Research In Action

Communication failures can occur in any interpersonal interactions within professional or service settings where trust and communication matter. They happen when comments or behaviors leave someone feeling dismissed, misunderstood, stereotyped, or disrespected. Some relational communication failures are identity-linked, meaning they are connected to race, ethnicity, gender, language, socioeconomic status, immigration background, disability, or other social identities. When these patterns are tied to a person’s identity or identities, they may be understood as microaggressions.

Shifting Toward a Behavior-Focused Approach

A key challenge in responding to these interactions is that intent is often unclear. Trying to determine intent can be exhausting, especially when similar failures recur. It can also shift attention away from the interaction itself and place an onus on the person affected to interpret and address the situation. A more practical approach is to focus on observable communication behaviors, their impact, and what can be done to repair the interaction. By shifting from debating intent to addressing what happened and what to do next, organizations can create more practical, less burdensome ways to respond. This approach is especially important in healthcare and public-serving systems, where trust and communication are central to whether people feel heard, respected, and able to fully participate. This is why a behavior-focused approach matters. Instead of requiring the person affected, or the person being called out to prove intent or nonexistence of intent, we can ask a more practical question: What response would be most helpful in the moment?

What Effective Programs Have in Common

In a recent systematic review, my colleagues and I examined 24 behavior-focused programs involving 1,384 participants across North American higher education settings. Although the programs varied in audience, format, strategies, and evaluation design, many shared a common goal: equipping participants with practical strategies to recognize and respond to identity-linked communication failures.

One important finding was that the most practical programs went beyond awareness alone. They taught concrete communication and conflict-resolution strategies, such as asking clarifying questions, using “I” statements, exploring impact, and identifying next steps. These in-the-moment strategies can be used to respond to communication failures without first resolving the question of intent. Furthermore, advocates can help organizations identify patterns, create clearer response pathways, and support people when communication breaks down.

An ACTION Framework

Although the focal context of our systematic review was university campuses, these microintervention strategies are also useful for clinic encounters, whether between clinicians and patients or among clinicians. One recommended framework is called “A.C.T.I.O.N.” (Crenshaw et al., 2023) and can be applied to a common incident in which a female physician is mistaken for a nurse or medical assistant by a patient who asks, “Can you ask the doctor when she will be coming in?” after the physician introduces herself. The physician could use this A.C.T.I.O.N. framework.

• Ask clarifying questions: “Can I ask what made you think I was not the physician?”
• Come from curiosity, not judgment: “I know it can be hard to keep track of everyone on the care team. I’m Dr. xx, the physician caring for you today.”
• Tell what you observed as problematic in a factual manner: I introduced myself as Dr. xx, but you referred to me as the nurse.”
• Impact exploration, meaning asking about or stating the potential impact of the statement or action on others: “That comment can make women physicians feel less recognized in their role”
• Own your thoughts and feelings around the impact: “I’d like to clarify because I’m your doctor today.”
• Next steps which involve requesting that appropriate action be taken: “Going forward, please refer to me as Dr. Smith.”

For policymakers and institutional leaders, the review highlights the need for role-specific communication training that clarifies responsibilities for targets, bystanders, and committers. Because relational communication failures often occur within unequal power relationships between students and faculty and junior and senior colleagues, targets may not feel safe speaking up when doing so could affect grading, evaluations, funding, mentorship, promotion, or future opportunities. Interventions should therefore avoid placing the burden of repair on those with the least power and instead prepare individuals in authority to respond without defensiveness, invite clarification, acknowledge impact, and take responsibility for repair.