Dear Crucial Skills,
In our hospital, we have a person who made a grave mistake during surgery. As the manager’s pet, she was not disciplined or reprimanded, but anyone else would have been fired on the spot. The rest of the staff noticed the special treatment given to this individual and are extremely resentful. How do I, as one of those staff members, interact with the offending person without letting my resentment show?
We studied this very problem in our research, Silence Kills, and found that 84 percent of healthcare professionals observe colleagues take dangerous shortcuts when working with patients and yet less than 10 percent speak up about their concerns.
I applaud you for raising your concerns. Nobody wants to work in an atmosphere of resentment that could compromise your paramount concern of patient safety. However, the situation you describe is complicated. There are many parties and probably many perspectives on the same set of facts. Let’s begin by examining your concerns.
1. Ask yourself, “What do I really want?” Think about what you want long-term for yourself, the other person, and for your relationship. This is what I learned from your question:
- You want fairness and justice. You think your peer is “the manager’s pet,” receives “special treatment,” and perhaps should have been disciplined, reprimanded, or even fired.
- You want to make sure your team provides patients with the safest, best care possible.
- You want a positive set of relationships so people don’t feel resentment toward one another.
2. Master your stories. Each of these concerns is based on a set of facts and/or a series of incidents, including the mistake that happened during surgery. But different staff members, and your manager, may interpret these same facts in different ways. All of you are telling yourselves stories about what these facts mean.
Treat your story as a story, not as a fact. Your story should be your best, most honest interpretation of what the facts mean. But also look out for what we call “clever stories”—interpretations that let you off the hook for feeling resentful and letting your feelings show.
Interrogate your story with two questions: a) “Do I really have all the facts I need to be certain my story is true?” and b) “Is there any other story that could fit this same set of facts?” Let’s examine two of the stories you’re telling yourself:
Your story about fairness and justice: What are the facts or incidents that combine to make you tell yourself a story about injustice? How confident are you that your story is true? Here are a few questions to consider:
It sounds as if you are holding your peer accountable for not being disciplined. Shouldn’t that concern be with your manager more than with your peer?
I wonder whether you and your manager are telling yourselves different stories about the “grave mistake.” Your manager may not have witnessed the mistake and that may mean he/she has less information. On the other hand, your manager may have interviewed your colleague as well as others who were there and this information might be both important and confidential.
Your story about patient safety: Any time you have a concern about patient safety you need to deal with it. It’s one of those non-negotiables. However, before you have this crucial conversation, examine your story.
It would be easy to tell yourself the story that your manager is putting friendship above patient safety. That would be a very troubling conclusion. But is it true?
In the old days, errors were often blamed on whoever touched the patient last. Every error was considered “operator error.” Then the pendulum swung toward “system error.” Errors and near misses were seen as caused by faulty processes and procedures rather than individuals. Of course, sensible people demand both capable systems and capable individuals. Neither is sufficient by itself. Do you see how this interplay complicates the stories you and your manager tell about the very same incident?
I don’t have enough information to know whose story is closer to the truth. But I think there is a lot of room for people who value fairness, justice, and patient safety to disagree. Have this conversation with your manager, but don’t assume he or she has bad intentions.
3. Start with the facts, then tentatively share your story. Take the time to prepare for this conversation. Try writing it out as a script and then review it to make sure you:
- Avoid accusations or any “hot” words or phrases.
- Begin with your good intentions—what it is you really want. Explain that this conversation is about patient safety. That is your mutual purpose.
- Start with the facts. These facts include the incidents you are fairly sure you and your manager will agree on. This is your common ground.
- Tentatively tell your story. Draw the pattern these facts are forming for you. But remember, your manager may see the facts—and almost certainly sees the pattern—differently than you do. Be careful to be respectful of your manager’s story.
- Stop so that your manager can share his or her perspective. Understand that some of the facts your manager has are likely to be confidential.
I also encourage you to review our latest study, The Silent Treatment, at www.silenttreatmentstudy.com or register for The Silent Treatment learning series to learn how to solve critical communication breakdowns and avoid dangerous mistakes in the hospital.
The ideas expressed in this article are based on the skills and principles taught in Crucial Conversations. Learn more about Crucial Conversations