What is the role of proximity and artifacts in non verbal communication?

Answer 1

Proximity really is magic. We know that at a very fundamental level, proximity is a trigger in nature. Cells become something very different in proximity to other cells than they were when they were independent and alone. When they get close, they set off changes in one another, sometimes remaking and reorganizing themselves into a higher order of things-a republic of cells. The old adage that 1 + 1 = 3 wasn't wrong. Indeed, people in proximity, like cells in proximity, don't become just a multiple of what they were before. They change exponentially. They become something completely different. In those differences are rich, new opportunities.

Proximity is an elixir often readily available but also often ignored, perhaps because its benefits are simply too obvious. If fragmentation is the enemy of quality, cost effectiveness and accessibility, then proximity is a priceless ally.

There is much that makes institutions like Johns Hopkins, Mayo and the Cleveland Clinic great, but central to that greatness is the simple power of proximity. Talented physicians, nurses and other caregivers have been assembled in close proximity to one another. It is physical closeness in time and space that overcomes many of the obstacles presented by fragmentation.

And it is simple stuff, like the ability to walk down the hall to consult with a colleague, to trade ideas over coffee, to bump into somebody who has part of the answer to the question you're battling. Proximity gives legs to ideas that might otherwise languish paralyzed. It provides a setting in which an idea can spring from a single mind, then capture the imagination and the commitment of many.

Proximity has been at the heart of many of civilization's forward thrusts. People in proximity to one another in a tribe were more self-sufficient than one or two people alone. The printing press, the telegraph, the telephone, the railroads, the highways, the automobile, the television, the internet-all of these were transformative because they were distance busters and proximity builders.

A plan puts proximity to work. Dowling had a plan. So did the Romans who brought men together to build aqueducts and roads. Those aqueducts and roads then further accelerated the benefits of proximity.

Ideas require the fertilizer of proximity to grow into shared commitment. The American Revolution was an idea, and not necessarily a widely popular idea. Taverns throughout Colonial America provided the points of confluence and proximity that the Revolution needed to gain legitimacy and support. For decades, hospitals have provided points of confluence for physicians who were otherwise independent. In the physicians' lounge, on the floors, in the cafeterias, physicians intersected for the benefit of patients as well as for their own needs.

Proximity is also the fertilizer of trust. Familiarity may breed contempt, but it also breeds trust. There are different kinds of trust, of course. There is the kind that people come to expect by living in civilized society. For example, I trust that you'll not run me over when I'm in the pedestrian crossing. But a deeper kind of trust can be built only on a foundation of knowledge. People need to know each other. They get to really know each other because they've been in proximity to one another. They've learned from direct experience that they can trust each other.

Failures of DistanceBut like Colonial taverns, hospitals have been losing their role as places of useful proximity. Many primary care physicians no longer come to the hospital; medical staff meetings increasingly suffer from poor attendance; and the doughnuts in the physicians' lounge frequently go stale. Without proximity, commitment and trust decay.

In the midst of complex business deals and intricate strategies, it's easy to lose track of some simple realities. The most powerful determinant of hospital utilization is proximity. Patients usually seek care close to home. Doctors usually prefer to admit patients to the closest hospital. Employees usually want to work close to home. If you have to prioritize which physicians' practices to buy, the best bet is usually to buy the ones positioned roughly equidistant from you and a competitor. The physicians located in close proximity to the hospital can usually be relied on to use it regardless.

Proximity builds intimacy, not only between people but with the value-creating work of the organization. In a hospital or a physician's practice, the job of management is to facilitate value creation between caregivers and patients. Executives who are in close proximity to the front lines of care are more likely to understand the critical realities of the value being created. Proximity allows executives to practice what the Japanese call "genchi genbutsu," or "go and see for yourself." Quality, cost effectiveness and access all are produced at the front lines.

Proximity reduces cycle time, including decision and communication cycle time. The distance from A to B matters. Quality in health care often depends on speed. A quick decision is a quality decision when time is of the essence. Communication quality erodes based on the number of connections it has to make and the distance it must travel. Like time, communication lives at the heart of quality. And proximity lives at the heart of time and communication.

When physicians express frustration with electronic medical and health records, they increasingly quantify that frustration in terms of "clicks"-the number of clicks needed to get to information or the utility they need. What they are really complaining about is distance-the value they are seeking is too far away. It is separated by too many clicks.

When doctors and nurses prefer to carry their PDAs and tablets to the bedside, what they are conveying is the value of proximity. They want the information there, at the point of care, close at hand. Not in the hallway, at the nurses' station or in an office someplace.

Here's a piece of heresy. Sometimes a chalkboard with handwritten updates on it is more proximate than a computer terminal. In both cases, the information travels at the speed of light. And sometimes paper is better. Information in a file folder in a cabinet can be more proximate than the same information buried under six clicks.

Too Many Players Decrease the QualityThe benefit of proximity often erodes in proportion to the number of participants. When too many people are in proximity, the quality of interaction can degrade. Think of a conference call with 20 people on it or the planning retreat with 100 people trying to reach consensus.

Of course, in big groups, including organizations, interaction occurs over time and involves a wide variety of individuals who relate in smaller subgroups. Even among large numbers of people in proximity, smaller circles of interaction emerge, coalesce, then disperse. Over time, thousands in proximity may interrelate. It is the role of a leader to catalyze interaction and steer it toward useful aspirations.

Every year, I interview hundreds of physicians. There is a theme that has only intensified over time. Physicians may value independence, but they don't necessarily like being isolated. Physicians feel very much alone as they face fundamental changes and challenges in medicine. There is a hunger for the collegiality and camaraderie that proximity can deliver.

Of course, people in proximity can choose not to interact. And in some instances this is a healthy thing. The key is to make the option of relating readily available. People separated by time, space, structure and conflicting goals may not even have the option of relating or find that it is just too difficult. So they and the organization suffer in unproductive isolation.

Technology's Most Important Benefit: ProximityAll things exist in relationship to other things. They draw their identities and purpose out of such relatedness. Absent proximity, there can't be a full sense of relatedness. And absent relatedness, there can be no full sense of identity and purpose.

It is the job of a leader to shape identity and make purpose. Leaders must create, then leverage proximity. They can do this by designing their organizations and their facilities to encourage shared vision and teamwork while providing physical space where people can intersect in ways that are natural and facilitating.

They can also avoid over-reliance on electronic links. Technology can support high-value interaction, but it can't replace it. There are many reasons to invest in electronic links, but the most compelling is to simulate and stimulate proximity-to put patients, physicians and others in more immediate contact. To deliver on that promise, such links must be as simple to use as a telephone or sending an e-mail message.

Ultimately, the benefits of proximity must be secured eyeball to eyeball and shoulder to shoulder. Electronic links need to be translated into relationships, relationships into commitments, commitments into action. And that requires people being in the same space. Not all the time or even most of the time, but some of the time.