Communication Breakdown- Ask don’t refer!


NB: image  from


We have all heard of the concept of ‘walking in another mans shoes’ (personally as I favour 3-4″ inch heels, I’m not sure ‘men’s’ shoes would suit me). But joking aside, we best understand others when we get into their heads, discover what makes them ‘do what they do’.

This is the essence of ‘social marketing‘, which cleverly uses ‘insight’ gained by various means, to give an understanding of people’s behaviours. When you use social marketing techniques, you start with the person, really understand them and then craft messages and interventions to change specific behaviours. In classic marketing, you tend to start with a product or service and then craft messages relevant to specific segments and ‘push’ them out.

Social marketing was first used in the 1970s and the idea was to change behaviours for ‘social good’; for example getting people to wear seat belts, to recycle and to save water. I studied ‘classic’ marketing and although there are many similarities, the main difference is the real understanding of behaviours. The real insight gained to craft appropriate messages, but also to link to policy change and service reconfiguration. Interestingly, it could be argued that the main driver in reducing the numbers of people smoking was not the medical information on the damage you can do as a smoker, but the  ‘ban’ on smoking in public places.  Thoughts please!

So, lets consider some of the messages we in the NHS ‘push’ out and the potential breakdowns that poor communications can cause.

Please picture a young woman who is pregnant and still smoking cigarettes. A well-meaning practice nurse or midwife will encourage the young woman to stop smoking to prevent ‘having a small baby’. The medical aim is to ensure the mum-to-be is fit and well and not causing any damage to the unborn child. To a clinician, it is a no brainer!

Now, to the young girl, who is frightened of pain, has heard horror stories of difficult births and is surrounded by peers who are pregnant or have been pregnant ans still smoked. To that girl , a small baby is just what she wants. In her mind there will be ‘less pain’ and ‘less problems’. The mum-to-be and the midwife exist in the same world but have very different outlooks. How do you deal with that? This is the opportunity to adapt your medical message relevant to the insight you have gained.

Consider the same mum-to-be who is then ‘referred to a smoking cessation clinic’. Now, lets be honest, how does that sound?  Being referred…. to a smoking cessation clinic

Come on, let’s get real!

This young mum-to-be may tell us;  firstly…… ‘I’m not ill’,    secondly, she may say…… ‘ask me to come and talk to you about smoking!’, ‘don’t treat me like I’m ill, and I’m bad!’  And lastly ‘what the @@@@ is smoking cessation?’

These are words and phrases we choose to use in the NHS.  We construct an NHS language that creates elitism, a language of power.

Lets stop the Communication Breakdown…. lets live in another mans, or woman’s shoes and lets think about the words we  ( Jimmy) ‘Choos’ to use which may have a negative impact on others.

And as a gift, here is a live version of ‘Communications Breakdown’ from my favourite band, Led Zeppelin

and  very gratuitous shots of some of my favourite shoes



About Michaela Finegan

Passionate about the NHS and making it better; for patients and staff. An avid fan of social media with the belief that, along with social marketing, social media the potential to positively affect how we use the NHS and how it provides services to us. First love is music, spending as much time as possible at gigs and festivals. Enduring, everlasting love for my two beautiful sons. All views my own.
This entry was posted in call to action, communication, social marketing and tagged , , . Bookmark the permalink.

6 Responses to Communication Breakdown- Ask don’t refer!

  1. Trevor says:

    “The problem with communication is the illusion that it has been accomplished” – George Bernard Shaw. I think Michaela that we can NEVER get into someone else’s head and then speak for them. The most important element of communication in my opinion is listening. I don’ think social media has made REAL communication any easier – in some ways it makes it more difficult. The only way we can really understand is to listen and then check our comprehension of the message from the sender. People want short cuts and short cuts often lead to false representation of the original message – Chinese whispers still very much alive and well despite Twitter, Facebook and any other Social Media. Effective communication is simply HARD WORK and constant checking.

  2. Rita Eagles says:

    Oh so true Mick, an understanding of patient knowledge and experience should be the first thing any practitioner tries to ascertain. Well thought through and well aimed… Go girl go …oh and love the shoes! Xxxxx

    • Michaela Firth says:

      Thanks Rita
      Appreciate that endorsement from an improvement leader and nurse. And yes, I love my shoes !

  3. Michaela Firth says:

    Thanks for your comments. Most appreciated. I agree listening is the best tool we have ( 2 ears, 1 mouth and all that )
    My point relating to social MARKETING is the theory and practice that we attempt to gain insight then craft messages related to the behavioural segments we uncover rather than just using geographical, age, gender,socio- economic segments. For example I may live next door to another lady of similar age, share postcode and other similarities BUT we will behave differently given specific situations. This is the rich insight.
    I agree social media can make communications more difficult in some cases but it is an additional tool in the box for us to use. However I do think social media such as Twitter gives us access to communities we may never otherwise reach. We just need to remember social media is not the choice of communication for many and ensure we have a mix of channels in our plans.
    My next blog I may described the attributes / positives / negatives of both social media and social marketing.
    Thanks again

  4. Melissa says:

    Ah “ask don’t refer” is a concept, philosophy, mantra etc that transcends “industry boundaries”
    How often in the the manufacturing and wholesale sectors do we “tell / refer” rather than ask what the need is and then act to meet it? Or push a course of action without considering why the distributor or customer is not already on that path? Philosophical moment now over, but with you 100%

  5. Nadia Chambers says:

    Food for thought and good replies. Being able to listen – really listen- is a skill and one that can always be improved. I guess the challenge is to be able to listen ‘with an open mind’ and hold your own agenda in abeyance for long enough to hear what’s going on with another person- or as much as they’re willing to share with you. Then maybe you can move into a more honest conversation which reflects your ‘concerns’ or observations along with acknowledging their needs. It truly is a two way street! And it’s always nice to have lovely shoes as a conversation icebreaker!

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