Cathy Parsons is a nursing practice consultant at St. Joseph’s Health Care London, and a Master of Applied Positive Psychology graduate, University of Pennsylvania, Philadelphia.
Practice changes are an everyday reality in the life of a healthcare provider. Clients, patients, and residents are more knowledgeable and expect care that is evidence-informed. All change creates some kind of emotional response. If the recommended change challenges staff members’ long-held assumptions and cherished beliefs, it may create frustration and moral distress. It may feel like the research negates years of tradition. For example, one of our units recently reflected on best practices for reducing patient falls and use of restraints, and practice changes have required a significant shift in staff behaviors and attitudes.
Don Ewert, Coordinator, Veterans Care, and I recently collaborated on ways to enhance the success of practice change by using an approach grounded in principles from VitalSmarts’ training. We used the skills from Crucial Conversations to achieve the organization’s vital behaviors of speaking up, holding each other accountable, and asking for help whenever concerned about safety, quality of care or service, and/or quality of work life.
Getting unstuck begins with our awareness of discomfort with the practice change. Our emotional response helps us to gauge whether we have a difference of opinion about the desired change, or whether we fear the stakes are high (maybe I won’t be able to do it). Starting with Heart reminds us that those promoting the practice change and those who put the change into practice usually have good intentions. By suspending judgment, admitting our biases, being open to new possibilities, and recognizing the role of Villain, Victim, or Helpless behavior, we Master Our Stories so that we can be fully engaged in the change process.
Stating Our Path requires us to share our views while also staying open to hear and consider others’ stories. During this step, Learning to Look for behaviors of Silence or Violence ensures that everyone continues to contribute to the Pool of Shared Meaning which is key to successful change. As we discover the Mutual Purpose of the change, we are more likely to show Mutual Respect when there are differences of opinion. This, in turn, makes it safe for dialogue to continue.
The term evidence-informed practice requires us to Explore Others’ Paths—including research on the subject, experience of the healthcare provider, and especially patient, client, and resident preference—this does not have to be an either/or choice! It also means that we prepare care providers with the skills and tools to successfully adopt the change. This is how we strengthen a person-centered approach to care in body, mind, and spirit.
Our Move to Action includes implementing and evaluating the change. The success of the change is assessed from the perspective of the patient, the care provider, and the care environment processes. Our vital behaviors help us to evolve the implementation process as we speak up about problematic aspects of the change, hold each other accountable when we see members of the team not modeling new behaviors, and ask for help when we feel unable to support the new practice. Ultimately, the way to enhance quality of patient care, build positive team relationships, and foster a shared and inclusive approach to practice change is grounded in the outcomes of these conversations.
The ideas expressd in this article are base on the skills and principles taught in Crucial Conversations. Learn more about Crucial Conversations