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Sucess Story

Success Story: VitalSmarts Training Helps Canadian Hospital Transform Its Culture

The Challenge
The staff at St. Joseph’s Health Care London didn’t talk to each other. Yes, they exchanged words, but when problems were serious and emotions were involved, many side-stepped core issues. Not only was this behavior unproductive and disrespectful for employees, it was potentially dangerous for patients.

The organizational development staff identified a training course that might help, especially in the interests of their main concern, patient safety. They also knew they needed an executive champion who could persuade busy physicians and nurses to participate. So they approached Dr. Gillian Kernaghan, a veteran family practice physician who was then the hospital’s Chief Medical Officer. She agreed something needed to be done.

“Only 50 percent of meetings were productive,” remembers Kernaghan, who is now the hospital’s President and CEO. “We had a lot of ‘Groundhog Days,’ where we talked about the same thing and didn’t find common purpose or get to actions that were agreeable.”

Kernaghan describes an environment where people wouldn’t speak up and sabotaged decisions that were made in the real “meeting” that happened in the hallway after.

“People pushed through their agenda by using power words like ‘patient safety,’ ‘evidence-based,’ and ‘family-centered,'” she says. “The implication was, ‘If you disagree with me you’re obviously not patient centered.’ Essentially, others couldn’t speak up because they felt shutdown.”

She also observed the initiatives that grew out of those limited discussions were less effective, leading to “rework” and “I told you so” comments even though people hadn’t spoken up in the first place.

“We needed to not only teach people to be nice to each other, but we also needed to get results by teaching them how to follow up and follow through,” she says. “We knew that if we could transform the way we communicated, our staff would be happier and more productive, and ultimately, our patients would be safer.”

So when she was asked to champion physician training that purported to address those needs, she agreed, knowing that in order to be an effective voice, she had to be “integrally involved.” So she registered to become a certified trainer of Crucial Conversations.

The Results: Read our case study to learn how Dr. Gillian Kernaghan used Crucial Conversations and Crucial Accountability Training to earn accreditation with exemplary standing, improve employee satisfaction scores, and see a significant improvement in holding others accountable.

What St. Joseph’s employees have to say: Read this guest post to see other ways employees at St. Joseph’s Health Care London have used Crucial Conversations and Crucial Accountability Training to change their culture.

Crucial Conversations QA

Guest Post: The Vital Behaviors of Practice Change

Cathy Parsons

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.

Crucial Conversations QA

Crucial Applications: Antisocial Networks? How to Hold Effective Crucial Conversations on Social Media

According to our recent poll, social networks are becoming increasingly hostile, with 78 percent of users reporting rising incivility online and two in five blocking, unsubscribing, or “unfriending” someone over an argument on social media.

Specific findings include:

  • 76 percent have witnessed an argument over social media
  • 19 percent have decreased in-person contact with someone because of something they said online
  • 88 percent believe people are less polite on social media than in person
  • 81 percent say the difficult or emotionally charged conversations they have held over social media remain unresolved

Social media platforms aren’t the problem, it’s how people are using them that is causing a degradation of dialogue that has potential to destroy our most meaningful personal relationships.

Here are five tips for communicating both candidly and respectfully on social media:

  1. Check your motives. Social media hasn’t only changed the way we communicate, it has modified our motives. Ask yourself, “Is my goal to get lots of ‘likes’ (or even provoke controversy)?” or “Do I want healthy dialogue?”
  2. Replace hot words. If your goal is to make a point rather than score a point, replace “hot” words that provoke offense with words that help others understand your position. For example, replace “that is idiotic” with “I disagree for the following reasons . . .”
  3. Pause to put emotions in check. Never post a comment when you’re feeling emotionally triggered. Never! If you wait four hours you’re likely to respond differently.
  4. Agree before you disagree. It’s fine to disagree, but don’t point out your disagreement until you acknowledge areas where you agree. Often, arguers agree on 80 percent of the topic but create a false sense of conflict when they spend all their time arguing over the other 20 percent.
  5. Trust your gut. When reading a response to your post and you feel the conversation is getting too emotional for an online exchange—you’re right! Stop. Take it offline. Or better yet, face-to-face.

For additional advice, including ten things NOT to do when communicating via social media, download our free e-book, “When Crucial Conversations Go Social: How to Handle Heated Discussions via Social Media.”