In any industry, there are several words and catch phrases that are used to highlight the "muscle memory" they bring up. Some of these are communication, transparency, collaboration, patient-centric, community focused. The part that goes unnoticed from time to time is the philosophy behind the "art of the comma." For example, in relation to communication, is your definition of transparency the same as my definition? It might be. Or, it may be completely different. This posting will be devoted to me clarifying my word relation of transparency and give a few real-life examples where I assumed the present company (of people) knew exactly what I meant when I said the word, only to find out we were not even close in our definitions. Transparency has two gears. It has the low gear of vanilla-based V-Transparency and the hyper-fast high gear of H-Transparency. V-Transparency is the elevator speech of notifications and updates. It is getting on the elevator with someone you do not know and they see your ID badge that says your name and your job title. You hear them next to you as the doors close, "Hi there. I see you work for XYZ Corporation. How do you like it and what do you do?" You smile back to them gently and see you have 25 steady floors to climb as they are getting off the elevator after you. This allows you to be generic. It allows you to say the department and very generic prideful moments of exceeding the customer's values and preferences. Your sales pitch is followed by a sincere smile, handing over a business card, and inviting any visits or questions in the future. H-Transparency has it's own sub levels but the mark of my definition of transparency is to be proud of what you do, even in the face of adversity or 'failure.' Please note that there will be a time not too long from now where I also explain the real definition of failure. It should never be used negatively. We learn and grow. We can't do that without failure. I digress. Hyper speed, taken from the Spaceballs movie we loved in the late 1980s, is using communication art and skill, to give the same information to the board of directors or CEO, or a front-line staff member, or other stakeholder the same information. The best example I can provide is financial information. To allow for full empowerment and accountability, everyone in your department should know how their department and the organization is performing on key performance indicators, including finances. The overall message is the same but greater detail and terminology is used for the CEO where as the monthly staff meeting involves generalities with visualizations to allow different people with different learning styles to absorb the information. The medical assistants or schedulers NEED TO know that overall income went down because demand went down leading to not having enough money for ABC. Would you not tell your family if McDonald's raised the price of a happy meal by $300 but you can find another great restaurant? Or, would you just avoid the requests without explanation? You can add your own favorite analogy. What seems odd to me is the reaction I see over the last 20 years. There are those leaders that understand the framework and expect hyper transparency and honesty laced with good communication.. However, I found, especially in the southern states, that the executives are fearful at what to share at what level. The best part is learning and teaching together. In one instance, the COO heard my sales pitch before my first department meeting. He said he would allow the sharing of financials but he was apprehensive. We talked through the emotions and I went as far as to present my slides to him first. Then the staff meeting came. I smiled from ear-to-ear to see attendance and get a whisper from one of my managers that the staff meetings were never attended well in the fast. Nothing like a little shake-up to make it interesting! Right!? People made their presentations, got questions answered, and I saved the State of the Union for the end. It took the staff a few meetings to fully engulf what I was doing. Some even thought I was just teaching without giving real numbers. Then, the best thing happened. I am still over-joyed today. The managers and I started getting more staff, supervisors, and even clinicians asking for more detail and talking through the numbers that were presented. They were empowered! Guess what happened next. You guessed it. In general, patient access and customer service improved. Efficiency increased and spending went down. One staff member even said they didn't realize how much a specific product cost the company. She found a better way to do a process without using the product. Thousands of dollars later, the department had funds for more improvements, investment in staff, and investment in services. Lesson here is - DO NOT EVER stay in low gear. Keep the petal pressed top the floor. You have a windshield and a steering wheel for a reason. It follows the cycle of input and output for better communication. Our customers and our staff deserve nothing less.