This document discusses creating a positive work environment and culture of learning. It provides scenarios of situations that occurred with medical trainees and evaluates how they could have been handled better. Some key points emphasized are creating a safe space for open communication, seeking to understand different perspectives, addressing issues directly with individuals involved, and finding solutions that benefit all parties. The document also proposes a competition between medical teams to complete tasks promoting teamwork, self-improvement, and mistake prevention.

1. Practical Leadership
“Supporting yourself and those around you”
Alex Ajeto (Uh-jet-oh), R2

2. © 2014 Virginia Mason
Totally not a real Scenario #1
Ingrid the intern is on her first wards block. While
presenting her first admit of the day Sam the senior is
busy still coordinating the rounding order via text.
Having not yet completed a formal med-rec Ingrid
decided to gloss over the pt medication list. Adam the
attending interrupts her presentation when he notes
the absence of an updated med-rec in Cerner. He
reminds her about pt safety, recommends that she
never forget to do this again, and sends her away to
gather this missing information.
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What could have gone better here?

3. © 2014 Virginia Mason
Creating an Open Culture of Candor
Identify: fear of failure, passive listening, punitive
behavior, missed teaching opportunities
• Allow those around you to communicate honestly
and openly
• Target active listening: sense, evaluate, respond
• Welcome all information and difficult conversations
• Thank those who bring errors to light
• Help create the learning needed to move forward
• File a PSA! Embrace a PSA you are part of!
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4. © 2014 Virginia Mason
Totes Related Poll Question #1
Which factor affects team dynamics most?
A. Frequent communication
B. Individual Competency
C. Defined Roles
D. A ‘safe’ working environment
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5. © 2014 Virginia Mason
Totes Related Poll Question #1
Which factor affects team dynamics most?
A. Frequent communication
B. Individual Competency
C. Defined Roles
D. A ‘safe’ working environment
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6. © 2014 Virginia Mason
This maybe happened Scenario #2
Ingrid the intern has received two admits with
“inadequate work-ups” from Dr. Eddy in the ED
in just the last two days. She laments out loud,
“These ED doctors have no idea what they’re
doing.” Sam the senior shares a similar story
about an “inadequate work-up” from Dr. Eddy.
Everybody then twirls their evil mustaches and
laughs maniacally.
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What could have gone better here?

7. © 2014 Virginia Mason
Creating a Culture without Gossip
Identify: Lacking communication, Condescension, Tribalism
• Seek explanations before building “your story”
• Acknowledge the effort within others
• Avoid condescension
• Talk directly with those you have a concern with
• Help those around you to do the same
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8. © 2014 Virginia Mason
Totes Related Poll Question #1
Which of these can predict divorce best?
A. Frequency of fights
B. Eye Rolling
C. Lying
D. Nagging
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9. © 2014 Virginia Mason
Totes Related Poll Question #1
Which of these can predict divorce best?
A. Frequency of fights
B. Eye Rolling
C. Lying
D. Nagging
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10. © 2014 Virginia Mason
OK this happens a lot Scenario #3
While working up a 4:59pm admit Ingrid receives a
page about her patient with MRSA endocarditis
who wishes to leave AMA. She calls nurse Nancy
back who explains that the patient is threatening to
leave if her “service dog” is not allowed to stay with
her. “She has also been asking for more narcotics
all day” Nancy adds. Ingrid drops her work to talk
with the pt, ultimately informing her that “she is
welcome to leave” as this “is not a prison.”
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What could have gone better here?

11. © 2014 Virginia Mason
Seeking a “Win for All”
Identify: ‘others’ as obstacles, emotional dysregulation,
apathy, resentment
• Seek a solution for you, your patient, your team
members, and the organization as a whole
• Avoid “difficult patient” narratives
• Acknowledge perspectives, blame no one,
accommodate if you can
• All people and circumstances are allies perfectly
suited to provide learning and growth
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12. © 2014 Virginia Mason
Poll Question #3
What percentage of AMA patients will be
readmitted within 2 weeks of discharge?
A. 3%
B. 12%
C. 21%
D. 34%
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13. © 2014 Virginia Mason
Poll Question #3
What percentage of AMA patients will be
readmitted within 2 weeks of discharge?
A. 3%
B. 12%
C. 21%
D. 34%
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14. © 2014 Virginia Mason
Conscious Leadership
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15. © 2014 Virginia Mason
Introducing!
The Tournament for the Most Awesome
Wards Team Ever in Existence
(TMAWTEE) *working title
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*Actual trophy pending approval

16. © 2014 Virginia Mason
Proposed List of Tasks
1. Have each team member set a tangible improvement goal for their block
2. Submit a VM Applause for a co-worker
3. Have an intern lead a teaching session
4. Bring a snack for your team
5. Senior completes a discharge summary
6. Read a poem or haiku for your team
7. Have a team discussion about identifying and preventing gossip
8. Take a team coffee break
9. Learn something unique about a co-worker
10. Thank a co-worker for bringing a mistake to your attention
11. Go outside for some fresh air
12. Recognize or celebrate another culture/heritage
13. Submit a PSA!
14. Hold a senior/attending “reverse feedback” session
15. Verbally reframe a ‘mistake’ as a ‘learning experience’
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17. © 2014 Virginia Mason
Rewards $$$$
• First prize will be $50 Visa gift card to be used
however you wish.
– Team Happy Hour
– Celebratory Snacks/Lunch
– Loan repayment
– Matching tees with Abdullah’s face
• Finishing the list of tasks before your final wards day
earns your team a $20 gift card to Copper Spoon
• Send any suggestions to Travis, David, or Alex
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18. © 2014 Virginia Mason
Thanks!
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