Healthy Organizations

(Doig, n.d.)

I was born into this world, faults and all, and the world just keeps happening to me.

Some good things happened. Love. Motherhood. Meaningful work. My cat.

Some less-good things happened. I struggled through postpartum depression (twice), and grew to be gentler and softer. My base personality (INTJ) can be quite harsh and unforgiving, but I learned through this challenge to take a deep breath and give others space to be human (it is hard on all of us) (Voskamp, 2016, 18 October). Though struggle is necessary for growth, there is no fathomable reason why we shouldn't all make things a little easier on one another. As a leader, I now ask questions like, "What could be influencing this person's behavior?" instead of assuming that he or she is performing poorly on purpose. I try to stop and listen and treat my colleagues (and people in general) as gently as I would my patients. (Voskamp, 2016, 18 October). I do not succeed at this every time. Thankfully, I know in part what it is like to be broken, and this knowledge drives me to try again tomorrow.

Our house wouldn't be the same with a cat (or two)

The Anger Profile survey and the Thomas-Kilman Conflict Mode assessment also remind me that I have work to do. I tend to communicate anger quickly, just to get it out and get it over. I have found that this method can feel abrupt and even aggressive to others. It does help that I do not naturally exhibit some aspects of the "Spewer" profile such as yelling, use of profanity, and violence (Ingram & Johnson, 2010). This is probably due to my upbringing, where I learned that it was okay to be angry, but not okay to treat others with disrespect. There are still times where I force myself to slow down, take a breath, and move on without making a small thing a big issue. Asking the question, "Will I care about this next week?" usually diffuses my frustration enough to derail the anger train. This is also helpful in conflict, as I tend to compete (Thomas & Kilmann, n.d.). My second-highest conflict tendency is compromise, a technique I intentionally implemented after learning that "winning" causes more problems than it solves (Thomas & Kilmann, n.d.).

All in all, I was not surprised by the results of the anger and conflict assessments. I am an objective, goal-oriented person who cares deeply about many issues. These qualities, though generally positive, do not excuse cold, harsh behavior. I must temper my strong convictions with calmness, listening, and respect for others (Thomas & Kilmann, n.d.). And again, it all starts with a simple question, "Will I care about this next week?"

(Hale, n.d.)

Dr. Dave Moen's thoughts on patient-centered care tie in nicely with my struggles to stop and see the person (patient) on the other side (Moen, 2012, 9 August). Healthcare professionals are trained to manage medical issues safely, but as Dr. Moen points out we are ill prepared in the crucial relationship-building aspects of providing care (Moen, 2012, 9 August). My nursing education taught me to complete physical assessments, administer medications, insert indwelling urinary catheters, place IVs, and so on. I did not learn how to talk with the homeless diabetic about diet control and smoking cessation. I had no idea what to say to a patient with suicidal ideation. Assertive conflict and competing will not work for these (and many other) patients. It takes a relationship, and I did not learn how to do this in school (Moen, 2012, 9 August). 

Fred Lee heartily agrees with Dr. Moen. Mr. Lee expands on the difference between objective, measurable patient satisfaction and the arguably more valuable yet less concrete patient experience (Lee, 2011, 6 April). Patient satisfaction gauges how I performed my tasks (assessment, medication administration) while the patient experience describes the relationship between the patient and nurse (Lee, 2011, 6 April). There is no better feeling (in my opinion) than "nailing" the patient experience. Most of the time, it involves going off-script (Lee, 2011, 6 April). Phrases like "It is my pleasure" and "Is there anything else I can do for you?" are helpful, but impersonal. My patients appreciated the respectful language, but it rarely helped me bridge the gap to a real therapeutic relationship. In my experience, the homeless diabetic wants to show someone pictures of his dog and the patient struggling with suicidal ideation is a voracious reader who loves to talk about literature. When I left the script behind and just enjoyed the dog pictures, that patient was more willing to engage in his healthcare. This rapport is where the real nursing starts (Robbins, 2015, 9 July). And I did not learn how to do this in school. 

Love this quote (Erikson, n.d.)

Crucial conversations is a required leadership course at my organization. I find it to be useful in resolving conflicts related to resources (Grenny, 2012, 14 December). As a quality professional much of my work depends on convincing others to do things for me. Starting the conversation at a point of shared knowledge, such as the need to improve patient safety or follow best practice, is effective (Grenny, 2012, 14 December). However, viewing crucial conversations in a more human, reflective context has provided me with additional insight. In many crucial conversations (especially with patients), the shared knowledge is simply, "You are unique and I think you matter." In my bedside career I used this (not knowing what it was called) with good success. However, there is great opportunity to use this same tactic with colleagues, especially millenials (like myself). For this group, difficult conversations about needed practice changes or resource allocations may not stand on the objective "why" alone. According to Simon Sinek, this newest generation in the workforce craves meaning and impact, both of which absolutely require relationship (Sinek, 2016, 29 October). What if I started colleague conversations from a "you matter" standpoint as well? Would it make a difference? I think it is worth a try. This ties back to my daily struggle of treating my colleagues with the same gentleness that I would my patients. 

(Pick the Brain, 2013, 13 May)

Caroline Goyder and Matt Abrahams provide great insight in preparing to have a difficult conversation. As an introvert, I do well on stage but struggle with anxiety in one-on-one situations, especially when the topic is "crucial". Ms. Goyder recommends using the diaphragm and conscious, intentional breaths to slow down and relax (Goyder, 2014, 24 November). Mr. Abrahams supports nearly the same technique, suggesting deep breaths while recognizing and naming anxiety (internally) (Abrahams, 2015, 24 March). I learned deep controlled breathing a few years ago from a patient relations colleague while I was still working at the bedside. These methods are effective in reducing my anxiety but unfortunately do not help me understand how to make small talk. As I have mentioned in previous blogs, this skill continues to elude me...

Another great tip from Mr. Abrahams that I had not considered is staying out of my own way (Abrahams, 2015, 24 March). My analytical mind loves to overthink things while searching for the "best" response, and tends to go into overdrive when I am put on the spot unexpectedly. When this happens I trip over my words and struggle to put together a coherent sentence. Mr. Abrahams calls this stockpiling, and defines it as the brain working so hard to find the right answer that it makes things worse. He recommends training the brain to think more freely in spontaneous interactions (Abrahams, 2015, 24 March). Many times, the knowledge is there but I need to let it flow naturally. I look forward to using deep breathing and forcing my brain to "take a chill pill." Stay tuned for results in next week's blog!

Love these cartoons...I always identify with Brain! (Awkward Yeti, 2017)

As I consider my personal (imperfect) approach to communication and conflict, my thoughts move to these topics at the systems level. Patrick Lencioni, in discussing team dysfunction, lists trust as the critical precursor to a healthy professional relationship (Lencioni, 2013, 9 July). Many of the methods discussed above contribute to trust. Leaders must know their anger and conflict styles and work to improve. Leaders must approach conflict from a place of shared understanding. Leaders must go "off script" and seek to know others. These behaviors are respectful and contribute to a healthy workplace (Porter-O'Grady & Malloch, 2015). I am lucky to be employed at a generally positive, supportive education where toxicity is not tolerated. Executives uphold high expectations for staff conduct towards patients and colleagues. That said, I have encountered individual toxic co-workers whose negative, dismissive, disrespectful behavior can infect an entire nursing unit (Porter-O'Grady & Malloch, 2015). Early in my career, a toxic nurse was tolerated if he or she was considered clinically competent. Excuses like, "he is a bit grouchy, but his care is really excellent" were common. Unknowingly, I internalized this knowledge until a nurse leader in my organization posed a question...

"Is a nurse who treats his or her colleagues with disrespect still a good nurse?"

This stopped me in my tracks. Of course, the answer to the question is "no". We are all responsible for one another, and for the culture of our workplace. Leaders must consider the whole person, and must avoid excusing incivility for the sake of clinical competency (Porter-O'Grady & Malloch, 2015). Since that day I have consciously worked to avoid toxicity in my own practice because I want to be a good nurse.

I will end this blog post as I have concluded others...with the resolution to do a little better every day through reflection, knowledge-seeking, and lots of hard work. Thanks for joining me on the journey.

I know it's not fall, but this is my favorite quote about growth through struggle (LifeWay Women, n.d.)

References

Abraham, M. [Big Speak Speaker's Bureau]. (2015, 24 March). Think fast, talk smart communication techniques. [Video file]. Retrieved from https://www.youtube.com/watch?v=S1IaLvRYBnw

Awkward Yeti (2017). Instant Gratification. Retrieved from http://theawkwardyeti.com/comic/instant-gratification/

Doig, I. (n.d.). Quotes. Retrieved from https://quotefancy.com/ivan-doig-quotes

Erikson, V. (n.d.). Getting to know someone. Retrieved from https://www.pinterest.com/explore/getting-to-know-someone/

Grenny, J. [VitalSmarts Speakers]. (2012, 14 December).Crucial conversations: Joseph Grenny. [Video file]. Retrieved from https://www.youtube.com/watch?v=PuJgqTs-G44

Goyder, C. [TEDx Talks]. (2014, 24 November). The surprising secret to speaking with confidence-Caroline Goyder-TEDxBrixton. [Video file]. Retrieved from https://www.youtube.com/watch?v=a2MR5XbJtXU

Hale, M. (n.d.). Quotes. Retrieved from https://www.pinterest.com/pin/60869032434485857/

Lee, F. [TEDx Talks]. (2011, 6 April). TEDxMaastricht-Fred Lee -Patient satisfaction or patient experience? [Video file]. Retrieved from https://www.youtube.com/watch?v=tylvc9dY400

Lencioni, P. [Jon T]. (2013, 9 July). Patrick Lencioni-The 5 dysfunctions of a team. [Video file]. Retrieved from https://www.youtube.com/watch?v=inftqUOLFaM

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

Ingram, C. & Johnson, B. (2010). Overcoming emotions that destroy: Practical help for those angry feelings that ruin relationships. Grand Rapids, MI: Baker House.

Pick the brain (2013, 13 May). Take a deep breath. Retrieved from https://www.pickthebrain.com/blog/3-surprising-ways-a-deep-breath-can-reduce-your-anxiety/

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Robbins, T. [Shari Leanne]. (2015, 9 July). The art of effective communication: Tony Robbins. [Video file]. Retrieved from https://www.youtube.com/watch?v=meLbMg7ySU4

Sinek, S. [David Crossman]. (2016, 29 October). Simon Sinek on millenials in the workplace. [Video file]. Retrieved from https://www.youtube.com/watch?v=hER0Qp6QJNU

Thomas, K.W. & Kilmann, R.H. (n.d.). Thomas-Kilmann conflict mode instrument. Retrieved from http://www.kilmanndiagnostics.com/catalog/thomas-kilmann-conflict-mode-instrument

LifeWay Women (n.d.). How beautiful. Retrieved from https://uk.pinterest.com/pin/200199145913712182/

Voskamp, A. [zondervan]. (2016, 18 October). The broken way small group bible study by Ann Voskamp: Session one. [Video file]. Retrieved https://www.youtube.com/watch?v=wIBvu_udMqA