People Can Handle Bad News.
They Struggle With No News.
A thirty second update can eliminate thirty minutes of anxiety, and it is the cheapest thing available to an understaffed building.
Think about the last time your flight was delayed.
Here is what I would bet on. You were not actually that upset about the delay itself. Planes are late. Everyone knows planes are late.
What got under your skin was that nobody was telling you anything.
The departure time came and went. The gate agent disappeared to somewhere behind a door. The board still said On Time, which by that point was insulting. And every single person sitting at that gate was thinking the same sentence.
I know you know something. Just tell us what is going on.
Nobody at that gate needed the plane fixed faster. They needed thirty seconds of honesty about what was happening.
Patients are sitting in exactly that seat, except the stakes are considerably higher and they cannot leave.
I know you know something.
Just tell us
what is going on.
Uncertainty is not a mild version of bad news
The instinct in most organisations is to wait until you have something definite before you speak. It feels responsible. You do not want to alarm anyone or say the wrong thing.
But the research suggests that waiting is not the neutral option people think it is.
Researchers at University College London had 45 people play a game where turning over a rock might reveal a snake, and a snake meant a mild electric shock. The odds shifted throughout, so participants were sometimes certain and sometimes had no idea.
They measured stress three ways: what people reported, their pupil dilation, and how much they were sweating.
Stress was highest when the chance of a shock was fifty percent. It was lowest at zero percent and, critically, also lowest at one hundred percent.
In the lead author’s words, it is much worse not knowing you are going to get a shock than knowing you definitely will. And the physiological measures tracked the uncertainty rather than the shocks themselves. Published in Nature Communications, 2016.
People who knew something painful was definitely coming were calmer than people who did not know.
Sit with what that means on your floor. The person in that room is not primarily distressed about the diagnosis. Much of what they are carrying is the not knowing, and that part is entirely within your control even when the medicine is not.
You cannot always give someone good news. You can almost always give them information.
Patients do not want more information
That sounds like a contradiction, so let me be precise.
Most people do not remember the detail of what they were told in a hospital. Ask somebody a week later to repeat what the consultant explained and you will get fragments at best.
What they remember with total clarity is whether they felt supported while it was being explained.
Which means in the difficult moments, reassurance often does more work than information does. Not false reassurance, and not pretending. Just somebody who slowed down, made it clear they knew this was frightening, and did not seem in a hurry to leave.
The update matters because it says somebody is thinking about you. That is the payload. The content is almost secondary.
Nobody likes not knowing where they are going
Have you ever been in a car with someone and suddenly realised you had no idea where they were taking you?
They might be a perfectly good driver. It is still uncomfortable, and you find yourself watching the road signs.
The moment they say where you are going, roughly how long it will take, and what happens when you get there, you settle back into your seat. Nothing about the journey changed. You just stopped having to work it out.
That is what anticipating a need looks like in a building. Seeing what somebody is about to be confused or worried about, and answering it before they have to ask. Sometimes it is a blanket. Sometimes it is explaining what the next two hours look like. Sometimes it is noticing that a family member has gone very quiet.
Uncertainty creates anxiety. Clarity creates comfort. That is nearly the whole discipline.
Death by papercuts
One more thing worth naming, because it explains a lot of survey results that otherwise look irrational.
Think about the last genuinely frustrating experience you had as a customer anywhere. Almost certainly it was not one large failure. It was five small ones stacked on top of each other.
Nobody explained the wait. Then you were sent to the wrong desk. Then you had to give the same information twice. Then somebody was short with you. Then the thing you came for took four minutes.
No single item there would appear on an incident report. Together they are the experience.
And patients do not experience your departments. They do not know your reporting structure or which of those people worked for which director. They experience the sum of every interaction they had that day, as one thing, with your name on it.
Which is why patient experience cannot sit with a committee. It is distributed across every person in the building, including the ones who never touch a chart.
Uncertainty creates anxiety.
Clarity creates comfort.
That is nearly
the whole discipline.
None of these require more staff
- Give the update before it is requested. Even with nothing to report. We are still waiting on radiology, I will check again in twenty minutes. The information is not the point, the contact is.
- Say what happens next and roughly when. People can wait a long time if they know what they are waiting for. They cannot cope with an open-ended silence, and the research says that is not a preference, it is physiological.
- Name the emotion before you explain the plan. I know this is frightening. Then the clinical part. People cannot absorb information while they are still managing the fear.
- Hunt the papercuts, not the incidents. Walk your own patient journey from car park to discharge. The five small frictions you find are what people describe when someone asks how it went.
Why this is the lever worth pulling
I spend most of my working life around organisations that are short-staffed, and I am careful about advice that assumes slack nobody has.
So here is why I keep coming back to this one. Clear communication, consistent experiences, and calm in stressful moments are the three things that move patient perception most, and not one of them requires another person on the rota.
They require somebody deciding that thirty seconds of information is part of the care rather than an interruption to it.
Because when patients know what is happening, know what to expect, and know they are not alone, trust builds very quickly. And once trust is there, they forgive an enormous amount of what goes wrong afterwards.
You cannot always fix the delay. You can always tell them about it.
UCL researchers found people were more stressed by a fifty percent chance of a shock than by the certainty of one, measured in sweat and pupil dilation rather than opinion. Uncertainty is not a milder version of bad news, it is worse than it. Which means the silence in your waiting room is doing more damage than the news you are waiting to deliver. Give the update before it is asked for, say what happens next, and go looking for the five small frictions rather than the one big incident.
The Power of
Small Moments.
Chris runs national healthcare staffing organizations and speaks to health systems, associations, and clinical teams on patient experience, retention, and the small moments that decide how care actually feels.
Response within one business day
The Team Playbook
A ready to run guide for turning this into real conversations with the people you lead. Free and printable, no email required.
