Silence Kills With Notes


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Effective Communication and Conflict Resolution for Healthcare

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  • Silence Kills With Notes

    1. 1. Silence Kills…Dialogue Heals Betsy Burtis, MEd
    2. 2. Impact of Communication <ul><li>1 in 20 patients receive the wrong medication </li></ul><ul><li>3.5 million get an infection from someone who didn’t wash hands or follow precautions </li></ul><ul><li>60% of sentinel events </li></ul><ul><li>Return to ICU or death during hospitalization </li></ul><ul><ul><li>Changes from 16% to 5% </li></ul></ul>
    3. 3. JCAHO 2007 Patient Safety Goals <ul><li>Goal 2: Improve the effectiveness of communication among caregivers: </li></ul><ul><ul><li>Verbal or telephone orders </li></ul></ul><ul><ul><li>Standardized list of unsafe abbreviations </li></ul></ul><ul><ul><li>Timeliness of Critical Test Results </li></ul></ul><ul><ul><li>Safe Handoffs </li></ul></ul>
    4. 4. Benefits of Effective Communication <ul><li>Consistent delivery of care </li></ul><ul><li>Helps manage the complexity of patient care </li></ul><ul><li>Staff safety </li></ul><ul><li>Learning from mistakes vs. punishment/blame </li></ul><ul><li>More rewarding work environment </li></ul><ul><li>Helps attract and retain employees </li></ul>
    5. 5. Safety Red Flags <ul><li>Things don’t feel right </li></ul><ul><li>Ambiguity </li></ul><ul><li>Reduced or poor communication </li></ul><ul><li>Confusion </li></ul><ul><li>Trying something new under pressure </li></ul><ul><li>Deviating from established norms </li></ul><ul><li>Verbal violence </li></ul><ul><li>Task fixation </li></ul><ul><li>Boredom </li></ul><ul><li>Being overworked & tired </li></ul><ul><li>Being rushed </li></ul>
    6. 6. The Silence Kills Study <ul><li>Columbia Disaster – lack of communication a key contributor </li></ul><ul><li>2004 - Surveyed >1700 people (300 physicians and 1400 clinical care staff) </li></ul><ul><li>Key Findings: </li></ul><ul><ul><li>> 50% had seen broken rules, mistakes, lack of support, incompetence, poor teamwork, disrespect and micromanagement </li></ul></ul><ul><ul><li>>50% say the problems have been going on for > 1 year </li></ul></ul><ul><ul><li>Fewer than 10% discussed their concerns with the person </li></ul></ul>
    7. 7. Typical Case Example <ul><li>A Group of nurses describe a peer as careless and inattentive. Instead of confronting her, they double check her work – sometimes running in to patient rooms to retake a blood pressure or redo a safety check. They’ve “worked around” this nurse’s weaknesses for over a year. The nurses resent her, but never talk to her about their concerns. Nor do any of the doctors who also avoid and compensate for her. </li></ul>
    8. 8. The 7 Most Crucial Healthcare Concerns <ul><li>Broken Rules: hand washing, abbreviations, identifiers </li></ul><ul><ul><li>62% </li></ul></ul><ul><li>Mistakes: trouble following directions, poor clinical judgment, medication errors </li></ul><ul><ul><li>65% </li></ul></ul><ul><li>Lack of Support: complain when asked to help, impatient, refuse to answer questions </li></ul><ul><ul><li>53-83% </li></ul></ul>
    9. 9. The 7 Most Crucial Healthcare Concerns <ul><li>Incompetence: competency and skill level </li></ul><ul><ul><li>53% </li></ul></ul><ul><li>Poor Teamwork: form cliques, gossip, try to look good at another’s expense </li></ul><ul><ul><li>88% </li></ul></ul><ul><li>Disrespect: condescending, insulting or rude </li></ul><ul><ul><li>77% </li></ul></ul><ul><li>Micromanagement: abuse of authority, pull rank, bully, threaten or force their point of view </li></ul><ul><ul><li>52% </li></ul></ul>
    10. 10. Why don’t we share our concerns? <ul><li>Drawbacks of confronting: </li></ul><ul><li>Benefits of confronting: </li></ul>
    11. 11. Crucial Conversations <ul><li>The Seven Steps to Mastering a Crucial Conversation </li></ul><ul><li>Start with Heart </li></ul><ul><li>Learn to Look </li></ul><ul><li>Make It Safe </li></ul><ul><li>Master My Stories </li></ul><ul><li>STATE My Path </li></ul><ul><li>Explore Others’ Paths </li></ul><ul><li>Move to Action </li></ul>
    12. 12. Start with Heart <ul><li>Ask Yourself: </li></ul><ul><ul><li>What do I really want for myself? </li></ul></ul><ul><ul><li>What do I really want for others? </li></ul></ul><ul><ul><li>What do I really want for the relationship? </li></ul></ul><ul><ul><li>What don’t I want? </li></ul></ul><ul><ul><li>How would I behave if I really wanted these results? </li></ul></ul><ul><ul><li>Use “and” rather than “but” </li></ul></ul>
    13. 13. Learn to Look <ul><li>Learn to look at content and conditions </li></ul><ul><ul><li>Watch for three different conditions: </li></ul></ul><ul><ul><ul><li>The moment the conversation turns crucial </li></ul></ul></ul><ul><ul><ul><li>Signs that people don’t feel safe </li></ul></ul></ul><ul><ul><ul><ul><li>Silence </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Masking, Avoiding, Withdrawing </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Violence </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Controlling, Labeling, Attacking </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Your own Style Under Stress </li></ul></ul></ul>
    14. 14. Make It Safe <ul><li>Two conditions of safety: </li></ul><ul><ul><li>Mutual Purpose – shared interest </li></ul></ul><ul><ul><li>Mutual Respect </li></ul></ul><ul><li>When safety is at risk: </li></ul><ul><ul><li>Apologize </li></ul></ul><ul><ul><li>Contrast (a do/don’t statement) </li></ul></ul><ul><ul><li>Commit to Seek Mutual Purpose </li></ul></ul><ul><ul><li>Recognize the Purpose behind the Strategy (get at the “why”) </li></ul></ul><ul><ul><li>Invent a Mutual Purpose </li></ul></ul><ul><ul><li>Brainstorm New Strategies </li></ul></ul>
    15. 15. Master My Stories <ul><li>Notice Your Behavior </li></ul><ul><li>Get in Touch with Your Feelings </li></ul><ul><li>Analyze Your Stories </li></ul><ul><li>Get Back to the Facts </li></ul><ul><li>Tell the Rest of the Story </li></ul><ul><ul><li>Why would a reasonable, rational, and decent person do what this person is doing? </li></ul></ul>
    16. 16. STATE My Path <ul><li>S Share your facts </li></ul><ul><li>T Tell your story </li></ul><ul><li>A Ask for others’ paths </li></ul><ul><li>T Talk tentatively </li></ul><ul><li>E Encourage testing </li></ul>
    17. 17. Explore Others’ Paths <ul><li>Start with an attitude of curiosity and patience. How do you rate as a listener? </li></ul><ul><ul><li>Ask </li></ul></ul><ul><ul><li>Mirror </li></ul></ul><ul><ul><li>Paraphrase </li></ul></ul><ul><ul><li>Prime </li></ul></ul><ul><li>When you begin to share your views: </li></ul><ul><ul><li>Agree </li></ul></ul><ul><ul><li>Build </li></ul></ul><ul><ul><li>Compare </li></ul></ul>
    18. 18. Move to Action <ul><li>Dialogue is not decision making </li></ul><ul><li>Decide how to decide </li></ul><ul><ul><li>Command </li></ul></ul><ul><ul><li>Consult </li></ul></ul><ul><ul><li>Vote </li></ul></ul><ul><ul><li>Consensus </li></ul></ul><ul><li>Determine who does what by when </li></ul><ul><li>Document Your Work </li></ul>
    19. 19. Preparation <ul><li>What’s the hardest thing you ever learned to do? </li></ul>
    20. 20. Practice <ul><li>In groups </li></ul><ul><ul><li>Crucial Conversation Starter </li></ul></ul><ul><ul><li>“ The Other Person” </li></ul></ul><ul><ul><li>Observer – what went well, what could be improved </li></ul></ul>
    21. 21. Final Thoughts? <ul><li>Sources </li></ul><ul><ul><li>Achieving Safe and Reliable Healthcare: Strategies and Solutions, Leonard, M., Frankel, A., Simmonds, T, 2004. </li></ul></ul><ul><ul><li>Crucial Conversations. Patterson, K., Grenny, J., McMillan, R., Switzler, A., 2002. </li></ul></ul><ul><ul><li>Silence Kills,, 2005 </li></ul></ul><ul><ul><li>ManageMentor on Giving and Receiving Feedback , Harvard Business School Publishing, 2003. </li></ul></ul><ul><ul><li> </li></ul></ul>