Document Type : Original Article


1 Department of Health Information Management, Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Health Information Management Research Center (HIMRC), Kashan University of Medical Sciences, Kashan, Iran

3 Department of Health Information Management, Student Research Committee, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran

5 Health Services Management, Deputy of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran


Background: A variety of clinical and administrative employees form a complicated communication network which makes various conflicts and contradictions possible in hospitals. This highlights the significant impact of internal communication in directing healthcare centers as one of the manager’s duties. Although improving hospital management is key to improvement of the healthcare delivery, few studies have been conducted to address internal communication as one of the main management tasks in hospitals. The current study aimed to determine the contributing factors influencing internal communication based on hospital managers and healthcare personnel’s points of view. Methods: A qualitative study utilizing a content analysis approach was performed. A purposive sampling method was recruited and twenty hospital managers and healthcare staff in Shiraz University of Medical Sciences participated in the study. Semi-structured interviews with open-ended questions were conducted. Data were analyzed using thematic analysis by MAXQDA version 10. Results: Eight managers and twelve healthcare staff including eleven male and nine female subjects participated in the study. Three main themes were discerned: namely “personal factors”, “technical factors”, and “organizational and structural factors”. The participants placed the most emphasis on leadership and new technologies as the influential subthemes. Conclusion: Many factors can affect internal communication, some of which depend mostly on managers to be applied effectively in the hospitals and some on healthcare staff. The identified factors help the managers and staff to recognize how their internal communication can be impressed by these factors and how they can create effective internal communications.


  1. Johnson C, Hackman M. Leadership: A Communication Perspective. seventh ed. the united states: waveland press, inc.; 2018.
  2. Ali M. An Analyis of Internal Communication Factors Influencing the Implementation of Business Process Reengineering (BPR) in the Bank. The Journal of Human Resource and Adult Learning. 2009;5(2):19-28.
  3. Steingrímsdóttir H. The Relationship between Internal Communication and Job Satisfaction. A Case Study Copanhagen Bussiness School. 2011;1900:20.
  4. Kalla H. Integrated internal communications: a multidisciplinary perspective. Corporate Communications: An International Journal. 2005;10(4):302-14.
  5. Argenti P, Forman J. The Power of Corporate Communication: Crafting the Voice and Image of Your Business. New York: McGraw-Hill. 2002.
  6. Bhatia K, Balani M. Effective internal communication: a crucial factor affecting employee performance. Proceedings of International Conference on Management,Economics and Social Sciences. 2015.
  7. Palomares M, Navarro C, Lara J. Determining factors of success in internal communication management in Spanish companies: The influence of social media. Corporate Communications: An International Journal. 2018;23(3):405-22 DOI: 10.1108/CCIJ-03-2017-0021.
  8. Ye C. Communicating the Business Value of Innovation. International Journal of Innovation Science 2015;7(1).
  9. Rosen MA, DiazGranados D, Dietz AS, Benishek LE, Thompson D, Pronovost PJ, et al. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American psychologist. 2018;73(4):433-50 DOI: 10.1037/amp0000298.
  10. Husain Z. Effective communication brings successful organizational change. The Business & Management Review. 2013;3(2):43.
  11. Lu H, Barriball KL, Zhang X, While AE. Job satisfaction among hospital nurses revisited: a systematic review. International journal of nursing studies. 2012;49(8):1017-38.
  12. Lee MK, Jung DY. A study of nursing tasks, nurses' job stress and job satisfaction in hospitals with no guardians. Journal of Korean Academy of Nursing Administration. 2015;21(3):287-96.
  13. Martini M. Communication — An important management task in the hospital market. Journal of Management & Marketing in Healthcare. 2010;3(1):9-12 DOI: 10.1179/175330310X12665775636346.
  14. Kebede S, Mantopoulos J, Ramanadhan S, Cherlin E, Gebeyehu M, Lawson R, et al. Educating leaders in hospital management: a pre-post study in Ethiopian hospitals. Global public health. 2012;7(2):164-74 DOI: 10.1080/17441692.2010.542171.
  15. Vermeir P, Vandijck D, Degroote S, al e. Communication in healthcare: a narrative review of the literature and practical recommendations. The international journal of clinical practice. 2015;69(11):1257-67.
  16. Berendsen A, Kuiken A, Benneker W, Meyboom-de Jong B, Voorn T, Schuling J. How do general practitioners and specialists value their mutual communication? A survey. BMC health services research. 2009;9:143 DOI: 10.1186/1472-6963-9-143.
  17. Altuntaş G, Semerciöz F, Noyan A. Linking Competitive Rivalry to Internal Communication in Private Healthcare Organizations. Procedia - Social and Behavioral Sciences. 2013;99:809-17.
  18. Ruck K, Welch M. Valuing internal communication; management and employee perspectives. Public Relations Review. 2012;38(2):294-302.
  19. Minter R. Organizational Communication Audits: Assessing Core Communication Competencies Within The Organization. International Journal of Management & Information Systems 2010;14(5) DOI:
  20. Tracy S. Qualitative Research Methods: Collecting Evidence, Crafting Analysis, Communicating Impact. 2019. John Wiley & Sons. first.
  21. Lincoln Y, Guba E. Naturalistic Inquiry. Newbury Park, CA: Sage Publications. 1985.
  22. Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis: Striving to Meet the Trustworthiness Criteria. International Journal of Qualitative Methods. 2017;16(1):1609406917733847 DOI: 10.1177/1609406917733847.
  23. Abdi Ali S. The influence of internal communication channels on employee performance in nonprofit organizations in somalia. A project report submitted to the Chandaria School of Busines. 2016.
  24. Mosquera M, Melendez V, Latasa P. Handling Europe's first Ebola case: Internal hospital communication experience. American Journal of Infection Control. 2015;43(4):368-9 DOI:
  25. Trahant B. Driving better performance through continuous employee engagement. Public Manager. 2009;38(1):54-9.
  26. Mishra K, Boynton L, Mishra A. Driving Employee Engagement: The Expanded Role of Internal Communications. International Journal of Business Communication. 2014;51:183-202 DOI: 10.1177/2329488414525399.
  27. Mazzei A. Promoting active communication behaviours through internal communication. Corporate Communications: An International Journal. 2010;15:221-34 DOI: 10.1108/13563281011068096.
  28. Turban E, Bolloju N, Liang T. Enterprise Social Networking: Opportunities, Adoption, and Risk Mitigation. J Org Computing and E Commerce. 2011;21:202-20 DOI: 10.1080/10919392.2011.590109.
  29. Werner NE, Holden RJ. Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review. Applied ergonomics. 2015;51:244-54 DOI: 10.1016/j.apergo.2015.05.010.
  30. Qasim A, Kharbat F, Razmak J, Alshawabkeh A. Enhancing internal communication in organisations using enterprise social networking. International Journal of Economics and Business Research. 2018;15:72 DOI: 10.1504/IJEBR.2018.10008880.
  31. Ewing M, Men L, O’Neil J. Using Social Media to Engage Employees: Insights from Internal Communication Managers. International Journal of Strategic Communication. 2019;13(2):110-32 DOI: 10.1080/1553118X.2019.1575830.
  32. Talke K. How a corporate mindset drives product innovativeness. Innovation orientation, innovativeness and innovation success. 2007:47-70
  33. Linke A. Internal communication and innovation culture: developing a change framework. Journal of Communication Management. 2011;15(4):332-48 DOI: 10.1108/13632541111183361.
  34. Kyoung Park Y, Hoon Song J, Won Yoon S, Kim J. Learning organization and innovative behavior. European Journal of Training and Development. 2014;38(1/2):75-94 DOI: 10.1108/EJTD-04-2013-0040.
  35. Dias C, Escoval A. Improvement of Hospital Performance through Innovation: Toward the Value of Hospital Care. The health care manager. 2013;32:129-40 DOI: 10.1097/HCM.0b013e31828ef60a.