Organizational Communication in Public Health Institutions

This paper examined the management of organizational communication in state owned health institutions in Ghana. The study revealed that there is a positive relationship between communication and employees commitment to their jobs. The most preferred tools for communication were memos and meetings in state owned companies. However, monitoring and control of communication was very poor. The study recommends the establishment of bi-weekly meetings. It is recommend that management of health institutions must monitor to ensure adherence to instructions. Organization of regular meetings in the various directories must be encouraged to ensure effective communication.


Introduction
Communication according to Mershamand Skinner (2005) plays a very crucial role in all aspects of organizations.They contend that communication permeates all activities in an organization both internal and external.It is a work tool that allows individuals to understand their organizational role, co-ordinates organizational sub-units and stakeholders.Garnett et al. (2008) draws our attention to the fact that effective communication within an organization can lead to positive organizational outcomes.For instance in an organization, procedures, policies, regulations and other information may flow from the top managers to the lower level managers and across all stakeholders of the organization.All forms of communication, to some extent, shapes the opinions and perceptions of people about various objects and places such as persons, communities, organizations, governments and society.
Moreover, Seitel (2004) points out that effective communication system have become the key to nourishing the organization.It is very essential that management show concern about the aspirations, attitudes and preferences by their employees.The organization stands to gain from satisfied employees, working at jobs to which they are best suited.When organizations commit themselves to effective communication with their employees, a number of important benefits can result.Well-informed employees are usually satisfied employees (Baskin et al., 1997).It is in the light of this that the study was conducted to evaluate the effective planning, monitoring and control of communication in public sector hospitals, how employees receive adequate information and what channels of communications are used to ensure effective delivery of messages to help employees carry their duties successfully.The widely held view is that, communication is the life blood of every organization; thus not being able to communicate well will create a vacuum which may also lead to distrust and speculation.However, information overload may also occur when the information is too much (Bartoo & Sias, 2004).One may receive large amount of information but it will not necessarily be the right amount of information, likewise when employees are deprived of information; it has the tendency of creating an avenue where they prefer to rely on speculation as a tool of information.Communication management in public hospitals has not achieved the desired results.The hospital runs a decentralized system made up of clinical directorates, non-clinical directorates and supporting units.It must be emphasized that, each directorate is run in a semi-autonomous manner with their own management team responsible for the day to day administration of the directorates.However, there is communication gap as most staff complain of not having access to most information issued by either their directorate management team or executive management of the hospitals and this may be attributed to reasons such as; the institutionalization of the decentralized administrative system; coupled with the increase in staff strength; increase in sub-specialized discipline and expansion of facilities; running of 24-hour service with shift system where some staff will be off duty or have to wait for their shift to start before they come to the hospital.These therefore make it very difficult for most staff to be abreast with information meant for their benefit as most staff tends to express misgivings about information flow in the hospital.This point to the fact that, poor organizational communication can sometimes create conditions where members in the organization may resort to grapevine information.It is in the light of this that the researcher is evaluating the management aspect of communication in the hospital.The study will bring to light the communication planning process in public hospitals.The findings will also help management, Board of Directors, staff members and policy makers to understand and appreciate the importance of effective management of organizational communication in public.

Communication within the Organization
Communication has beyond reasonable doubt proven to be most significant tool in our daily, social and even management of businesses.Duncan and Moriarty (1997) believe that communication forms the backbone of all human activities.In the organizations, Barker and Camarata (1998) argue that communication cannot be left out if the organization is set to be an effective and continue learning one.Organizational communication is a collective process of interacting, generating and interpreting messages among individuals in the organization through one-way or two way manner (effectively termed as directional or bidirectional respectively) (Stoll, 1995).Communication in an organization is therefore seen as a transfer and receiving of ideas, feelings and attitudes between management and the workers.It also involves an understanding of the information (Frost and Bondy, 1994).Stoll (1995) examined how communication patterns within organizations are influenced by the hierarchical relationships.In concluding the research a high bureaucratic organization usually focuses their communication on the vertical direction as formal as possible.These top-down chains of command in high bureaucratic organizations are characterized by written forms of communication with little or no forms of personal interactions.Research on organizational communication mostly focused on understanding how organizational communication changes depending on organizational type and structure.Mersham and Skinner (2005) have also emphasized the importance of organizational communication citing it as the life-line of every organization hence the removal of this key tool (organizational communication) would invariably lead to the non-existence of any organisation.In the opinion of these researchers, communication is a key element of all activities of an organisation; it provides an important medium through which individuals understand their organizational role whilst bringing various sub-units in an organization together.Poor organizational communication may pose a threat to harmony and to a large extent chaos among the various units in the organization.

Channels of Internal Communication Practices
Organizations can easily assess the usefulness of formal communication as a function of management if they are able to apprehend the relevance of mission and vision statements, goal statements, plans for implementation, and channels used to disseminate them (Lewis, 2000).The challenge for management is to determine what to communicate, when to do so, who to receive the communication and most importantly which channel will be convenient for the communication.Data on research about big institutions posit that recipients of formal communication formulate their own understanding of a message and the purpose for that information.A sender's ability to select and present the best way to send messages to recipients will help eliminate self explanationswhich will improve effective communication.The effectiveness of communication is to some extent determined by the usage of organizational network and the method of selection.Passage of information from one person to the other in an organization depends on the interconnected channels referred to as networks.Communication flow may be downwards, upwards, laterally, and by diagonal means in an informal network.Organizations may have different forms of communication; the most common modes of communication are: vertical (upward communication, downward communication) horizontal communication and diagonal communication.

Vertical Communication
The vertical channel of communication perceived as one of the most common and important channels of communication in an organisation.The free flow of this form of communication usually prevents friction within the organisation, a situation that will provide a healthy work environment, free of conflict and frustration (Van Staden et al., 2005).

Upward Communication
Upward communication is said to be any message sent from a subordinate to a supervisor or manager (Barker & Gaut, 2002).This mode of communication serves a variety of needs: it is often used by the employees to communicate valuable information to management.This communication's direction enables the employees to communicate their concerns to the management.Smith (2005) argues that, emphasis is now being placed on how communication is channeled back in an organization from the employees.Serious emphasis is now put on attitude surveys which tend to bring out employee voice.Frost and Bondy (1994) poses an argument which believes that upward communication presents a valuable feedback mechanism, and also provide information for decisions.More importantly it helps employees to relieve some of the pressures and tensions of work; and it adds to their sense of participation in the organization.Tubbs and Moss (1991) states that, after supervisory communication, the second most important factor in determining the communication climate in an organization is downward communication.This form of communication is initiated by the organization's upper management; and it goes downwards through the "chain of command".Organizations owe it as a duty to initiate various channels of communication to mitigate tensions and to clearly explain policies and procedures.Job instructions, organizational procedures, individual expectations and evaluation, training and company directed propaganda are examples of downward communication (Tubbs & Moss, 1991).Fieding (2006) postulates that "downward communication serves five important functions which includes provision of specific instructions about duties of a job or task that would be performed.

Lateral/Horizontal Communication
Lateral communication is the form in which individuals on the same level of authority in an organization communicate across horizontal channels.Communication in this form may take place during structured meetings or informal conversations, just as it often takes place higher up in the organization.Frost and Bondy (1994) explains that horizontal communication mostly informal, as the questions of relative status do not arise in this form of communication, this gives room for it to be explained as between communication between equals.

Diagonal Communication
Diagonal communication on the other hand refers to interactions between managers and workers in an organization who operate in different functional divisions (Wilson, 1992).People at different levels of the organizational heirarchy and departments practice diagonal communication (Gibson & Hodgetts (1991).It strengthens the purpose of open sytem as well as an all inclusive management system in an.It creates room for authority based on knowledge rather than position in the organisation.

Data and Methodology
The population of the study comprised of all managers in Public Hospitals who receive information from Executive Management.They form the internal stakeholders and are made up of Heads of Directorates and Units, Business Managers, Nurse Managers, Accountants, Pharmacy Managers, Sectional Heads, whose responses were relevant to the study.Stratified sampling and simple random techniques were used in selecting the managers for the study.The population characteristics of the managers (heads of directorates, unit heads, business managers, nurse managers, accountants, pharmacy managers and sectional heads) in Public Hospitalsrequired the use of stratified sampling technique.Simple random sampling technique was used to select respondents from each stratum to form the total sample size.Both primary and secondary source of data were gathered for the study.A data collection instrument of opened and closed ended questions was used to solicit information from the respondents.

Planning Process of Communication in Public Hospitals
Table I depicts respondent's assessment of the first objective of the research which sought to examine communication planning process in Public Hospitals.The researcher employed the five point Likert Scale to elicit respondents' perception about the extent to which they agree or disagree with the statements of planning process of communication in Public Hospitals.From the table I below, 69% of the respondents overwhelmingly agreed to the statement that need assessment ensures effective management of communication, despite the fact that 10% remained neutral to the statement.This indicates that more than half of the respondents believed in the need to conduct need assessment before communicating, this is in line with Andrews and Andrews (2004) assertion that need assessment ought to be done to address communication gap.Again, when the statement that current communication system in the hospital is analyzed before issued was put before respondents, 39% remained neutral, 10% disagreed, 3% strongly disagreed, however, despite this trend 35% agreed to the statement whilst 8% strongly agreed to that assertion.This is in line with the view of Kalla, (2006) that effective communication is generally analyzed before they are issued in organizations.
Moreover, when a statement that communication achieves its goals and objectives was put before the respondents, 43% remained neutral, 14% disagreed, 6% strongly disagreed, 3% strongly agreed whilst 32% agreed with the statement.This indicates that even though, majority of the respondents remained neutral, majority agreed that communication in the hospital achieved its stated goals.Seitel (2004) stated that communication is the key to the nourishment and achievement of organizational goals and objectives.The finding points to the fact that the public hospitals are able to meet the stated goals and objectives through the effective communication reported.Again, when the statement that communication in the hospital meets the needs and expectation of staff was put before the respondents, 4% strongly disagreed, 30% disagreed, 25% agreed, 4% strongly agreed, whilst 36% remained neutral, However, with mean score of 3.05 it can be deduced that respondents were not too sure about how the organizational communication are able to meet the demands of the staff.Mersham and Skinner (2005) define communication as the lifeblood of organizations which seeks to meet the needs and expectation of employees and that without which there will be no organization.Per the outcome we realize that staff needs on certain organizational information are not adequately addressed.From these two outcomes, it can be deduced that communication on how to effectively carry out duties are effective but the problem is how management are able to communicate issues that affect employees.Furthermore, when a statement that key messages are communicated to staff at the right time was put before respondents, 36% disagreed, 3% strongly disagreed, 21% remained neutral, whilst 32% agreed and 6% strongly agree with the statement.This points to the fact that with a mean score of 2.98 and a standard deviation exceeding one (1) it indicates the extent of variations in the responses to the statement and how dispersed the responses are from the mean.This therefore depicts that there is no significant difference between respondents who disagreed and those who agreed with the statement.These diverting views are also attributed to how the staff in question is close to management for them to receive their information on time.Formal means of communication in these hospitals which are limited to paper memos and meetings are not able to widely disperse information.When the statement that current communication practice in the hospital is free from challenges was put before respondents, an overwhelming majority of 43% disagreed, 29% remained neutral, 17% strongly disagreed, 7% agreed and only 2% strongly agreed with the statement.This indicates that communication in the hospital is plagued with lapses which are reflections of the outcome of respondents view to the statement.Sengupta et al. (2000) that the quality of communication is determined by the received and understood content by the receiver.From the current trend of communication which leaves a few people in the known with the remainder relying on grapevine which may lead to distortion of information.

Monitoring and Control Mechanisms of Organizational Communication
Table II depicts respondent's perception of monitoring and control mechanisms of organizational communication in Public Hospitals, they were given a five point likert scale type to choose from the extent to which they agree or disagree with the statements enumerated.When the statement that Public Hospitals has a set standard for effective communication was put before respondents, 53% remained neutral, 30% agreed, 9% disagreed, 3% strongly agreed with the statement whilst 2% strongly disagreed.The results points to the fact that respondents were not certain to the statement under reference which could be attributed to the fact that most employees may not be aware of any standards set for communicating in the hospitals.
Moreover, when the statement that corrective decisions by management of Public Hospitals ensure effective monitoring and control of communication was put before respondents 32% were supportive to the statement, 15% disagreed, 5% remained neutral, 4% strongly disagreed whilst 3% strongly agreed.It can be deduced that with a mean score of 2.85, it is an indication that when management of Public hospitals put in corrective measures it will lead to effective communication.This means that these corrective actions are usually meant to undo a damage for which a total prevention of the damage could a better option.When the statements that management act on feedback accordingly was put before the respondents 32% agreed, 29 % disagreed, 28% remained neutral, 10% strongly disagreed, interestingly none of them strongly agreed with the statement.This point to the fact that respondents view on the statement were evenly spread with mean score 3.18 and a standard deviation exceeding one (1).Although the perceptions are wide it is interesting to note that employees did not believe in managements' ability to act on feedback.As a result there is the need to embark on sensitization to help employees appreciate the essence of feedback which is a tool for the achievement of organizational goals.Furthermore, when the statement that management of Public Hospitals uses feedback to ensure that objectives of communication are met was put before respondents, the results revealed that 31% disagreed, 8% strongly disagreed, 22% remained neutral, whilst 35% agreed, 2% strongly agreed with the statement.This point to the fact that even though majority of the respondents were in support of this statement, the mean score of 3.08 and a standard deviation of 1.043 is an indication that respondents had issues with the effectiveness of management's ability to effectively act on feedback to ensure objectives of the communications are met.

Management of Organization Communication Channels
Table III shows respondents view on management of communication channels in Public Hospitals.When the statement that upward vertical communication is effective in Public Hospitals was put before respondents, 3% strongly disagreed, 20% disagreed, 19% remained neutral, however, 8% strongly agreed whilst 47% agreed with the statement.This point to the fact that upward vertical communication is has a well-structured means.In most public institutions in Ghana, there are formal means of communicating to superiors hence making it more effective.In line with the assertion of Barker et al (2002) that upward communication is often used by the employees to communicate valuable information to management, the findings have adequately shown that effort are being made to ensure this effective flow of information within the public health sector of Ghana.This ensures the effective gathering of data to inform management decision making.
On downward vertical communication is effective in Public Hospitals, responses were, 8% disagreed, 2% strongly disagreed, 17% remained neutral, however, 35% strongly agreed, whilst 35% agreed to the statement, this is a confirmation of the reality of what prevails in the hospital so far as medium of communication from superiors to their subordinates is concerned.The downward communication under review reflects formal and instructional communication within the public health sector.As depicted by respondents, the formal means of downward communication are viewed as effective.
Moreover, when the statement that management acts on informal communication in Public Hospitals was put before respondents, with 5% strongly disagreed, 16% disagreed, 54% remained neutral, whilst 18% agreed and 4% strongly agreed with the statement.This points to the fact that there is a communication gap when it comes to the informal communication within the public sector.It also indicates that the sector is crippled with bureaucratic and formal means of communication which may not augur well for the effective address of issues relating to a particular department.
Furthermore, when the statement that horizontal communication facilitates the management of communication in Public Hospitals was put before respondents, 1% strongly disagreed, 15% disagreed, 51% remained neutral 26% agreed whilst 3% strongly agreed, This indicates that majority of the respondents who took part in the study were not aware about the extent to which horizontal communication facilitates the management of communication in the hospital.It should therefore be noted that horizontal communication in organizations are normally informal and it exists amongst people on the same level of authority.Frost et al. (1994) indicated that the function of horizontal communication includes task co-ordination, problem solving, and information sharing and conflict resolution.

Respondents Views on Frequency of Communication to Subbordinates
The graph below (Figure I) samples the views of Public Hospital managers on how often they communicate to their subordinates, when the statement was put before the respondents of how often do they communicate to their subordinates 48% indicated that they communicate with their subordinates very often, whilst 50% of the respondents often communicated to their subordinates, however, two of the respondents did not respond to the statement.This is in line with Scriven (2002) assertion that in this era of information world, there is the need for constant communication to employees through the use of new technological devises such as the Internet, intranet, and other electronic devices like mobile phones.Also when respondents were asked a follow-up question to indicate the tools they used in their communication, all the respondents coincidentally chose memo, proposal report, meetings, notice board, durbars as the tools used in communication, interestingly none of them chose hospital newsletter and the website, this was due to the unavailability of the regular production of the news bulletin and slowness of the website which discourages them from using it.Moreover, when respondents were asked to choose the most preferred tools that ensures effective management of communication.Their responses are indicated in table V below.
Figure 1.Respondents views of frequency of communication to subbordinates

Tools that Ensure Effective Communication
It is interesting to note that when respondents were asked to indicate which of the tools that ensures effective management of communication in the hospital, 44% chose memo, whilst 43% chose meetings, 5% chose notice board and durbars respectively, whilst 1% chose report (Table IV).This means that most of the respondents were comfortable with memo which coincidentally is the most preferred tool of communication in the hospital at all levels.Furthermore the choice of meeting and durbars as the second and third tools of communication can be attributed to the need for constant interaction as a result of the shift system where some category of staff has to come for afternoon and night schedules and the working of the team system which is in place at the hospital.

Effect of Communication on Hospital Employees
The table below (Table V)shows respondents view on the effect of communication on the variables which has been explained below, the predictors: (Constant) variables were internal communication responsive to employee's needs, effective communication improves productivity of workforce, effective monitoring of communication improves employees commitment to the job, Internal communication systems create an enabling environment for employees to develop interpersonal relationships and internal communication system creating an environment that enables co-workers to support each other, whilst the dependent variable is the effect of communication.The results were based on the regression analysis with a margin of error of 0.05 and a confidence level of 95%.It can be deduced from the table that out of the five independent variables used in the Respondents view on frequency of communication to subordinates predictions, only three representing internal communication systems are responsive to the employee's needs, effective monitoring of communication improving employees commitment to their job and internal communication systems creating an enabling environment that enables co-workers were the statements that were affected by the dependent variable which is indicated as effect on communication.
This means that effect of communication on employees had significant contribution on the statements .however the extent of significance depended on the co-efficient variable.It should be noted that a negative coefficient signify that there is no direct relationship between the variables whilst a positive co-efficient variable indicates that there is a positive relationship amongst the variables.This therefore suggest that even though effect of communication contributed significantly to the statements there is a positive relationship between effect of communication and the employees commitment to their jobs to a large extent.This is line with Kitchen et.al (2002) proposition that effective employee communication is crucial to achieving successful change in organizations.They believe that internal communication programmes must motivate employees support for a new direction, encourage high performance, limit misunderstandings and rumours and align employees behind the company.

Conclusion
The study succeeded in the effectiveness of the need in embarking on need assessment in the planning process of communication, scaling up the monitoring and control mechanisms of organizational communication effectiveness in Public Hospitals.All the managers who were selected from the various directorates and units participated in the study by effectively responding to the items on the questionnaire.The study revealed that the need to embark on need assessment in the planning process of communication was very high.Also, the issues regarding monitoring and control mechanism for organizational communication in Public Hospitals are very poor thus accounting for higher rate of neutrality of respondents view in that regard.The study also showed that staff responded to all the elements in monitoring and control mechanism for organizational communication, in Public Hospitals as well as the management of organization communication channels and the effect of communication on employees in Public Hospitals.From the study, it indicates that monitoring and control mechanism in communication is absent and not effective in Public Hospitals.The study showed that staff overwhelmingly agreed to the use of downward vertical communication as an effective tool of communicating in Public Hospitals but were not certain about the effectiveness of upward vertical communication in the hospital even though there were frequent interactions between managers and their subordinates.The study stressed that the most preferred tools for communication in the hospital were memos and meetings.From the study it was found that effective communication is poor according to respondents and this affect the efficiency of rendering quality service in Public Hospitals.

Recommendation
In spite of the fact that the study found need assessment to be a vital tool in the planning process of communication, some few staff members however revealed some weaknesses which must be addressed by internal stakeholders including executive management, heads of directorates/units and other officials for the necessary corrective actions.The recommendations are based on the weaknesses identified in the study: Planning process, monitoring and control mechanism of communication, management of the channels of organizational communication and effects of communication on employees.It is believed that the recommendations will help managers to improve the management of organizational communication in Public Hospitals.

Planning Process
From the study findings, majority of the respondents agreed that the effectiveness of need assessment before communicating was high thereby enabling to ensure that all communication gaps that give room for speculations are addressed effectively.It is therefore recommended that in order to ensure effective planning process in communication in Public Hospitals, there is the need for continuous engagement of managers on issues such as relevance of the structures in Public Hospitals, communication process, rules and compliance of communication to test internal control policies.

Monitoring and Control Mechanism for Organizational Communication in Public Hospitals
From the above, it is clear that monitoring and control mechanism for organizational communication is very low, indicating that there is weak monitoring and control communication mechanism in Public Hospitals.It is recommended that managers of in Public Hospitals should embark on effective follow-up on instructions or circulars issued to their subordinates to check whether their instructions have yielded results.

Management of Organization Communication Channels in Public Hospitals
It is recommended that managers must encourage upward vertical communication through bi-weekly meetings and encourage staff durbars at the respective directorates of the hospital where subordinates can freely express their concerns to their superiors in a cordial manner devoid of intimidation in order to improve transparency and bring benefits to the hospital.This will ensure high moral amongst employees when their views are held in high esteem, it will also offer subordinates the opportunity to serve as watch dogs to protect the interest of the work by easily identifying the chain of command in their respective directorates or units.

Effect of Communication on Employees in Public Hospitals
According to the respondents, effect of communication being responsive to employees' needs and creation of enabling environment for employees to develop interpersonal relationship had negative significance whilst its impact on effective monitoring of employees commitment to their jobs had positive significance.It is therefore recommended that management should improve on all bottlenecks surrounding communication and there should be clarity in the language communicated to staff which should be understood by all stakeholders including subordinates and superiors.

Table 1 .
Respondents view of communication planning process

Table 2 .
Respondents view on monitoring and control mechanisms of communication

Table 3 .
Respondents view on management of communication channels

Table 4 .
Tools that ensure effective communication

Table 5 .
Respondents measurement on effect of communication