Healthy Organizations

Dealing with Setbacks

Often life experiences teach us new things about ourselves. We find new perspectives and strengths we may previously not have been aware we possessed. It was hard for me to listen to Ann Voskamp’s reflections on broken lives. As I have said before, I prefer to solve problems rather than dwell on them, and her reflections, while useful, seemed unnecessarily emotional to me. (Sorry, I call them as I see them!) Perhaps more to the point, I related her thoughts to my own experiences, and I usually spend less time thinking about how I feel, and more time deciding my next steps. Regardless of the approach, however, I do agree with the idea that disappointments or failures can help us grow.

Back when I was in junior high, several of my friends became part of a clique, and I suddenly found myself alone on the outside. At first, I was upset and angry, but before long, I decided I was not going to spend all my time wishing I were in their group. If they were no longer going to be my friends, I would make new friends. I joined the cross-country team and auditioned for the school play, and soon I had many new friends with a variety of interests. From this experience, I learned to think for myself, and I gained the ability to act independently. It boosted my confidence, and it helped me to see I was not a victim of circumstances. Similar situations have occurred over the years, and they have taught me I am not helpless, and I can have a say in what comes next. While I cannot necessarily change a situation, I can certainly choose my response. This crucial lesson has served me well for many years.

Acceptance is not submission; it is acknowledgement of the facts of a situation. Then deciding what you're going to do about it.”    ― Kathleen Casey Theisen

Anger Management

The Anger Profile Survey was another difficult exercise for me (this was a rough week!).  My results indicate I am a “stuffer”, suppressing or hiding angry feelings. It is true in the sense that I do not openly express angry feelings in the moment. It is also somewhat inaccurate, however, because I do express anger in a safe and appropriate environment. For example, if a patient’s parent is being unreasonable and difficult, or a nurse is not receptive to my comments, I try to maintain a calm demeanor and neutral tone, regardless of my feelings. Expressing anger will not help the situation, and it may make things worse. Once I am in the charge nurse office, or at home with my family, I will most likely vent. We have a saying, “what is said in the CN office, stays in the CN office!” If I need to follow up with the family or the nurse, I will do it with emotions in check and the same neutral tone in order to keep communication open. In my mind, this is necessary anger management. I can’t think of very many situations in which openly expressing anger towards another person will help resolve an issue.

Demonstrating Care

Fred Lee defined patient satisfaction as a situation in which a patient has received the needed care. They got everything they expected, and they have no complaints. This situation is different from a positive patient experience, which covers the patient’s total impression of the care received. We once had the father of a patient come and talk to our nurses at a unit update. He talked about how important all of the “little things” were to the patient and her parents. It meant a great deal when two of the nurses spent time washing his daughter’s hair after several days in the ICU. They took extra time and effort to dry it, braid it, and add a few bows, and this gesture meant a great deal to the family. He also talked about nurses stopping by even when they weren’t caring for his daughter on a particular shift. He talked about being kept informed of plans and what to expect. In other words, he sensed the caring attitude, and his family did as well. This ultimately led to a very positive patient experience.

A nurse I worked with always called parents by their names instead of the usual “mom” and “dad” which most of us used. I thought about it and realized this approach was more personal. It let parents know they were seen as an individual, not just the mom or dad of the patient. I have adopted this practice myself, and I can often see the appreciation in a parent’s face as they realize someone is recognizing them. I am thankful to have learned this from my colleague, and I am happy to use it in my daily interactions. Having a child in the hospital is traumatic, and anything we can do to make the experience better is worth considering!

The Team Approach to Conflict

I appreciated the talk about team dysfunctions by Patrick Lencioni. While the five elements he discussed may seem appropriate for a list of items contributing to dysfunction, his descriptions of how these might look in a real life setting helped drive home the point. I could especially relate to his description of fearing conflict would disrupt harmony, even if the harmony is artificial. He gave an example of a church committee with a member promoting a poor idea, but no one wanted to hurt her feelings. I have seen this situation in our “politically correct” culture. Some committees I attend strive to be supportive and encouraging, and as a result, members are reluctant to point out issues or problems with ideas or projects. This situation results in an enormous amount of time wasted and energy spent on weak or ineffective solutions.

As the unit QI coordinator, I remember helping to facilitate my first team project in our unit. We brought together several nurses and respiratory therapists to develop a standard method of securing endotracheal tubes (ETTs) in an attempt to decrease our rate of unplanned extubations (when the ETT is accidentally dislodged before intended).

Early in the conversation, it was suggested that the new standard should require both an RN and an RT  for this two-person procedure. Immediately one of the more outspoken RNs stated she did not trust several of the therapists and she did not want them anywhere near the ETT. A therapist shot back with a similar sentiment about some of the nurses. It was a little tense for a few moments, but the conversation moved on to address the problem of lack of trust among coworkers. In reality, the feeling of mistrust was  shared by members of both teams throughout the unit, and it was an important step to voice the concern and talk through solutions.

In the end, the group agreed it would be impossible for less competent clinicians to learn correct procedure if they never had a chance to tape the ETT. Rather than avoid certain nurses or therapists, the group’s recommendation was to pull in a third party (another nurse or therapist) to help if someone was uncomfortable with a particular coworker’s skills. Once the group had agreed on this point, they were able to address it with their peers when the question came up during the introduction of the new process. The issue had already been voiced, discussed and resolved by those who would be using the procedure on a daily basis, and they were able to explain the rationale to their colleagues.

If the concerns had not been raised during the initial planning, the distrust, which was clearly simmering beneath the surface, could have sabotaged the effectiveness of the entire project. Instead, the process designed by the group was quite successful in its implementation and in decreasing the rate of unplanned extubations, and it is still in use today!

Difficult Conversations

Several years ago, I attended a Crucial Conversations workshop for CNs at my institution. I told about my biggest take away from that conference in last week’s blog as the leader guided us through learning “the real story” before reacting to situations. A valuable lesson!

As a CN, I have to have difficult conversations with some regularity. Some go better than others, and I learn a little with each attempt. The most challenging conversations for me are those I must have with aggressive personalities. It is difficult for such people to take accountability, and the response is often defensive, and on occasion, even belligerent. Still, I learn, and each time is an opportunity to put new information into practice. I am always open to more ideas, and I read whatever I can on this topic. The list of tips below summarizes an effective approach that certainly increases the likelihood of a successful interaction.

Speaking to be Heard

The various talks about communication indicate it can make a difference in how we are perceived by others, and how effective we are at presenting our ideas. Tony Robbins talked about establishing rapport by mirroring the communication style of the person we are talking with. This concept was interesting and I will definitely be paying attention to the phenomenon in future conversations. Matt Abrahams focused on speaking in front of large groups, and he gave some helpful tips. Approaching the situation as a conversation is one I routinely use to keep from sounding too formal or boring. Using questions to engage the audience and providing structure to the talk are useful ideas, which I will keep in mind with my next presentation. I appreciated his easy to follow narrative and concrete examples. I was fully attentive throughout his talk, which is what I would hope for when I give a presentation myself! I will definitely check out his website for more tools and ideas.

NO FREAKING SPEAKING

References

Abrahams, M. (20107). No freaking speaking. Retrieved from http://www.nofreakingspeaking.com/

Lencioni, P. (Director). (2013). 5 dysfunctions of teams [Video file]. Retrieved from https://www.youtube.com/watch?v=w42Sfbh91vU

Robbins, A. (Director). (2013). Best methods to build rapport - Anthony Robbins [Video file]. Retrieved from https://www.youtube.com/watch?v=dENi7K2lX4U

Stanford Graduate School of Business (Director). (2014). Think fast, talk smart: Communication techniques [Video file]. Retrieved from https://www.youtube.com/watch?v=HAnw168huqA&t=2933s

TEDx Talks (Director). (2011). TEDxMaastricht - Fred Lee - "Patient satisfaction or patient experience ?" [Video file]. Retrieved from https://www.youtube.com/watch?v=tylvc9dY400

The Coaching Tools Company. (2015). 5 terrific conflict tips to make "Difficult conversations" easier and less stressful. Retrieved from https://www.thecoachingtoolscompany.com/5-terrific-tips-to-make-difficult-conversations-easier-less-stressful/

Zondervan (Director). (2016). The broken way small group Bible study by Ann Voskamp - session one [Video file]. Retrieved from https://www.youtube.com/watch?v=wIBvu_udMqA