Preventing the Communication Triangle Dilemma: 5 Tips for Facilities
When poor communication practices take root within a healthcare organization, they can lead to mistrust, gaps in communication, and a decreased quality of care. The communication triangle is a form of dysfunctional communication that involves a nurse voicing a grievance about a coworker to a manager or supervisor instead of addressing the issue directly. This type of triangulation tends to enhance problems rather than solve them, and creates an unnecessary burden for managers.
If you’re a leader dealing with this dynamic on your nursing staff, you’re not alone. It’s a common issue in healthcare settings, where there’s a strong reliance on the chain of command. To complicate matters, the urge to cast blame and create drama are human tendencies that nurses aren’t immune to.
With a clear understanding of this pattern, you’ll be able to spot it and prevent it on your team. Learn the differences between issues that deserve escalation up the nursing hierarchy and those that can be discussed peer-to-peer, and use these five tips to promote direct communication on your team.
What Is the Communication Triangle Model?
The triangle model is a form of communication that involves a nurse (the complainer) voicing a grievance about a coworker (the wrongdoer) to a manager or supervisor (the confidant). This model is dysfunctional when the grievance could easily and safely be discussed in a direct manner, without involving leadership.
An Example of Triangulation on a Healthcare Team
Here’s an example to demonstrate how this style of communication typically plays out, followed by an analysis of how it harms team dynamics
Communication Triangle Example: A seasoned nurse, Ellen, stops by her nurse manager’s office and asks for a brief meeting in confidence. Once the door is closed, Ellen voices her concern that a new graduate nurse is not pulling his weight on the team: “Mitch spends too much of his time goofing around at the nurses’ station and not enough time working.”
The next day, the nurse manager asks Mitch to step into her office, and reports, “It’s been brought to my attention that you are spending a lot of time joking around, and there are concerns you’re not giving enough attention to your patients.”
Analysis: Consider the potential consequences of this scenario. How is Mitch’s morale when leaving his manager’s office? Probably lower than when he arrived. He may later decide to relay the conversation to others to try to figure out who complained about him. With a diminished trust in his coworkers, he may not seek advice or request help when he needs it, creating higher risks for his patients.
Why Does This Type of Communication Pattern Happen?
The psychology behind triangulated communication patterns is universal and two-fold:
- Projecting blame can temporarily make a worker feel better.
- A desire to be polite or well-liked creates conflict aversion.
These tendencies can tempt nurses to complain to managers instead of engaging in direct communication.
Reasons to Involve Management
In some instances, involving leadership is the right decision. Here are some cases when your staff is justified in bringing you into the loop and requesting your input and intervention.
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Suspected Drug Diversion |
When a nurse suspects a coworker of diverting medications, they should immediately report it to their supervisor, not directly to the coworker. |
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Failed Attempts at Nurse-to-Nurse Resolution |
After speaking to a peer about an issue at least once (perhaps multiple times) and failing to see a positive change, a nurse is justified in seeking backup from an authority figure. |
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Patient Safety Is at Stake |
When a nurse is concerned for a patient’s safety, going directly to management with a problem may be the most efficient and effective way to reach a resolution. Protecting the patient takes precedence over team dynamics. |
How to Help Staff Prevent the Triangle Dilemma
Though there are some scenarios that require managerial input, for the most part it’s healthier for coworkers to communicate directly with one another. Here are ways to foster clear and open communication on your team.
1. Lead by Example
Before grumbling to a third-party confidant, check yourself. Have you spoken directly to the person with whom you hold a grievance? If not, you’re modeling dysfunctional communication.
Reverse this with self-awareness. You can be an example of a person who accepts responsibility for your mistakes instead of projecting blame onto someone else. You can also demonstrate courageous, direct communication instead of taking the easier route of passive-aggressive complaining.
2. Provide Training on Effective Communication
Teach the importance of direct, professional communication practices. Provide examples that cover:
- How to raise an issue to a coworker in a factual, logical manner (vs. confrontational or emotional).
- How to practice active listening.
- How to collaborate to work toward a solution.
3. Show Appreciation
The urge to involve a third person in a conflict is based on a desire to alleviate tension and feel emotionally safe and protected. By highlighting how a coworker is falling short, a nurse may feel better about their own job performance. Leaders can prevent this by providing proactive encouragement and appreciation, so that nurses don’t feel they have to bring someone else down in order to feel okay.
4. Refuse to Participate
When a member of the healthcare team brings an issue to you, consider whether your involvement is justified. If not, refuse to become the messenger. Instead of agreeing to speak to the wrongdoer (let’s call her Jane), place responsibility back on the complainer by saying something along these lines: Have you spoken directly to Jane about this? Here are some strategies you can use to make the conversation positive and productive.
5. Focus on Shared Purpose
Healthcare workers have an advantage when it comes to overcoming communication challenges and working as a team. Many people on this career path are driven to help people. Teach staff that speaking directly to coworkers about issues may be uncomfortable, but it can lead to better team dynamics and therefore better outcomes for patients — and that’s what matters.
Looking for More Leadership Tips?
Now that you’ve explored communication triangle psychology, you may be looking for more insights to help you lead your team. Our healthcare resources and guides deliver helpful and practical information on management tactics, staffing strategies, and more.