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American Association for Physician Leadership
American Association for Physician Leadership

Operations and Policy

Leadership and the Language of Nonverbal Communication

Joan Lowery, MEd


Learn about numerous studies confirm the significance of nonverbal communication in building trust and rapport with patients.

To achieve seamless communication, make sure that how the message is conveyed matches what is being said.

Effective leadership requires being highly attuned to both verbal and nonverbal spheres of communication. Numerous studies confirm the significance of nonverbal communication in building trust and rapport with patients as well as ensuring adherence to agreed-upon medical protocols. In terms of building cohesive and interdisciplinary teams, being astute at reading nonverbal cues ― along with being skilled in delivering authentic, clear and supportive nonverbal messages ― is essential.

While nonverbal communication isn’t magic, it can seem like magic to the untrained eye and ear. It is a sophisticated language all its own and must be understood to accurately assess context at its fullest. It includes both visual and vocal expression, and these channels provide a rich array of information that may confirm, contradict or put into question the words someone uses.

Seminal research conducted by Albert Mehrabian, a psychologist and emeritus professor at UCLA, found that when a mixed or incongruent message is presented, recipients evaluate that message, consciously or unconsciously, by assessing what is primarily revealed through the communicator’s body language and voice tone. Mehrabian found that the visual and vocal components of a message account for 93% of how an incongruent communication is interpreted. The visual dimension was weighted at 55%, the vocal at 38% and the actual words at just 7%.1

Certainly, message content is extremely important. To be clearly understood, however, it must align with both the vocal and visual communication channels. If a leader is insincere or dishonest in his communication, his body language will often express that. Conversely, a leader who delivers a fully aligned (verbal, vocal and visual) message is much more likely to be believed and trusted.

RELATED: What Are You Really Saying? The Importance of Nonverbal Clues

At a time when transparency, openness and clear communication is crucial to building the trust and supportive climate required to successfully carry out challenging health care changes, it is incumbent upon leaders to be aware and skilled at communicating on all three cylinders: verbal, vocal and visual. Further, to optimize the patient-caregiver partnerships necessary for delivering excellent care outcomes, innovative leaders must promote efforts to build the verbal and nonverbal acumen of their health care teams.

When the visual and vocal dimensions are in alignment with content, we say that a message is “seamless” and clear. But when nonverbal communication is at odds with the words being used, it behooves us to explore further to understand the full meaning behind the message.

You only have to watch television news, listen to radio talk shows or eavesdrop on conversations to validate the truth of the expression, “It’s not just what you say, but how you say it.” Let’s explore the visual and vocal dimensions to shed light on this vast and fascinating subject.

The Visual Dimension

The visual dimension includes body language ― eye contact, gestures, posture, facial expression (especially whether one smiles, frowns, purses lips, etc.); the energy or force of movement or gestures; and how a person sits or stands when conversing or presenting.

RELATED: Listening, Learning and Leadership ― A Prescription for Excellent Patient Care

It includes how near or far you position yourself in relation to others, as well as the use of touch. In some cultures, the use of space, touching, smiling, eye gaze and gesturing may be interpreted very differently than in your own. So, it’s wise when communicating cross-culturally to be aware of positive and negative nonverbal practices specific to the person or group you are engaging.

Whether it’s patients or subordinates, bosses or peers, reflect on the importance of physical presence.

Sitting vs. Standing, and Patient Perception

In a study conducted by University of Kansas Hospital in Kansas City, the same physicians sometimes stood at their patients’ bedsides and sometimes sat down at eye level with patients when speaking with them.2 The results were noteworthy:

Physician standing visits lasted an average of 1 minute, 28 seconds. The patients thought the appointment lasted an average of 3:44.

When physicians sat down, their visits lasted just slightly more than a minute. However, patients thought the physicians had spent 5 minutes with them. They perceived that the seated physicians spent 40% more time with them than the standing physicians did. They also expressed greater satisfaction with the interaction and demonstrated greater understanding of their medical conditions than patients who met with standing physicians.

In a leadership context, just as in a patient-physician encounter, team members are impacted, consciously or unconsciously, by both verbal and nonverbal messages. This affects their overall perception of the quality of leadership provided.

The Vocal Dimension

The vocal aspect is the often-ignored “stepchild” of nonverbal communication. It includes pitch, rate, volume, rhythm; articulation, pausing, word emphasis and those pesky, habitual fillers such as like and um., so, OK, well, uh

RELATED: How Delivery Affects the Message

I have been surveying people informally to learn whether they actually hear themselves as they speak. The result is a resounding “no.” Most people, unless they’ve trained as speakers, actors, singers or newscasters, typically have no idea what they sound like until they are recorded. Yet, how you say something has a tremendous impact on how your meaning will be understood.

For example, if you say, “Patient safety must be our No. 1 objective!” but you deliver these words in a monotone or in a flippant manner, listeners won’t believe you. If you pepper your sentences with “uh, um, so” or other fillers, your message will be depleted − and your fillers may distract listeners to the point that they start counting your fillers instead of hearing what you said.

Voice Tone Predicts Whether Surgeons Will Be Sued

In a landmark study, it was found that a surgeon’s tone of voice was predictive of whether the physician would be sued for malpractice. Within 40 seconds of hearing a surgeon’s voice on audio recordings, patients’ responses to the tone of voice correlated positively with the actual malpractice history of the surgeon.3

Surgeons perceived as demonstrating dominant voice tone traits were most often sued for malpractice. This was conveyed by deep, loud, moderately fast, unaccented and clearly articulated speech. The researchers speculated that expressions of dominance may communicate a lack of empathy and understanding for the patient, as well as indifference.

Concern or anxiety in the voice was often related to expressing concern and empathy. These surgeons were less likely to be sued. The research indicates that the manner, or tone, in which a physician communicates, might be as important as the actual words in determining whether a patient will sue for malpractice.

Nonverbal Behavior Shapes Minds and More

Harvard Business School social psychologist Amy Cuddy, PhD, contends that not only does nonverbal communication influence whether one is perceived as competent or incompetent, but also we are influenced by our own nonverbal behavior. In a compelling TED Talk, Cuddy describes her research on how standing or sitting in a “power pose” with one’s feet shoulder-distance apart and hands on hips for 2 minutes before a stressful event can change hormone levels and markedly improve one’s capacity for effective leadership.4

The late management guru Peter Drucker summed it up: “The most important thing in communication is hearing what isn't said.”

We want to be astute at reading others’ nonverbal language and skillful in how we communicate nonverbally. The one influences the other and most certainly impacts the perceived quality of leadership we provide. The good news is that you can make the decision to notice how you and others communicate verbally, visually and vocally. Practice new vocal and visual behaviors and enjoy how that impacts your results.

Joan Lowery, M.Ed., is a communication skills trainer and coach specializing in health care. This article was originally published by AAPL in November 2016.


  1. Albert Mehrabian; Silent Messages: Implicit Communication of Emotions and Attitudes, Wadsworth Publishing, 1971

  2. Swayden, KJ; Anderson, KK; Connelly, LM; Moran, JS; McMahon, JK; Arnold, PM; “Effect of sitting vs. standing on perception of provider time at bedside: a pilot study,” _Patient Educ Couns._2012 Feb; 86 (2): 166-71.

  3. Ambady, Nalini, and Rosenthal, Robert; Nonverbal Communication, Encyclopedia of Mental Health, Volume 2, 1998.

  4. Your Body Language Shapes Who You Are . TED Talk video with Amy Cuddy, PhD. June 2012.

Joan Lowery, MEd

Joan Lowery, MEd, is a communication skills trainer and coach specializing in health care. 

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