and 3 show the detailed and arranged factor loading for all the factors after running the first iteration.

Table 2 presents the final cause factors of poor communication and their symbols, which are used in the model. It also shows the factor loading generated from running algorithms for the first iteration.

Tables 2 and 3 show the factor loading resulted from running the first iteration. To decide which factor to delete the rule of thumb described by Hair et al. (2021) described that any manifest less than 0.4 is deleted and any factor more than 0.4 and less than 0.7 is deleted if there is a resultant of improvement in the CR and AVE, therefore, an iterative check is performed to achieve the standards criterion. The following table presents the parameters of convergent validity assessment resulted from iteration 1.

Table 4 presents the assessment of the convergent validity of the measurement model for the first iteration. It is shown that one construct (behavioral and cultural, BC) has less than the criteria described in each parameter. This requires further repetition by deleting poorly measured manifests to achieving the standard values to develop a fit model as suggested by Nagapan (2014) . In the second iteration, any factor that attains less than 0.6 outer loadings is deleted then checking the outcomes.

Table 5 shows the factor loading for causes factors resulted from iteration 2. After deleting one item, the factor loading improved to achieve the threshold value.

Table 6 shows the factor loading for effect factors, which is generated after running algorithms for iteration 2.

Table 7 shows the convergent validity for the measurement model and shows that Cronbach’s alpha, CR and AVE achieved all the standard requirements. The results show that the CR for all the constructs is more than 0.7 and the AVE is more than 0.5 and these results achieved the criteria of convergent validity.

7.2 Discriminant validity

After checking the model performance and achieving all the requirements stipulated by Hair et al. (2021) , the following step in the assessment of the measurement model is to check the discriminant validity. Discriminant validity is defined as the degree to which the manifests differentiate among the constructs or measure different concepts by assessing the correlation among measures of potentially overlapping constructs ( Hair et al. , 2021 ; Wong, 2013 ). The discriminant validity is assessed using ( Fornell and Larcker, 1981 ) criterion and cross-loadings ( Henseler et al. , 2015 ).

7.2.1 Cross loading.

Cross loading assesses the discriminant validity by examining whether each manifest has a higher loading correlation with the IV in which the outer loading of each associated construct is more significant than all of its loading if applied on other constructs ( Hair et al. , 2021 ).

Table 8 shows the cross-loading analysis. It is demonstrated that the values generated in bold from cross-loading for each manifest have a higher value if it is placed in another construct/group and this indicated the discriminant validity concerning cross-loading is achieved.

7.2.2 Fornell and Larcker criterion.

Fornell and Larcker’s (1981) criterion is also used to assess the discriminant validity of the model by comparing the square root of AVE with latent variable correlations in which the square root construct should be higher than its highest correlation with any other constructs ( Hair et al. , 2021 ). The criterion of Fornell and Larcker stated that the latent variable must explain a better variance of its indicator than the variance of other latent variables ( Ab Hamid et al. , 2017 ). Fornell and Larcker is considered a significant approach for assessing the discriminant validity of PLS-SEM and it works by comparing the square root of the AVE with the independent variable correlations ( Hair et al. , 2021 ). The latent variable correlation generated from running the PLS algorithm is shown in Table 9 .

Table 9 demonstrates the correlations of the latent variables and it is shown that the root square of AVE at the diagonal matrix for each variable is higher than the non-diagonal values, which indicated in boldface and this is satisfied the criterion of Fornell and Larcker, therefore, discriminate validity is fulfilled and the following step is to discuss the outcomes of measurement model assessment.

7.3 Discussion of measurement model results

The measurement model has been previously verified and assessed by satisfying all the prerequisite criteria prescribed in Table 1 by running two subsequent iterations of algorithms. The first step achieved is convergent validity, which is the degree to which factors are related to measuring their corresponding constructs. From the data described in Tables 5 and 6 , the factor loadings are more than 0.5 and vary among different items.

The constructs under causative factors are organization and management, PI, BC, technologies and methods. For the first construct organizational and management (OM), the most loaded factor is infirm organizational communication structure with 0.785 loadings and that exhibited the significance of this factor in comparison to other adjacent factors, which duly proved the lack of awareness toward managing communication in construction projects. Regarding the second causative construct, which is PI, the inaccessibility of PI factor with 0.841 loadings is the most important factor and that interprets higher contribution to cause poor communication. The third causative construct is BC in which a lack of confidence factor (0.793) has the most loading factor under the construct and this explains the gap of information exchange in the project space. Regarding the fourth construct (technology and methods, TM), the most weighted factor is the improper introduction of new technology (0.803) and that described the issue of implementing newly added technologies, such as BIM in its different dimensions as a method of managing and executing the project.

Table 6 presented the factor loading for effect factors and that includes three constructed named practitioners, performance and process. From the results, factors under practitioners vary in the loading weight and demotivation weighted the most factor with 0.788 and that signified the effect of improper communication and causing demotivation to the workforce. However, for the performance construct the most prevalent factor is waste generation with 0.859 and that was earlier proven by Nagapan (2014) which considered poor communications a leading factor to cause waste generation. Regarding the processes, the most weighed factor is a redesign with 0.791 and that critically occurs during the early stage of the project. Referring to Table 7 , all the measures of convergent validity achieved the threshold criteria in which Cronbach’s α is more than 0.7, CR is more than 0.7 and AVE is more than 0.5, hence the model satisfied the convergent validity.

The second step is to check the discriminant, which is intended to ensure the construct has the most substantial relationship with its own manifests in comparison with other constructs. Cross loading and Fornell and Larcker standards are used to assess the discriminant validity, which collectively proved acceptable and valid discriminant.

In conclusion, the measurement model is assessed for its validity and reliability and it can be concluded that the iteration process applied and modifications have positively improved the model performance. All the weak manifests were deleted and after iteration two the required threshold values were accomplished for all the criteria, therefore, the measurement model is assessed and further assessment of the structural model followingly is carried out.

8. Assessment of structural model

After confirming the reliability and validity of the outer model, the following step is to assess the inner model by evaluating the model’s predictive capabilities and relationships among constructs. The structural model is defined as the networked relationships, which connected the hypothetical model whereby the purpose of this assessment is to examine the relationship among dependent and IV ( Hair et al. , 2021 ) and the significant steps to assess the structural model are presented in Figure 6 .

Figure 6 shows the steps required to assess the structural model, which sequentially starts by testing the predefined hypothesis then checking the ability of IV in measuring the DV using the coefficient of determination. Following that, assessing the effect size and assessing the predictive relevance by evaluating the confidence of the model and finally checking the goodness of fit (GoF) for the model to measure the overall model’s performance.

8.1 Hypothesis testing

Hypothesis testing is performed to confirm the significance values statistically ( Yuan, 2012 ) and check the hypothesized relationship among constructs in which the causes (IV) have a significant impact on the effect factors (DV). To determine whether the relationship is significant or not, both t -values and p -values are used as a cutoff value whereby T -value has to be more than 1.96 or P -value has to be less than 0.05 ( Hair et al. , 2021 ).

Table 10 shows the results of hypothesis testing after running bootstrapping in Smart-PLS3. The bootstrapping was run using subsamples of 5000 to achieve maximum stability of the results ( Hair et al. , 2021 ) According to Table 10 , eight hypotheses out of twelve have a significant relationship with the pre-assigned path model. These include the groups/constructs, which obtained a T-value higher than 1.96 and a p -value less than 0.05. Those IV (constructs/groups) which have no significant value on the DV is explained by the data obtained from respondents have no significant power to find the dependency level. Therefore, more investigation is required to improve the model. The generated t -values for the structural model are shown in Figure 7 .

Figure 7 shows the t -values generated from running bootstrapping for the model. It shows that any t -values that exhibit less than 1.96 are considered insignificant.

8.2 Coefficient of determination (R 2 )

The coefficient of determination is defined as a statistical criterion to measure how the regression predictions are accurately fit for the data. In PLS-SEM, it represents the extent of variation in the dependent variables, which can describe one or more predictor variables ( Hair et al. , 2021 ). In other words, it measures the ability of IV in measuring dependent variables. As a cut-off value, Falk and Miller (1992) suggested an R 2 value of 0.10 as a minimum acceptable value for the model, nevertheless, Chin (1998) recommended the R 2 value of above 0.67 considered substantial while values ranging between 0.67 and 0.33 are moderate and values less than 0.19 are weak.

Table 11 shows the results of the R-square for the model. It is shown that the constructs PER and PRO have weak R-square while PRA is moderate, henceforth, the results explain that the power in representing the groups is satisfactory for PRA and shows the higher ability of IV in measuring DVbut weak for PER and PRO and that is explained due to the less complexity of the model in which more predictive latent variable increases the coefficient of determination ( Tenenhaus et al. , 2005 ; Yuan, 2012 ).

8.3 Effect size

Effect size (f 2 ) is an indicator of the degree of the relative effect of exogenous latent variables on an endogenous latent variable by the mean of change in R 2 and it is calculated as the increase of R-squared of the latent variable in which the path is connected ( Chin, 1998 ). According to the guidelines introduced by Cohen (2013) the effect size can be evaluated if the value of f 2 is less than 0.02 is then is considered as no effect size, from 0.02 to 0.15 is a small effect, from 0.15 to 0.35 medium effect size and more than 0.35 is a large effect of the endogenous latent variables.

Table 12 shows the f 2 values after running the algorithm for the model. The results show different size effects of the exogenous variables on the endogenous variables.

8.4 Model’s Predictive relevance (Q 2 )

Predictive relevance (Q 2 ) is an indicator of the model’s ability to predict values from the data. It is obtained using the approach of blindfolding, which is defined as the sample reuse technique that deletes every distance (D) of the data points in the endogenous construct indicators and estimates the parameters with the remaining data point besides the blindfolding procedure is only applied to latent constructs, which have a reflective measurement ( Hair et al. , 2021 ; Henseler et al. , 2016 ). Q 2 is a form of statistical validation for confidence in the model ( Yuan, 2012 ). The recommended omission distance is between 5 and 12 ( Chin, 1998 ; Hair et al. , 2021 ). In smart-PLS two values are calculated, which are cross-validated redundancy (cv-red) and cross-validated communality (cv-comm); however, for the assessment purpose, the cv-red is used to evaluate the model. According to the recommendation by Fornell and Larcker (1981) if the value of cv-red value is more than 0 then the model shows predictive relevance while if the value is less than 0 then the indication of the model lack predictive relevance.

Figure 8 shows the results obtained from blindfolding predictive relevance. The values are arranged accordingly in Table 13 .

Table 13 shows the predictive relevance values for dependent variables. It is shown that all the values are more than 0. Therefore, this indicates the model has satisfactory predictive relevance and is fit to predict endogenous variables.

8.5 Goodness of fit

The GoF is an index used to measure the geometric mean of the average communality and average coefficient of determination for all endogenous constructs ( Tenenhaus et al. , 2005 ). It is also used to evaluate the reflective indicators and is considered as a factor for assessing the global fit and validity of the model. The primary purpose of determining GoF is to test whether to account for the study model for both components measurement and structural model of its overall performance ( Chin, 1998 ; Tenenhaus et al. , 2005 ; Vinzi et al. , 2010 ; Yuan, 2012 ). There have been many criticisms on the cut-off value of GoF, ( Wetzels et al. , 2009 ) suggested the cut-off value of GoF to be 0.5 for the commonality. However, Cohen ( Cohen, 2013 ) suggested 0.10 as small GoF, 0.25 as medium GOF and 0.36 as large GOF. Calculation of GoF is performed manually using the following formula ( Coughlan, 2008 ): G o F = ( R 2 ¯ × A V E ¯

Referring to Table 7 and Table 11 , the overall average value of AVE is 0.56 and the average value of R 2 is 0.26, then GoF is calculated as follows: G o F = ( 0.26 × 0.56 = 0.38

To decide upon the evaluation of GoF value, the standard criteria suggested by Wetzels et al. (2009) stated that GoF is considered. No fit if the value of GoF is less than 0.1, between 0.1 and 0.25 is a small fit, 0.25 to 0.36 is medium fit and more than 0.36 is considered an ample fit. According to the value calculated using the GoF formula (0.38) and the criteria suggested by Wetzels et al. (2009) . It can be concluded that the GoF for the model is large enough to be considered to obtain sufficient global PLS model validity.

After finalizing all the assessments of the structural model, the developed hypothetical model is presented and then the relationship among cause-and-effect factors of poor communication in the construction industry, hence after performing the structural model assessment. As a result, the final PLS-SEM model of the relationship between cause-and-effect factors of poor communication in the construction industry is presented in Figure 9 .

Figure 9 shows the final PLS-SEM for the relationship between the causes and effects of poor communication in the construction industry. From the figure, the indication of relationship strength is interpreted by the path coefficient, which shows the extent of the relationship between causes (IVs) and effect (DVs). It is indicated that OM has a strong relationship with PER and weak relation with process interruption (PRO) and the path coefficient values explain this.

9. Discussion of structural model results

The model developed intended to study the relationships among causes and effects, which considered effects are the subsequent outcome of the causes. Thus, a comprehensive investigation of the collective relationships is required to take preventative measures of the causes at the early stages of the project. This section explains the outcomes of structural model assessments.

The causative factors of poor communication in construction under the construct named BC exhibited relationship with the effect construct named performance and practitioners, however, it did not support any relationship with the process, which relatively provides logical justification of the outcome, hence behavioral factors, such as individual habits can impact on the performance and the demotivation of practitioners.

OM causative factors poor communication have a significant relationship to the effect’s underlining performance, practitioners and process, which explains the importance of management and organizational standpoints in the involvement of the project throughout the lifecycle.

The construct PI has a noticeable relationship to cause deterioration of performance, practitioners’ productivity but is slightly significant to cause a process breakdown.

TM have a relationship with practitioners and process, however, no detection of significance in relation to the performance.

BC related causes factors have a small impact on causing PER, however, it has a large impact on producing unproductive practitioners (PRA) and no impact on the process (PRO).

The causes under OM have a small effect on PER and PRO and medium impact in producing PRA.

The cause factors of poor communication related to PI have a small effect on PER and creating PRA but no effect on PRO.

The cause factors of poor communication, which are related to TM do not affect the PER and PRA, nevertheless, it shows a small effect on PRO.

Referring to Figure 9 , which shows the final model of cause-and-effect factors of poor communication in construction. It indicates the relationship strength among causes (IVs) and effects (DVs) by the path coefficient values. From the figure, it is shown that causes factors under OM have the most substantial relationship with performance deficiency. Regarding the causes under BC, the most substantial relationship exhibited with PRA-related effects. Similarly, for the causes under the PI corresponding causes shows the strongest relationship with PRA. However, the causes under technology and method show the strongest relationship with process deficiency.

10. Model outcome interpretation and verification

Although the SEM has been previously assessed and verified statistically for its measurement and structural components. There is still one more process to be carried out to accept the model as a representation in the construction industry. This part introduces the interpretation and verification process of the model through the participation of construction experts. Interviews were carried out to share their understandings and opinions on the model’s applicability in the construction projects setting. The method is carried out by dividing the outcomes of the model into three main parts, which the first part includes the measurement model by ranking the factors based on their importance while the second part is evaluating the effects of the relationship among causes and effects. The final part is to investigate the possibility of applying the model in construction projects.

10.1 Model interpretation

This part aims to interpret the model of poor communication cause and effect factors with the reference to previous findings in previous sections. The purpose of interpreting the model is to produce understandable outcomes for participants. Table 14 shows the ranking of the factors based on the factor loading produced by the final iteration. The model comprises four groups called IV (causes) and three groups of DV (effects).

Table 14 shows the ranking of causative factors of poor communication based on the loading generated from SEM. The ranking displayed is based on constructs.

Table 15 shows the effect factors ranking based on the individual factor loading for each construct. It is shown that demotivation ranks first under the unproductive practitioner’s group, waste generation underperformance and redesign under process corresponding effect. The second part of the outcome is the relationship analysis among causes (IVs) and effect (DVs) groups, which is explained by the path coefficient illustrated in previous sections in the final model. Table 16 shows the relationship among causes and effects of poor communication in the construction industry.

Table 16 shows the relationships among cause-and-effect factors of poor communication using the path coefficients illustrated in the final model presented earlier. The following part is to verify these findings by involving construction experts.

10.2 Model verification process

The data obtained from the model were verified by selected experts. The purpose of carrying model verification is to relate the data obtained statistically with the construction project setting. The expert attributes have been defined as a person whose age is more than 30, worked in construction for more than 10 years and who is positioned in a managerial post. Semi-structured questions interviews were conducted alongside with questionnaires to verify the outcomes. A total of 14 experts participated in the model verification process. The first section of the question is about their background, the second part evaluating the factor ranking obtained from the measurement model and the last part was to evaluate the structural relationships among causes (IV) and effects (DV).

10.3 Demographic profile of experts for model verification

The first part of the question is to verify whether the participants have the attributes of experts by introducing questions on their experience and positions in their companies.

Table 17 shows the demographic profile of experts who participated in the model verification process. It is shown that all the experts have been working in construction for more than 10 years and have been assigned for managerial positions in their corporations. Furthermore, all experts have obtained bachelor’s degrees in civil engineering and some others obtained higher degrees. Due to the profound role of the experts in the construction industry and their academic achievements, their inputs, critic and opinions are a significant contribution to this study. Furthermore, the prescribed attributes of the selected experts qualified them to be the targeted respondents for model verification.

10.4 Verification of measurement model

This part introduces the analysis of the results for model verification. The method of collecting the data was by the mean of interviews with each individual expert. The questions contained two parts. The first part was about their profile and the second part on the model verification. The model architecture was briefly explained to them prior to asking them questions then the participants were given enough time to answer the second part after that the open-ended questions were raised to them on the model applicability and uses in the construction project lifecycle. The result is divided into two parts in which the first part focused on the verification of the measurement model and the second part discussed the structural model. The experts were asked to agree or disagree or else suggest a new ranking based on their experiences. Table 18 illustrates the verification of the measurement model for cause factors.

Table 18 shows the results of measurement model verification for causes factors, which were attained from the expert’s viewpoint. From the results, most of the experts agreed upon the outcomes produced from the PLS-SEM model. Nevertheless, few experts disagreed about the ranking of some factors, which they believe either the rank should be for all the groups, the first ranking factor for each group was also confirmed by the expert and all of them agreed upon the model findings. However, for the second-ranked factor, not all the experts agreed on the outcome. For the first group (OM), only 11 experts agreed that contractual barriers (restrictions) ranked as the second, but the rest 4 experts disagreed on this finding. This is justified based on their opinions some other factors are more important to be considered as the second-ranked in the group.

The second group is causes related to PI. From the results, the agreement percentage in the interval of 100 to 86 minimum and this is shown equivalent agreement between expert’s verification and model outcomes. The third group is BC-related causes. It is shown the minimum disagreement percentage is 86 which is relatively acceptable and, thus the group expert verification is in line with the model outcomes. The same applied to the fourth group which is TM related causes and the agreement is more than 50% and that is exhibited similar outcomes with the model.

As an overall result, the disagreement on the findings in most cases is less than 50% of the experts and that shows the outcome of the model is verified as most experts confirmed the results obtained from the model. The second part is to verify the ranking of effect factors.

Table 19 presents the verification results obtained from experts who participated in the model verification process. The table shows the ranking of the effect factors of poor communication in construction based on their corresponding groups. From the results, most of the experts agreed upon the outcomes produced by the model. Hence, the ranking of effect factors is verified and both results produced from the model and experts are correspondingly equivalent and accepted for further discussions. The following part is to verify the relationship between IV (causes) and DV (effects) based on the path coefficient level produced by the model analysis.

10.5 Verification of structural model

This section outlines the assessment of the cause-and-effect relationships based on the outcome produced by the coefficient of the path model. The cause factors are considered the IV, which have a relationship to impact on the effect factors (DVs). The relationship level is justified numerically using the coefficient of path models produced from the model analysis and the confirmation of the predeveloped hypothetical model in the previous sections.

Table 20 illustrates the verification results of cause-and-effect relationships. From the results, all the experts agreed that the causes factors under OM have strong performance deficiency and 13 experts agreed that it has a medium relationship with PRA-related effects and 12 agreed that it has a small effect with PRO. As an overall conclusion, most experts agreed upon the results produced by the model and the relationships are verified accordingly.

10.6 Model application

This section explores an opportunity on applying the model to construction activities among the same selected experts as in Section 17. This exploration was conducted by showing the model to the experts and requesting the expert to share their opinion on the possibility of applying the model to the construction activity. According to the experts, the model is likely to be applied in different three stages of the project including planning, execution and project closure.

Table 21 shows the outcomes of the model applications in the stages of planning, execution and closure. All the experts agreed the model can be applied in the planning stage and the possible applications can be during developing a communication plan whereby the model is likely to be used to induce more attention to dominant causative factors to produce an effective communication plan. Experts also added the model is a beneficial guideline to introduce comprehensive understanding to main parties to improve and smooth communication exchange. It was also revealed; the outcome of the model is also useful to individual technical project participants including managers and engineers whereby they can be able to identify the issues that hindered the production of effective communication. However, during the execution stage where many activities are executed concurrently and that makes the communication and information exchange more complex and intricate and a clash is likely to occur and rework may happen. According to the experts, the model is possibly applied in the construction stage in the following context:

The outcome prioritizes the causes of poor communication by highlighting the most critical causes and help them to take precautionary actions to avoid the causes.

The model also uncovered the effects of poor communication and, thus help construction practitioners to consider what if the communication is not properly executed, thus avoiding the causes.

The model established the classification of the causes and effects to different groups, hence it helps the decision-makers to relate the factors to their respective categories.

The model is likely to be applied to assess the health status of communication during the project execution.

The model helps construction parties to understand what causes the communication interruption, thus defining pre-measures to produce a more efficient information exchange process.

Assessment of communication status based on the causes and effects significances.

11. Conclusion

This article introduced the development of the PLS-SEM model of cause-and-effect factors of poor communication in the construction industry using Smart-PLS 3 which is used to study the relationship among causes and effects, which has been identified from previously published literature ( Gamil and Rahman, 2017 ). The hypothetical model consists of 12 hypotheses and 7 constructs which 4 of them are considered as independent cause factors and 3 as dependent effect factors. The model developed has undergone a thorough assessment process for both model’s parts, which are measurement and structural model. At the initial stage iteration process was adopted to delete indicators, which have less item reliability and loadings factors, After the second iteration, the measurement model achieved the required criterion for convergent validity than the model used for discriminant validity using cross-loading and Fornell-Larcker criterion. After finalizing the assessment of the measurement model, the structural model is assessed for all path modeling and hypothesis. The model was also assessed for global GoF and the results achieved the requirement prescribed by Cohen (2013) and Wetzels et al. (2009) and the model resulted in 0.38 GoF, which is considered as large enough to be considered to obtain sufficient global PLS model validity. From the final model presented in Figure 9 , it can be concluded that there is a possible relationship between IV and DV, which is illustrated by the path model verified. The model has been also verified by 14 construction experts. An explanation of the model was introduced prior to answering the question then experts were asked to answer the predefined questions and give their thoughts on the model. The results show that most experts agreed on the model outcomes. Therefore, the results have been verified practically and the outcome of this part assumes to help the construction players and other construction industry policymakers to understand the causes and effects of poor communication and their associated relationship to achieve maximum comprehension of the phenomenon of poor communication in the industry. To conclude, the developed model is significant for construction parties to understand the relationship between cause-and-effect factors of poor communication in the construction industry. It is also significant for construction practitioners in all perspectives to understand the phenomenon of poor communication in the construction industry.

Processes of model development and assessments

Hypothetical model of poor communication causes and effects relationships

Assigned manifests of the model (Smart-PLS output)

PLS algorithm simulation (Smart-PLS output)

Factor loading results of first iteration (Smart-PLS output)

Assessment steps of structural model (adapted from: ( Hair et al. , 2021 ))

Structural model t -values generated from bootstrapping (Smart-PLS output)

Values of cross validated redundancy

Final PLS-SEM model of poor communication

Model assessment criterions

Factor loading for cause factors (iteration 1)

Factor loading for effect factors (iteration 1)

Convergent validity of measurement model (iteration 1)

Factor loading for effect factors (iteration 2)

Convergent validity of measurement model (iteration 2)

Latent variable correlation

R-square of the endogenous latent variables

Effect size (f 2 ) for the model

Predictive relevancy (Q 2 ) for endogenous variables

Ranking of cause factors of poor communication based on factor loadings

Ranking of effect factors of poor communication based on factor loadings

Relationship level among causes and effects from the model

Experts’ demography for model verification

Verification results of measurement model (cause factors)

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Acknowledgements

Authors acknowledge the financial support provided by the Ministry of Higher Education in Yemen and the research supports by the university.

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