Dr. Cohn Facilitating Physician-Hospital-Board Retreat

• Communication
• Representation
• Incentives to improve
• Transparency
• Trust
• Engagement
• Reimbursement
• Speed

I know that this hospital will thrive for two reasons that I have discussed in previous posts: 

1) They are becoming comfortable with paradox: they have moved beyond finger-pointing and blame-storming toward embracing a common vision that requires both-and rather than either-or approaches; 

2) They have a collaborative culture: although physicians are not known for team behavior, they can accomplish great things together when they feel that they are making their time count. 

What do you think? 

• What variations of CRITTERS have you tried where you work?
• Are you reaching a balance between problem-solving and becoming more comfortable with paradoxes that you cannot solve
• Are you building a culture of collaboration from the ground up?

 As always, I welcome your input to improve healthcare collaboration. 

Kenneth H. Cohn 

© 2010, all rights reserved 

Disclosure: 

I received compensation for facilitating the hospital-physician-board retreat to accelerate physician-hospital integration. I have a warm, proud connection to the hospital mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

I use the word “relearning” because I can remember the page from freshman year high school describing the defenestration of Prague May 23, 1618, in which over 100 Protestant nobles led by Count Thurn stormed the palace to protest the succession to the throne of the Habsburg Archduke Ferdinand, whom they regarded as intolerant.

Windows through which two Catholic governors were thrown

Depth to which Catholic governors fell

The Protestants confronted the two Catholic governors whom Ferdinand appointed and, failing to obtain satisfaction, threw them and their secretary out of the palace’s eastern window to the ground over 50 feet below, starting the Thirty Year’s War.  The three survived because they landed in a dung heap.

Next time that I feel overwhelmed, I will encourage myself to remember that being knee-deep in dung proved life-saving for two adults in 1618.  That battles can last thirty years reminds me of the long memories involved in physician-physician and physician-administrator disputes on which I am consulted.

 History can teach us perspective when we are open to learning.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content.  I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

Steel girders supporting upper floors

My grandfather, who sold commercial real estate, told me to begin a tour of a house for sale at the basement, where one can see, feel, and even smell the quality of workmanship and attention to detail.  Witness the I-beams used in construction of skyscrapers that support the top two floors of my new home.

Two healthcare analogies come to mind:

1) During my residency, an attending surgeon stayed in the Operating Room until the skin incision was closed; he told me, “If patients see perfectly approximated skin edges, they assume that their surgeon paid attention to detail on the inside. First impressions count.”

2) When I help hospitals set up Physician Advisory Panels, I encourage them to pick physician co-chairs who, based on inside knowledge, are the physicians that physicians turn to for advice and care; these physician champions create a safe environment for learning and growth that builds transparency and medical staff trust from the ground up in the same way that a home builder starts construction with a solid foundation

Imagine the potential, as we design a system to deliver more collaborative cost-effective healthcare, of being builders designing a home that we are going to live in.  For those of us at or nearing our mid-century mark, the timing could not be more favorable.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

In a recent Advisory E-Alert, entitled the Hospital-Government Complex, Mark Weiss, warned physicians:

The fact is, the ACO is simply a model for hospital control of physician practices, cloaked in the respectability of quality of care. Tied to the focus given to the notion of paying for quality of care as opposed to simply the volume of care, pundits suggested that organizations linking hospitals, physicians and other providers can be used to contract together, take risk based in part on achieving quality (however quality is defined), and distribute the income.

The reality is that there is only one acronym at play here: PCN — Power, Control and Naiveté. Issues of power and control underscore all levels of healthcare. As to the “N” for naiveté, it’s yours that they are counting on.

 An ACO is about power and control over physician services rendered and, importantly, power and control over physicians’ incomes. ACOs are the intended funnel of payor funds – they serve as a mechanism to distribute those funds and, as such, invoke the Golden Rule: He who has the gold makes the rules.

 As a physician, if you think that it’s difficult to negotiate with third party payors or to obtain stipend support from the hospital to shore up declining reimbursement, think what it will be like when there is one real payor in town, the hospital-controlled ACO.

In Surgeon Frustration, I mentioned that we are no longer viewed as captains because we lack process skills in communication, win-win negotiation, and conflict resolution that are necessary for leadership.  However, the lessons that guide me through these uncertain times come from my inadvertent fellowship in oncology, when I received chemotherapy for lymphoma and learned the mope-cope-hope strategy for dealing with helplessness. 

I paradoxically derived strength from admitting that I did not have control and focused on what I could influence, especially my attitude toward helplessness.  I quoted Paul Tsongas’ book Heading Home about his battle with lymphoma:

Now the matter of belief is central to me and gives me a truer sense of direction.  These changes are a precious gift.  My illness gave them to me. I treasure them.

President Reagan told advisors who brought him bad news, “You have shown me the manure. Now find me the pony.”

I think that we need to look for the gift of these times: an opportunity to improve healthcare delivery, so that we can improve clinical outcomes and cut costs at the same time.  Every one of us who cares for patients can play a role by doing things right the first time and being mindful of what we are doing for patients in the present moment.

At Sentara Health, the acronym SAFE stands for:

• Stop
• Assess
• Focus
• Evaluate

It seems counterintuitive, when we have so many tasks to accomplish, to stop first, but we have precedents.  Before operations, we take time out to verify that we are performing the correct procedure on the correct patient on the correct side.  At most hospitals, we pause to obtain a sponge and instrument count before closing.

Control means different things to different people.  For most physicians I know, control of their time is far more important than control of material assets, like property, plant, and equipment.

The Copernican model of putting patients and families at the center of our universe says nothing about control except that we try to control what we do to patients to cause no harm.  I believe that caring physicians will play a central role and that successful ACOs will coordinate care, optimize outcomes, and limit readmissions regardless of who is in control.

What do you think?

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

The oath of office that he took reads:

 I solemnly swear that I will support and defend the Constitution of the United States against all enemies foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the office upon which I am about to enter. So help me God.

My son is living his passion to become a naval aviator.

Well-meaning friends have asked me if I am concerned for his safety. They point to the hazards of an aircraft carrier, where approximately 65,000 pound fully armed aircraft accelerate from 0 to over 150 mph in 3 seconds, launched by catapults, whose controls are set by 20-somethings with an average of 2-3 years experience. And then, there are the landings on a slippery flight deck bobbing up and down, with only four arresting wires to halt the plane.

Knowing that arguing would be futile, I respond, “Sure, any parent would be concerned for his child’s safety. One never stops being a parent.”

But deep down, I feel secure because aircraft carriers embody the five principles of high reliability organizations:

• Preoccupation with failure: focusing on predicting and eliminating catastrophes rather than reacting to them
• Commitment to resilience: assuming that systems can fail in unanticipated ways and learning to contain errors quickly by discussing and practicing responses to systems failures and near misses
• Deference to expertise: de-emphasizing hierarchy to gain input from people with the greatest knowledge relevant to the issue at hand
• Reluctance to simplify: accepting that work is complex and that failures are multi-factorial
• Sensitivity to operations: understanding how processes really work and paying attention to a broad range of factors, such as distractions, availability of needed supplies and personnel, and length of time people have been on duty

Why is healthcare generally not as reliable as aviation? 

As Jack Barker and I discussed in Collaborate for Success!, aviation utilizes organizations such as the Federal Aviation Administration (FAA) to develop and enforce regulations and the National Transportation Safety Board (NTSB) to investigate accidents. Furthermore, aviation has a mechanism through the Aviation Safety Reporting System (ASRS) to report near misses and errors that impact safety. Widespread use of medical guidelines and a process for reporting all medical errors that is not subject to legal discovery are in their infancy.  Healthcare professionals face difficult transitions changing their status from craftsmen to people that value safety and interchangeability.  Distinguishing between iatrogenic injury and complications due to disease often is a judgment journey.

One hospital system journey that gives me hope is the Sentara Safety Initiative which began in 2002 when hospital leaders became frustrated with the pace of change.  Dr. Yates, VP and medical director for clinical effectiveness, wrote that the missing piece was a stronger organizational culture focused on patient safety.  A group of 14 physicians and 2 nurses developed 5 behavior-based expectations (BBEs):

• Pay attention to detail: using the mnemonic SAFE (Stop, Analyze, Focus, Evaluate) to focus attention on the task at hand and decrease skill-based errors
• Communicate clearly, using clarifying questions and repeating back orders
• Have a questioning attitude, empowering healthcare professionals to stop actions when unsure about their safety
• Handoff effectively, using the 5P checklist to ensure successful transfers (Patient/ Project, Plan, Purpose, Problems, Precautions)
• Never leave your wingman, using peer checking and coaching when appropriate

To convert expectations into organizational habits, supervisors provide everyday feedback on BBEs which serve as core competencies on performance reviews. Managers use walk rounds to reinforce safety culture behaviors and make sure that shift-change reports, handoff reports, and pre-procedure briefings are handled appropriately. As in aviation, staff receive encouragement and recognition for reporting near misses and unsafe events. Meeting patient safety goals is a criterion for medical staff reappointment.

Hospital leaders use a system call Real-time Behavior Based Monitoring to monitor overall performance. One quarter of variable executive compensation is linked to achieving safety goals, as is one half of the annual employee gainsharing bonus.

In 2 ½ years, Sentara decreased ventilator-associated pneumonia 84% and device-associated bloodstream infections 63% (Yates GR et al. 2004. Sentara Norfolk General Hospital: accelerating improvement by focusing on building a culture of safety. Joint Commission Journal on Quality and Safety 30: 434-542.). They experienced a 50% reduction in events of harm per 10,000 adjusted patient days system-wide (McCarthy D, Blumenthal D. Committed to Safety. Commonwealth Fund pub. no. 923; 2006:17:165-200).

Sentara has shown that they can enhance culture change by embedding tactical safety improvement projects in a larger organizational strategy. They have promoted a virtuous cycle of organizational culture driving behaviors which drive improved outcomes that reinforce the safety culture and improve reliability.

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

I liked what she wrote about communication differences (p.20):

Whereas nurses may focus more on the person and patient knowledge bases, physicians may concentrate on the case knowledge….Although all three aspects may be important when considering the patient’s plan of care, the person considering one set of knowledge may not think the other set of knowledge is as important….Although the physician and the nurse may focus on different aspects, their ability to collaborate for the benefit of the patient should not be affected.

She recommended using the situation, background, assessment, recommendation (SBAR) format to standardize information transfer (p.17).

Ms. Stukenberg’s analysis of the role that physicians and nurses can play regarding financial issues also intrigued me (p.36-37).  For example, reimbursement can nearly double if pneumonia and a urinary tract infection (UTI) that was present on admission cause a major complication in an elderly patient.  Clinical scenarios (p. 107-110) illustrate the importance of physicians and nurses working together, for example when a nurse notes cloudy, foul-smelling urine on admission, contacts the physician to order a urine culture, and when it comes back positive, the clinical documentation specialist makes certain that the chart notes support that the UTI was present on admission.  If not documented properly, payers may conclude that a UTI represents a hospital-acquired condition that they do not need to reimburse.

Ms. Stukenberg wrote that clinical documentation improvement programs are in their infancy and represent a source of competitive advantage for hospitals that are willing to invest in improving documentation and care processes.  Success depends on:

• Hiring the right staff, who are clinically knowledgeable, understand coding and the impact of proper documentation on finances, and know how to communicate with coders, case managers, nurses, and physicians
• Providing the right tools, using a computer program to review charts in real time and match physician documentation with diagnostics (coders can only code off physician documentation)
• Assuring administrative support, especially senior hospital leaders who understand complexity, see the value of their investment, and support the documentation specialists’ credibility when physicians or nurses challenge new processes
• Having a trusted physician advisor who is well-respected clinically, able to explain coding to physician peers on a strategic level, and be a liason when needed to weigh in on important issues
• Educating coding personnel, clinical documentation specialists, nurses and physicians on an ongoing basis
• Monitoring case mix, length of stay, complication co-morbidity(CC), major complication comorbidity (MCC) capture rates,  reimbursement, and effect of documentation on hospital finances 
• Implementing systems to prevent people from reverting to previous habits once their training period ends

 Implications in an era of healthcare reform

I interviewed Ms. Stukenberg by telephone and learned of a number of benefits of investing in improved clinical processes:

• RAC (recovery audit contractors): Being proactive regarding documentation criteria for admission avoids the need to payback money already spent on patient care
• Improving transitions of care: As I wrote in Collaborative Handoffs, approximately 80% of readmissions within 30 days of discharge are preventable
  Reconciling medications, calling  patients within 48 hours of discharge to make sure that they are taking medications as ordered and have scheduled outpatient appointments with their caregivers, monitoring weight of patients with heart failure, and including family caregivers and community providers in predicting home-going needs are all tasks that clinical specialists can facilitate
• ICD10 implementation: By 2013, providers will need to use a more detailed coding system; it is not too early to develop systems that facilitate adoption of the new standard
• Public reporting: in an age of increased transparency and scrutiny, doing processes correctly the first time can improve clinical and financial outcomes and build an organization’s credibility and brand recognition
• Building a culture of collaboration: As I wrote in Collaborative Culture, a culture built by healthcare professionals from the ground up (rather than imposed from above or by outside regulatory agencies) helps to sustain improved clinical processes.

Readers who would like to communicate directly with Ms. Stukenberg can reach her at MCRN@AEROINC.NET.  Her book is also available through www.crcpress.com.

This 113-page book is loaded with practical strategies for improving healthcare collaboration and clinical and financial outcomes.  I believe that it is a must-read for middle-level and senior healthcare leaders in this era of healthcare reform.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure: I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

©2010 Healthcare Collaboration. All Rights Reserved.

Dr. Cohn speaking on Physician Recruiting, Contracting, and Retention Strategies

I believe that this Congress of the American College of  Healthcare Executives was the best educational forum that I have ever attended.  Imagine Congress passing major healthcare legislation the same week that over 4,000 healthcare executives met in Chicago to discuss implications of healthcare reform.  I felt that I was part of the present, especially as Mike Fecher and I addressed over 100 people re: Field-Tested Physician Recruiting, Contracting, and Retention Strategies.  I found it provocative that nearly everyone conducted exit interviews of departing physicians to ask why they were leaving, but nobody in the room asked physicians who had been with them at least five years why they stayed and what they could do to make their time more productive.

Some of the many highlights of this outstanding meeting included:

• Maureen Bisognano’s Building Strong Connections Between Cost and Quality, in which she encouraged leaders to “think outside the building,” to improve safety, engage patients in improved self-management, reduce arbitrary individual variation, root out waste, and create a culture that supports the delivery of cost-effective care
• Chuck Mowll’s Best Practices of High-Reliability Hospitals, in which he cited Sentara’s practices of putting red tape around medication dispensing machines to warn people not to interrupt the person using them, using simplification experts to review processes, and encouraging staff to comment on any safety issues that concern them
• Nate Kaufman’s Proven Strategies to Enhance Performance Under Healthcare Reform, in which he encouraged participants to view upcoming challenges as thrills rather than threats as they approached physicians to break even on Medicare by strategic cost reduction, rebalancing payer contracts, recruiting clinical stars, improving coding, revenue cycle, and patient flow, developing an embedded medical group, selectively adding fixed costs, and auditing all financial relationships with physicians
• Ruth Brinkley’s Positioning Yourself for Success, in which she summarized the six ingredients for career success: competence, confidence, courage, resilience, humor, and people
• Gerry Ibay and James Higgins’ How to Succeed as an Early Careerist, in which they described the capacity for deep listening, challenging one’s own point of view to hear others’ perspectives

Although I usually do not stay through Thursday, I was glad that I did this time, to attend Kathleen Bartholomew and Joe Bujak’s Of Lions and Lambs: Transforming Physician-Nurse Communication.  They dressed in costume to role-play disrespectful dialogue and its effect on clinical and financial outcomes, especially in causing people to take out frustrations on colleagues who had nothing to do with the harmful interaction. 

They pointed out that depersonalization protects power and autonomy and that we need to come to know each other as people by celebrating successes rather than focusing solely on mistakes.  When respected physician and nurse leaders come to consensus on behavioral expectations to which everyone is accountable, the majority of those who transgress will apologize and those who don’t will leave.  Safety and clinical quality establish the moral high-ground.

What do you think?

• Does the prospect of healthcare reform make you excited, fearful, or ambivalent
• Can we build a strong connection between cost and quality
• What physician-hospital collaboration do we need to do to break even on Medicare reimbursement
• Do nurses and physicians where you work share behavioral expectations to which everyone is held accountable to improve healthcare communication

As always, I welcome your input to improve healthcare collaboration. 

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

Stress has become something of a badge of honor in today’s society…. We are quickly realizing that people who experience stress act in ways that can be problematic for their organizations and for their own well-being.  Over the long term, what starts as a relatively minor complaint can blossom into burnout, lower performance, and even turnover and violence…. If we could help ourselves, stress would not be considered an epidemic….  The goal of this book is to put practicing administrators in a better position to address the stress of those with whom you work.

On page 108 is an interview form that contains questions to ask, including:

• What are the primary challenges you face
• How often do you face these challenges
• What do you enjoy about your job
• What suggestions do you have to make your job better

On the following page, the author writes practical guidelines for facilitating stress focus groups, such as:

• Establish ground rules (for a list of such rules, readers may consult my article on Surgeon Frustration, p. 82)
• Facilitate more than participate
• At the session wrap-up, communicate possible next steps and obtain feedback

I appreciated his answer to, “How can we sustain our work so that we don’t run into future stress-related problems?” (p.75):

• Close the loop
• Continue to reach out and make rounds at your facility
• Retain your team of stress management champions: even as your meetings become less frequent and less intense, they should continue

My only (minor) disagreement based on my experience over the past 12 years was (p.70), “Open-ended questions don’t work with physicians.”  As I wrote in Dealing with a Medical Staff in Crisis, I worked closely with the Medical Staff President to devise a survey instrument that included open-ended questions, such as:

• How would you rate your experience here?
• What is going well for you?
• How likely are you to recommend this hospital to a friend, colleague, or a family member?
• On what do you base your rating?
• What is the future of this hospital?
• What role do you see yourself playing?
• Which obstacles need to be addressed now for the hospital to thrive?
• Whom else should we interview?

Most physicians found the discussions therapeutic, an indication that someone valued their input and validation of their anger and frustration.  Momentum built and physicians who were initially too busy to participate asked why they weren’t interviewed, so I returned about a week later until we had more than 25 physicians’ comments in our database.

Dealing with stress and confronting workplace burnout allow leaders to have an engaged workforce, committed to their organization’s goals and mission as manifested by the:

• vigor that they bring to their jobs
• dedication to advancing the organization’s mission
• absorption in their work, the flow state

Dr. Halbesleben concludes by advising healthcare organizations to acknowledge and deal with stress and burnout:

You have nothing to lose.  You have only to gain a productive, safe organization with engaged employees who stay with you for the long haul- a challenging goal, but one worth pursuing.

I recommend this book because of its practical approach to acknowledge and deal with the causes of stress and burnout. 

What is the situation where you work?

• Are you experiencing an epidemic of stress and burnout
• If so, how are you and your organization dealing with it
• What measures are working

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have a material connection because I received a review copy that I can keep for consideration in preparing to write this content.

©2010 Healthcare Collaboration. All Rights Reserved.

The most common response was hammer, followed by gun, and then chain saw.  For a number of reasons, I felt fortunate to get out of the room alive.

I can understand the fascination with tools and building a toolkit.  It offers a readily comprehensible framework for the question, “What do you do,” i.e., ”I fix problems.”  We value problem-solvers.  They rise through an organization to become its senior leaders.

For a different way of looking at tools, I salute Chris Warner, who wrote High Altitude Leadership and has led over 150 international mountaineering expeditions.  He lists Danger #3 for high-altitude climbers as Tool Seduction:

Cho Oyu has become such a popular mountain, that the same level of infrastructure that is built on Everest is applied to climbs on this peak.  Each tent is equipped like a hotel room with sleeping bags, ministoves, bags of food, and bottles of oxygen.

Climbers waited for the storm cycle to play out… Precious time was wasted because Sherpas needed to move even more gear into place…. And when the tiny window finally opened, a small handful of us, those not needing all sorts of tools and comforts, snuck to the summit.  The largest groups watched helplessly from base camp.

An overdependence on Sherpas, tools, and infrastructure can limit talented climbers.  Similarly, a parade of consultants packing the latest tools and theories can bog down progress and distract companies from focusing on vital issues.  Of course, tools are important.  But in critical moments, even the best tools break or fail in some other way- yet you must still survive.  The problem isn’t with the tools; it’s in how you relate to them.

Tools offer hope, and they make people feel that they have the right answer.  But a problem occurs when people use tools as crutches for safe answers.  Both dead climbers and dead companies are found grasping great tools.

Act in the face of real fear; subjugate your personal desires to the greater goal of the group; fight arrogance with humility; seek out and nurture partnerships; be seduced by passion and not by tools.

As I wrote in Collaborative Listening, the most important tool for hospital leaders and physicians to grasp is dialogue.  In “Embracing Complexity,” in Better Communication For Better Care: Mastering Physician-Administrator Collaboration, I stated that face-face conversations are the only sustainable way that people can deal with complex situations in which predictability is diminished, experience does not guarantee success, and relationships are key.

 Physicians can help because our training prepares us to make major decisions based on limited information.  When lives are at stake, we often do not have time to obtain perfect information and have to rely on our clinical intuition.  Act-learn-adapt, or as we say in surgery, “Ready, fire, aim,” characterizes clinical practice.

What do you think?

• Do we use tools as crutches
• Are there tools other than dialogue that improve physician-hospital relations reliably
• Can you fathom extensions of act-learn-adapt into administrative situations

 As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

©2010 Healthcare Collaboration. All Rights Reserved.

Something called out to me about Confident Voices: The Nurses’ Guide to Improving Communication and Creating Positive Workplaces, written by Beth Boynton and edited by Bonnie Kerrick:

• In Collaborative Insight, I saluted the nurses who helped me improve my bedside manner and my communication skills; although I may not have been as forthcoming as I would have liked to be upon receiving their feedback, in retrospect, how nice it is to know that they considered me trainable
• I think that many of us career-focused physicians come late to value relationships and teamwork in facilitating a practice environment in which we enjoy coming into work
• My wife is a nurse, who shares with me her workplace challenges occasionally

I admit that I found stories in this book, like certain medicines, difficult to swallow but (in the long run) beneficial:

• A nurse, finishing her first year of training, confessed that she was finally used to being yelled at (p.122)
• Connie, an experienced ED nurse in a new hospital was chewed out by a physician for not telling him about laboratory values soon enough in a patient whom Connie suspected of having internal bleeding (p.142); the nurse who relieved Connie for lunch dismissed the issue with a shrug, saying that the values had come back just a minute ago; Connie’s nursing colleague dismissed the situation with a comment that everyone has to earn their stripes; her nursing supervisor told her not to be so sensitive; a nurse reviewer recalled the catch phrase in the 1980′s that “nurses eat their young”

I entitled my post Collaborative Naivete because I felt unaware of the interpersonal difficulties that existed among nurses.  In reality, I was aware but did not want to acknowledge my awareness because resolving conflicts is a subject in which I had no formal training during medical school, residency, or fellowship.  Only within the last decade, have I come to realize that conflict is inevitable in times of disruptive change and that acknowledging it can bring about more robust solutions than pretending that conflict does not exist, the principal theme of my second book, Collaborate for Success!

I recommend Confident Voices: The Nurses’ Guide to Improving Communication and Creating Positive Workplaces not only because it is good medicine but also because it has practical guidelines to help us improve the practice environment where we work. For example (p.128-130), giving and receiving feedback:

• Check to see if your feedback is desired
• Use specific events rather than hot-button words that judge or exaggerate (like always or never)
• Focus on behavior rather than personality
• Ask the person for his or her opinion
• Listen actively, validate the other person’s input, and thank the person
• Reflect upon the feedback to create greater self-awareness

Although it disturbed me to learn that the ED nurse ended up leaving her job, I was happy to learn that she pursued graduate study and found a nurse-manager position in another ED that had a zero-tolerance policy for workplace bullying, which included training for all staff, including senior management.

Approximately two decades ago, my wife encountered similar feelings of resistance as a CCU nurse when we moved from Boston to New York.  Had I read or been exposed to a resource like Confident Voices, I could have been more supportive and nurturing rather than telling her that she was experiencing growth pains. 

What do you think?

• Have you experienced workplace bullying or do you know someone else who did
• What does it do to people’s confidence and judgment to experience bullying
• What are the implications for patient care if we continue to ignore workplace abuse

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2010, all rights reserved

Disclosure:

I have a material connection because I received a review copy of this book.

©2010 Healthcare Collaboration. All Rights Reserved.