Healthy Organizations

         The Success of the Team is the Teams, the Failures are the Leaders to Own!

    This has been my motto since I stepped into the role of a nurse leader. I knew I would never take credit for the wins and successes of those that are doing the work. I would own the failures as it meant I did not do a sufficient job at preparing them or communicating the expectations of the job to be completed.

    I was sitting in a meeting where awards and announcements were being handed out. An announcement was made that someone had accepted an executive position. During the announcement, the achievements of this person were discussed. As I listened I had a sinking feeling and rush of adrenaline, I realized that some of the reasons this person was being awarded this position were based on the work I did, my ideas, and a program I had conceptualized and built from ground zero. From that day forward I knew I would never take credit for work I had not done. I was amazed at how this person could look me in the eyes and not say a word about the work that they just took credit for. This was a defining moment for my leadership role and style. To build a healthy and trusting relationship with the workers you are charged to lead and guide, there has to be healthy and honest communication. One of transparency. I always felt left out in the dark as to what was going on with the goals of the organization. This was definitely one of my broken experiences professionally. So I took my broken heart and decided then I would never do what was done to me. I would be a leader that celebrated those that did the work and own the failures. I am there to provide and protect those that are taking care of those that cannot take care of themselves.

    I have asked myself many times, should I address this issue with her? How do I make sure that I achieve the goal I am setting out to achieve without getting into a fight or confrontation? I never did, with much regret. I don't know if this makes me toxic but I believe in Karma and also that my light and hard work and contributions will be recognized eventually by the leadership team. I am more careful with my information and what I tell people.

    Communication is a tricky thing and has so many aspects, from your tone of voice, the inflection in your words, facial expressions, body language, and even any external factors that could have happened to you or the person you are talking with, prior to the conversation or confrontation. Sometimes when there is miscommunication all we hear is the sounds Charlie Brown's teacher makes. Whatever the reason communication is key to confronting issues and improving or achieving the outcome we want.

    My organization has invested heavily in how to have a healthy organization and how to achieve a highly reliable organization. That is the ultimate goal. We want to deliver high-quality care that is patient-centered and the only way to that is through healthy communication and conversations. In Dave Moen's talk, he discovered he could not have been more wrong in thinking he knew what was best for his patient because his communication was not truly patient-centered. Communication and conversations are not just talking but listening and listening to understand the other person. High-reliability organizations recognize that healthcare is complex and fast-paced. When you add in many different types of people from many different backgrounds all placed under the same pressure cooker of healthcare we better know how to communicate effectively. The investment of the communication classes for 'Crucial Conversations', Clinical Team Training, LEAN Management, and VA Voices has provided tools to assist in better ways, structured ways of communicating. 

The Bottom Line Is This: If You Don't Talk It Out, You Will Act It Out. ~ Joseph Grenny

    One of the greatest tools I have learned along the way to talking about things is from our Clinical Team Training. It is called using the 3 W's. State what you see, state what you are concerned about, and then state what you would like to happen. This has aided me in talking about process issues where safety issues were a concern to even addressing a behavior or way someone is talking negatively or disrespectfully. One thing as a nurse leader I have to mediate many interpersonal dynamics while making sure I do not alienate one side of the other. Crucial conversations training speaks to working on you first, starting with your heart, getting unstuck, and mastering your story. This is where the 3 W's have really helped me to state the story or restate what I hear is the issue between two people. I always start with encouraging the person that came to me to discuss or attempt to discuss the issue with the other person first. I believe in managing up and encouraging the staff to address issues first before I get involved and try to mediate the situation. We will discuss these tools and sometimes will even give them some scripting or dialogue to incorporate. 

    A healthy team is paramount for success, especially in the healthcare industry. In the old, hierarchical system, issues were just taken to the manager, as a tattletale system and then there was not much for investigation. The employee would be brought into the office and spoken to or even reprimanded. In this new environment and even for my unit, a lot of newer team members there has been a lot of growing pains I will call them. It is very easy to pick out those that are toxic. Their communication style is never taking accountability and when an issue arises they immediately get defensive and you can see they do not hear anything else. There have been many times where you have to end the conversation between the two employees and talk with them separately. In a perfect world that goes well, or at least one hopes. Many people feel like they are being punished if you address a concern with them, even when you are trying to educate or identify where things broke down and went wrong.  

    As a leader I want the team to be able to work things out on their own and lead the unit because they are the leaders for the unit. I encourage them to ask themselves 2 questions. First, is it safe and second, is it the right thing to do? This more specifically is trying to encourage them to start having the robust conversations they are afraid to have about safety concerns, which is where I see the origin of a lot of issues. The majority of people in healthcare want to do provide safe care to their patients and this is where I see anger rise, especially if they do not know how to communicate what it is they want or need. Albert et al. (2022), propose, "Healing and hope are the responsibilities of the clinicians who practice in healthcare organizations, and organizations are responsible for living their values, which often include respect, justice, ethical practice, compassion, and inclusivity."

    We as leaders have to recognize conflict as opportunities for growth. I have a philosophy, both professionally as a leader and personally with respect to raising my children and for myself. Everything is a learning opportunity, to grow and learn from, to become better, and then show others how to do better. Nurse leaders can help to weaken toxic traits by being transparent with information, giving quick updates as I do in daily huddles, and especially with the quick paced changes that came with COVID updates. UGH! 

I know I was exhausted and I know the staff was exhausted. Trying to influence healthy relationships with the staff and decrease any negative or toxic traits I tried to engage the staff with any and all decisions that they could possibly have input on (Albert et al, 2022). I openly listened to their identification of issues and championed for them, advocated, and sometimes even had the Chief of Staff call me at 02:00 A.M., on a Saturday morning, to advocate for them. Their voices need to be heard and supported. I even asked that the Chief of Staff go into the hospital the next morning and talk to the staff to explain why the sudden change occurred in the middle of the night. I wanted their minds put at ease and would be best coming from the man that made the decision and listen to what it was based on.
Development of team-based solutions, discussed the need to increase their workload when COVID numbers got very high, I went into staffing to help, reallocation of work resources facility-wide was implemented, there were debriefings and briefings as well as defining roles clearly as new processes were rolled out, just as Albert et al., 2022 states to do. There were still toxic attractors that emerged. Sometimes, despite your efforts, there are still toxic behaviors and people. As a leader, I  have learned not to take these as personally as I use to. 

    Albert et al., 2022, states that mandatory OT is an example of an abuse of power. I do have a hard time swallowing that as we almost got to a point where we had all hands on deck and were asking for voluntary OT and it was our next step. This was definitely not something I wanted to do but we were running out of options. All employees were reallocated to inpatient staffing and all leaders were in staffing as well. Sometimes, just sometimes, maybe leaders are doing all they can, and still, it is not enough. I have at times, not in this specific situation, but felt like I have given everything that was asked by the staff and listened to their needs and wants and it was still not good enough for a handful of employees. Advocacy leadership is a proactive process (Albert et al., 2022), but there are times that you will not remove all barriers you encounter in leadership. But you hope to build a bridge and instill hope into a better future for the rest of the team as this is a process and journey for me also.

References

Albert, N., Pappas, S., Porter O’Grady, T., & Malloch, K. (2022). Quantum leadership: Creating sustainable value in health care (6^th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

Patterson, K., Grenny, J., McMillan, R., & Switzler, A. (2012). Crucial conversations: Tools for talking when stakes are high (2nd ed.). McGraw-Hill.

Moen, D. (2012, September 9). The future of patient-centered care: Dave Moen at TEDxUMN. [Video] TED. https://www.youtube.com/watch?v=hUsyuloD198