What is at the core of this sad miscommunication story?

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doctor listeningWhen doctors don’t talk to doctors, by Allison Bond depicts a dying patient’s wishes that were honored by one doc while another unknowingly went forward in an unwanted intervention.  Check it out and see what you think is the most underlying core issue.

Underlying emotional intelligence that makes assertiveness and listening so difficult. Click To Tweet

I think it is a lack of respect for others.  We could call it arrogance, but that is a symptom.  Respect for self and others is integral to emotional intelligence.  Sure, lack of time for listening, a system that focuses on billable interventions as a priority, are also involved.  But, it is the underlying emotional intelligence that makes assertiveness and listening so difficult.

I’ve been teaching communication and collaboration for over a decade and have been a nurse for almost 3! Healthcare professionals already have the intellectual knowledge to be effective communicators, collaborative leaders, and team-players. So why do we continue to struggle so with symptoms of poor communication and interpersonal skills like workplace violence, medical errors, poor patient experience, and morale/stress/burnout?

We need to change our behavior and this requires safe, practice opportunities for the emotional risk-taking that underlies assertiveness and listening. I’m talking about complicated ‘stuff’ like trust, self-and other-awareness, self-and other-respect, perspective-taking (especially in conflict), critical thinking, accountability, sharing power, empathy, ownership, creativity, forgiveness and overall being human.

Will TeamSTEPPS do this? Crew Resource Management?  Checklists? I suspect to some extent, but I don’t know if the work goes deep enough.  Please share your insights.  This issue is not simply about speaking up, it is about human behavior and relationships.  Among all of the healthcare team and with patients.

I do know that Med Improv is an experiential learning process that promotes individual and organizational behaviors associated with safe, quality, cost-effective, and compassionate care!  And ManageUp is a new software program that will help complete communication loops and make time for building ‘soft’ skills.

Med Improv Resources

This issue is not simply about speaking up, it is about human behavior and relationships. Click To Tweet
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14 Responses to What is at the core of this sad miscommunication story?

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  4. Marsha Ann says:

    Thanks for sharing Beth. Communication is ultimately the key in taking good care of our patients. And I agree that we all, as healthcare professionals, have the intellectual knowledge to do so. But, what’s often lacking is the key ingredient– listening, first.

  5. Elizabeth Scala says:

    Such a timely post as we talked about the new medical staff starting July 1 on RNFMRadio last week. The core to good communication, which we also discussed in our own way, is evident in this post. Listening. Thanks for sharing this important message with us, Beth.

    • Beth_Boynton_RN_MS says:

      Thanks, Elizabeth. Sounds like an interesting radio show and I’ve added to list to LISTEN to it! 🙂

  6. Hi Beth,
    Assertiveness and listening skills are imperative to improve communication without boundaries across all interdisciplinary healthcare team members. Removal of traditional hierarchal dictatorship within healthcare and initiation of shared governance is a core concept to effective successful interprofessional collaboration. Some colleges have begun interdisciplinary communication simulation labs, or “collaboratories,” such as between medicine and nursing departments. However, it will take continued efforts to change the culture within healthcare that has not been founded on shared governance with inteprofessional collaboration.

    • Beth_Boynton_RN_MS says:

      Shared governance is a beautiful thing, especially as professionals are prepared to fully participate in dynamic listening and speaking up. I love the concept of ‘Collaboratories’ Rachel! Please keep me posted as you come across any literature. I think Med Sim programs provide a landscape for a natural evolution of med improv with the caveat of stepping back from the clinical focus. I suspect this will allow for deeper work in assertiveness and listening that encompass clinical/patient safety, yet also enhance self care, collaborative leadership (and followership), and QI….really any initiative! Sometimes, I worry that ‘we’ teach nurses how to be assertive for patients but not for themselves and don’t really know how effective TeamSTEPPS or CRM is in this regard. And I’m very interested on the inside scoop re: this.

  7. Dara Byrne says:

    Beth, we have 131 interns starting work in our network next week and I agree with Donna Carol that communication is a nightmare for them. They are not “trained like they will fight” in medical school and so are unprepared for this transition. I do think that CRM and team based training in hi fi sim can go some way to helping this situation, provided the medical and AHP disciplines are all training together – this has been challenging for all of us.
    I am particularly concerned for this bunch of interns as the 2014 Your Training Counts report (which gathered data from 1636 irish trainees and trainers), from the Irish Medical Council reported that bullying was endemic in the clinical environment.

    • Beth_Boynton_RN_MS says:

      Hi Dara,

      Sadly, bullying or other inappropriate behavior IS pervasive in our cultures. And medical students who are approaching their internships are charged with enormous intellectual demands must also emerge as collaborative leaders, even in the midst of toxic workplace cultures. This is no small task and requires a different skill set. Being able to take charge while inviting input from others, who may have less status, but more knowledge and experience is quite challenging. Add to that, a dysfunctional dynamic and the urgency of clinical demands! I think med improv is very helpful in building collaborative leadership skills and imagine instructors/mentors who can coach inrelationship-building as well as Dx, Rx, etc would make a huge difference. Just as you suggest, the efficacy of TeamSTEPPS and CRM will depend on the relationships that exist between Docs and Nurses and all other members of the team. New nurses face similar challenges in that they emerge from their educational programs with enthusiasm and knowledge, yet the cultures they walk into are often not supportive. http://stopbullyingtoolkit.org/Facts-sheet.pdf

      A one day ‘medical improv’ workshop with new interns and key nursing staff would make a huge difference in their success. I’d bet my reputation on it!

  8. Gregmercer601 says:

    Traditional health care training offers extremely thin preparation in communication and other people skills. I’m glad to see you helping us out in such an importsnt area.

    • Thanks, Greg. Communication is much more complicated than meets the eye and we need to make it more of a priority in every healthcare professional’s education! I’m very excited about my upcoming textbook, “Successful Nurse Communication: Safe Care, Healthy workplaces, & Rewarding Careers” (http://bit.ly/1FLRQOd) and a behavioral focus for building and practicing the skills! You Psych nurses, I think, have great expertise and experience to bring to the table in this regard!

  9. Donna Carol Maheady says:

    This is such a timely post given it is the beginning of July and time for new interns and residents to begin rotations at teaching hospitals. This annual “event” can be a communication nightmare.
    How can we do a better job communicating during these transitions? We all need to work harder to welcome newcomers. We need to communicate freely and honestly…and help new folks learn the ropes. The sooner people feel comfortable the better… trusting can begin…along with listening and sharing.

What are your thoughts?