Four crucial conversations concepts for leaders Healthcare leaders who want to engage social influence to eliminate disruptive behavior will have to break the code of silence in four specific conversations:
Administrations must go public about the pervasiveness of concerns.
Most hospitals attempt to put a good face on disruptive behavior by dismissing it as a problem with “a few bad apples.” The truth, according to the Silence Kills study, is that it happens every day in most hospitals. The problem is much more pervasive than just a few bad apples. In order to influence change, leaders need to begin by acknowledging the frequency of concerns.
Caregivers must directly confront disruptive behavior.
Next, leaders need to invest substantially in increasing the will and skill of every employee to speak up when they see problems. The focus needs to be not just on confronting disruptive behavior, but on speaking up when people see mistakes, incompetence, violations of safety standards and more. The Silence Kills study identifies seven kinds of problems; fewer than one in ten people address these problems effectively, which can lead to burnout, disengagement, errors and worse.
Medical directors and nurse managers must respond appropriately to escalations.
The research also shows that the problem is not just upward, it’s sideways and downward. Nurses fail to speak up to their peers when they have concerns. Managers fail to confront direct reports. Medical directors give their underlings a “pass” rather than make waves. The silence is deafening in every direction—and lower level employees will not feel the expectation to address concerns if their leaders don’t lead the way.
Administration must back up sanctions when they occur.
The most common reason people fail to speak up in hospitals is because they adopt the attitude of “It’s not my job.” The second most common reason is the belief that “Others won’t back me up if I do.” For example, nurse managers worry that if they confront a disruptive doctor who brings a lot of money into a hospital, no one in administration will back them up. Administration must make it clear that if code-of-conduct violations occur, they will back up those who take appropriate action. As the saying goes, “Silence betokens consent.” The pervasive and risky problems with disruptive behavior in hospitals today will not be eradicated by codes of conduct—although these are a worthwhile step in the right direction. the real change will occur when we substantially increase skills in conversation—especially the emotionally and politically risky conversations we so consistently avoid. When this vast potential of social pressure is finally tapped, our hospitals will become healthier for patients and caregivers alike.
Conflict management is a challenge in every work environment but can be even more challenging in the ever-changing chaos of the health care environment. share two specific concepts that you found most beneficial.
