Spectrum Health is a not-for-profit, integrated health system based in West Michigan providing inpatient and outpatient services at a variety of locations throughout Michigan. Spectrum Health’s 16,000 employees and 1,500 physicians share a common mission: to improve the health of the communities they serve.
The executive team at Spectrum Health was committed to building a culture of shared responsibility and accountability for the patients they served.
Driven to delivering the highest quality care, Spectrum Health purposefully set out to create a culture that ensured an excellent patient experience coupled with the highest standards in safety and quality.
To reach this culture goal, it became apparent that leadership and staff needed the tools (and the permission) to speak up and hold each other accountable. That’s why Kristine White, now Spectrum’s Vice President of Innovation and Patient Affairs, along with the hospital group executive team, decided to bring in a VitalSmarts presenter to speak at the hospital group’s annual 800-person leadership conference.
“Initially, I wasn’t looking for any sort of training initiative,” White said. “But the language the speaker used during the presentation became viral almost instantaneously in the organization. We left the session with people talking about ‘crucial conversations’ and ‘making it safe.'”
The Training Course
Spurred by the stickiness of the keynote speech, White and her fellow executives decided to implement the VitalSmarts training course Crucial Conversations within the system’s hospital group.
“Crucial Conversations Training fit hand-in-glove with the other work we were doing with leaders, from the executive and director level to staff supervisors and physicians,” White said.
Spectrum Health executives implemented the training in a unique way; they resolved it must be leader-led. This meant their organizational development staff did not conduct the training—executives and directors did.
In 2006, Spectrum Health’s twelve-person executive team completed the course, led by a team of Master Trainers from VitalSmarts. Once a week, the executives would then train the directors who reported to them. In turn, the directors would train their managers. Shortly, the material had cascaded through the entire organization.
After the initial top-down training rollout, Crucial Conversations was offered in formats tailored to the needs of the organization’s various audiences.
For example, physicians received the course in its traditional two-day format while staff received a consolidated version and a series of post-training coaching sessions. When new leaders took the course, offered three times a year, they attended in four, half-day sessions.
To date, an estimated 3,000 people at Spectrum Health have completed Crucial Conversations Training.
Since the introduction of the training, crucial conversations skills and vocabulary have permeated the culture at Spectrum Health. The executive team, including the president, keeps the skills front-and-center in their meetings and shares success stories regularly.
“To see the real results, you have to listen to what is happening at patients’ bedsides,” White said. “You have to hear the stories of managers reporting that staff members confront col- leagues on their own instead of going to their managers to resolve issues.”
White says “resounding” evidence of Spectrum Health’s culture change is that the staff are effectively addressing issues and concerns, and appropriately having the right conversations with one another. White describes the behaviors as being embedded in the “fabric of the culture of the organization.”
Perhaps even more remarkable, staff members are also speaking up about the behavior of physicians or others who may be perceived as unapproachable.
Here are some examples:
- The president begins his monthly leadership meetings with what he calls “Patient Perspectives, the good, the bad, and the ugly,” in which staff members share real stories—good and bad—related to patient care. The stories illustrate how every action has an impact on patient experiences and patient safety. One story described a conflict between two colleagues whose very fractured relationship affected their performance. White coached one of the individuals by practicing the crucial conversation she needed to have with this colleague. “She ended up not only resolving the relationship, but the other person was also grateful for the dialogue. They went on to not only have a positive and impactful working relationship, but personally enjoyed working together.”
- An executive was participating in rounds and entered a patient’s room without washing his hands, thinking this wasn’t a problem as he likely wasn’t going to touch anything. But the hospital had agreed on a mandatory policy that employees must wash their hands every time they go in and out of a patient’s room. A staff nurse was nervous about speaking up to the executive, but she used her Crucial Conversations skills to remind him to wash his hands. “It went very well for both parties. The executive appreciated the coaching and it built confidence in our staff member” White said, noting that the experience was shared as a best practice.
- Remarking on the employees’ perceived value of the training, White indicated that new leaders must get on a waiting list to attend the training. Even while dealing with the demands and pressures of a new role, new leaders don’t require prodding to sign up for the course. “The training is a time commitment, so the fact that these busy leaders are prioritizing it is significant,” White said. “In fact, we had to reserve a larger conference room so new leaders would not be turned away.”
White emphasized that experiences like these are common at Spectrum Health.
“The training really works – that’s why we keep doing it,” she said, citing regular e-mails from staff and physicians, appreciative of the tools and training.
When asked whether outcomes can be tied to a specific ROI, White references improvements in staff satisfaction, patient satisfaction, efficiency and safety. “This is a key tool in building leader and organizational competence so that we can achieve our goals. I am not sure there is any greater tool than giving people the skills to speak the truth and hold each other accountable.”
White feels the skills have reached enough people to become embedded in the hospital group, and the resources are now rolling out to other entities within Spectrum Health.
“If we had reason to think Crucial Conversations was not making a difference, we would not invest any more time and energy into the initiative,” she said. “This training is part of our bigger strategy, and a key tool in preparing our organization to thrive not only today, but also in the future.”