Tag Archives: hospital

Crucial Conversations QA

Dealing with Resentment at Work

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?

Sincerely,
Resentful Coworker

Dear Resentful,

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.

David

Crucial Conversations QA

Showing Respect for Your Colleagues

ABOUT THE AUTHOR
David Maxfield is coauthor of the New York Times bestseller, Influencer.

David Maxfield is coauthor of the New York Times bestseller, Influencer.

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Crucial Conversations

Q Dear Crucial Skills,

I am a physician and I have to admit that, although I am respectful toward my patients, I have great difficulty when I am dealing with fellow physicians and nurses who, in my opinion, don’t seem to know basic skills to care for our patients.

My frustration with their ignorance often manifests itself not necessarily in the words I choose, but more in the way I voice my opinions and in the tone of my voice. I am dealing with people’s lives and am frequently pushed to go too fast. Often I am sleep deprived or emotionally exhausted. These things make it even harder to be as respectful as I would like to be with colleagues.

I totally understand that my lack of respect just makes the situation worse, but I don’t know how to deal with ignorance in people who I think should know better and who often have egos that prevent them from listening very well. Please help.

Dr. M

A Dear Dr. M,

Thank you for writing such an open and revealing letter. It’s clear you’ve thought deeply about this concern, and your good intentions shine through. I see three elements to your situation:

1. Crucial Moments: In key situations, you are both emotionally exhausted as well as in the middle of a high-stakes medical issue.
2. Primed Stories:
You’ve become especially sensitive to certain problems: caregivers who “should know better” or “have egos that prevent them from listening.”
3. Visible Actions:
You show your frustration—not in your word choice, but in the way you voice your opinions and the tone of your voice.

I can imagine I might do the same. And yet, as you note, these lapses just make the situation worse.

You’re already motivated to maintain a respectful relationship and you already control your choice of words. However, you realize your frustrations are seeping through anyway and damaging relationships. What more can you do? Here are four tips you might try.

1. Identify the crucial moments. The more you can do to recognize when you’re in these moments, the more prepared you will be. Take a pen and paper and map out when, where, and with whom you are most likely to experience these crucial moments. Focus on the moments where you are most at risk of being disrespectful to others.

2. Apply the skill “master my stories.” It sounds as if, when you are emotionally exhausted, you are especially apt to use “villain stories“—to interpret others’ actions in a negative way. And when you judge others, the verdict shows on your face.

James Gross, the head of Stanford’s psychophysiology lab, is the leading researcher in a field called “emotional control.” According to Gross, we control our emotions in two very different ways. One way is to suppress them—we rage inside, but keep our faces calm. Gross explains that this approach results in immediate cardiovascular costs as well as a variety of long-term negative impacts. Living your life behind a mask is not good for you. In Crucial Conversations, we call this “going to silence.”

The second way we control our emotions is through reappraising the events that have made us angry and re-evaluating the situation. This second strategy is the “master my stories” approach we teach in Crucial Conversations. Gross says people who use this approach are more successful in controlling their emotions, as well as happier and healthier over the long term.

So, what do you do? Right now, while you’re calm and relaxed, ask yourself the following questions: “Do I really believe the people I get frustrated with ‘should know better’ and ‘have egos that prevent them from listening’? Or are my stories symptoms of the pressure-filled moments and emotional exhaustion?”

If the problems are real, address them using your crucial conversations skills. But don’t wait until the crucial moment, when you are exhausted. Instead, select a time when you can have high-quality dialogue.

If you decide your stories have more to do with the pressure of the situation and your exhaustion, ask yourself how you would like to handle these frustrating moments. Assume the caregivers around you are reasonable, rational, and decent and that they are trying to do the right thing. Then ask yourself, “What can I do to help them help my patient?”

3. Prepare before the situation. It’s always harder to use these skills in the heat of the moment. So establish a rule for yourself and decide now what you will do and say when you find yourself in that situation. For example, if I’m in one of my crucial moments and feel intensely frustrated, I will say, “I know we both want what’s best for the patient. Let’s each share our perspective.” Create a rule, pick the words that will work for you, and write them down.

Establishing these if/then rules in advance is very powerful, especially when the moments you need them involve a lot of stress and competing demands. They work in two ways. First, they highlight the crucial moments, making it more likely you’ll recognize these moments when you’re in them. Second, they help you move from “consciously competent” to “unconsciously competent.” Instead of having to think about and make decisions in the moment, you act on the decisions you’ve made in advance. (Peter Gollwitzer at NYU has published several interesting studies showing how these rules work).

4. Enlist support. Ask your colleagues to help you recognize when you’re starting to go over the edge. An anesthesiologist I respect told his team, “In general, please call me by my first name, Jim. But if you think I’m becoming intimidating or not listening, then call me Dr. Smith. That will be our signal.” I like this cue because it’s subtle and respectful. Making this request is also a powerful way of convincing people that you really want to do what’s right.

I hope these ideas help. Let me know how it goes.

David