Good afternoon and welcome to today's session. We'll be covering psychological safety as a follow up to last month's burnout it's my pleasure to welcome you. My name is Victor Gonzalez the quality improvement specialist with TMF Health Quality Institute, if you joined early, or you've been with us before, we're happy to have you back and certainly have seen these slides, but let me go ahead and cover these just for the sake of making you comfortable and hopefully, uh, let me enjoy the time that you are sharing with us today, so there's a couple of ways that you can interact with us and we want to cover those right now you can use the Q and a feature, which is available on the right hand. Side of your screen. We refer to that as the participant panel, you'll see the section there labeled Q. A, if it's collapse just click to the left of the word on that little Chevron it will point down. It'll expand that section type in your question. Send it on and we'll be happy to answer or even incorporate it into the. The conversation you may also request to speak. Clicking on the hand icon, which is located to the right of your name. If you clicked on that, you'll indicate to us that you're wanting to join the conversation. We'll find your line and at the appropriate time on mute you say that you can. Definitely interact with our speakers and moderators. Also be sure you check your chat link or chat section of the participant panel will be dropping in some links there, uh, as well as allowing you to communicate with us through that feature as well. So you use the chat check it often. We'll be sending you some good information there. Well, without further ado, it is my pleasure to welcome, Vanessa and our, our. TMF hospital quality, improvement, contractor project director Vanessa. Welcome to today's call. Vanessa holds an MBA in healthcare administration from Texas university to corporate Christie. She also holds a variety of professional certifications and most notably she is a sort of, she is certified as a project manager through the project management Institute. She also holds a coveted certificate as a professional in healthcare quality from the National Association of healthcare quality, along with the prestigious certified professionals in patient safety credential, Vanessa good afternoon. Welcome to the call. Thanks for pulling us all together. I'm going to turn the microphone over to you now. Thank you so much Victor and with that, it is my pleasure to welcome today's subject matter experts from safe and reliable health care. Dr, Don Kelly and Jeff Dunaway. Dr cannoli's that position leader who has focused half of his 35 year career on improving the quality and safety of patient care after leaving executive work. Dr, candidly has spent the last 3 years sharing lessons, learned with consulting clients, committed to the journey of delivering care that we all want for our own families. We can only received the BA, from Harvard College and MD and PhD degrees from Washington University in St. Louis. Where he also did his internal medicine residency, he has published 50 papers or book chapters. Received a variety of awards and several on federal and regional advisory committees. And served as a sounding board member of 2 patient center, nonprofit organizations. Jeff join safe and reliable health care in March of 2020 and as a primary focus of supporting the high reliability journey in the. He has practice as rich as a registered nurse for 25 years with the last decade dedicated to the performance improvement space. Jeff is passionate about helping health care at both a national and local level. Through the empowerment frontline workers and training of executives. It brings a servant leadership model to all his engagement and has a deep understanding. That culture each strategy for lunch every time. Gentlemen, it is my pleasure to welcome you and our audience to today's event. The floor is yours. Thank you. All right. Well, I'm a lead lead off here and, uh, I just want to, uh. 1st of all start by saying it's really great to be talking about psychological safety today. It really is at the very core of a healthy culture, and without it organizations may be really kind of dim to remain in a reactive culture and not be able to move toward being proactive and generative and the models that we've shared with you before I want to before we get into this particular illustration, which is a great 1. I want to just share a brief story that, uh, I think many of us are motivated by stories and I'm going to lead off with 1 as a physician trained 40 years ago. This topic was nowhere to be seen. In fact, 1 of the leaders, uh, often when he was interacting with junior faculty, or students would say Here's a dime call your mother, she'll know the answer. And, uh. Clearly, that is not the kind of thing that makes people feel comfortable speaking up. But, as I learned about safety and quality and saw pioneering organizations that had established sake safety, I realized that, uh, this is what needed to be the 1st thing to work on when I became my job to be leading patient safety. So, what did we do at the get go and the purpose of sharing this is to make it clear to you that this is very doable. What we did was we studied and found that we had a lot of preventable harm and, uh, we discussed the importance of having a stop the line policy that empowered everyone to speak up when they perceived the risk to be developing. We used a line of healthcare's term I need some clarity so that even when a team member was with another in front of the patient, they could communicate that they really needed to have a conversation to make sure they were on the same page. So, um, the policy really said that this was not just an option, but that everybody had had to speak up when they were concerned. And the people who heard that concern needed to. We need to respond and criticism or retribution of a person who spoke up was not only prohibited, but it would result and did result in disciplinary actions to some. This simple and very clear policy was really a start, but it was important to be deploying, especially where they're power gradients and people feel uncomfortable about saying things in front of powerful people. Next we added a quarterly celebration of those who had the courage to stop the line because it really does take courage to do that senior executives presented formal recognition certificates to each of the participants who had spoken up in the last quarter. And they took those stories to the board and about 10 years after we had made some fairly significant progress we all sat down and said, what do we think was the. And we needle. We do so I. I strongly encourage you to, uh, to feel empowered by us to really make this important to yourselves. This is a great slide that points out that at the very center of the illustration on the right is care. I mean, that's what we're all about right. Is is patients receiving care and a, to do that uh, you can see that. We've got, uh, humans and systems in the next layer out and they work together. Um, we, you know, humans alone without systems don't work systems without humans don't work. And when we really think about, how does this play out, we think about the idea that in order to be reliable, that is to have failure free to be failure free over time. It really falls into 3 areas. Clinical operational and cultural, and so we all have to be knowing that healthcare is complex not just complicated. Uh, and for those who don't know the difference, I would encourage you to spend some time reading about complexity theory and, uh, and to achieve. Reliability is hard, but for key mindsets are important to keep in mind that we've talked a little bit about but I'm just gonna remind you about briefly being preoccupied with failure. That is to avoid failure. We must be looking for it and not to be avoiding it. And to be recognized failures and evolution, the 2nd, is that when we look at problems, we need to be reluctant to simplify and just have the 1st answer. That comes to us. We really don't want to gloss over things. We really want to know what happened. And what we're going to do to make it better keeping the 5 why concept active in your thinking, which gets you deeper into the causes. The 3rd area is sensitivity to operations, and this is really important for those of you who are leaders, because it's really easy to spend time in your office but really understanding what's happening at the front line. And the things that frontline staff are experiencing is really important. And they have to spend enough time really understanding that to be able to support the beneficial changes that you really want to have happened. Finally, the 4th thing is deference to expertise rather than rank or hierarchy looking to the person who knows a lot about this has been around a long time, not just the person with the highest rank and encouraging them to be able to speak up and to participate actively in the solutions, not just those who are high up in the organization. Okay, if we go to the next slide, that'd be great. And will speed up from now on. You've seen this before, so I'm not going to spend a whole lot of time on it, but just this is a reminder of the safe and reliable framework for high reliability. If you haven't seen it, take a look at the white paper that is available to you on the TMF website, though far from simple it pulls together 4 major domains that comprise the activities of organizations that are on an HR journey, leadership, culture, knowledge and. Learning we've introduced this before and talked a fair amount about it and I do want to just remind you, as we talk about culture today, that is the culture that involves psychological safety that the 4 areas that are illustrated there, personal accountability that is to be professional. And in providing care, and to speak up with any patient care concerns. The 2nd is teamwork and communications and mindful of everyone's roles and limits team members must clearly communicate to prevent misunderstandings that put good care at risk. A healthy environment is the 3rd area, and it nurtures stopping the line and, uh, is a, and productive team communication. Clearly communicating organizational values that guide thinking and behavior of individual clinicians and leaders contributes to a healthy environment as do the conversations and negotiations that are part of it. This is not simple. It's really something that is in daily life and affects many interactions and finally consensus in alignment is the 4th component of culture, and Jeff will go more into detail on the topics concepts and ways to bring them to lie. Thanks, Don, and thanks for opening this up. With what? A, such a great story. Uh, done appreciate it. Uh, next lot victor. So, psychological safety as it. Speaks to culture of courses in all the domains of the framework um, but specific to culture today and culture is manifested into behaviors the relationships and the interactions of its people culture is very complex. It's adaptive and it's inherently human HR rose continuously invest and providing the elements of HR of culture and conditions necessary for it to thrive being a supportive teammate and actively participating and reporting defects and sharing ideas are also key elements of an HR culture. This can't. And it won't happen without an environment to support that 1 that makes it safe to ask questions, bring up ideas and Paul's for clarification and a time and space where people are supported valued. And not to me. That made to feel less than or feel fearful of retaliation based on their words and their thoughts. So, let's keep driving forward. So, are people talking are there are they comfortable to speak up? Um. In your facility, how confident are you that, you know, what's happening at the bedside? You're in a meeting right now, but there are activities that are happening, uh, if something bad happens, or if it comes close to happening how confident are you that your staff are gonna speak up and tell you about that? Um, how safe for your staff filling to speak up and here's the key question. What are you doing to understand that environment and really establish the psychological safety? These are some of the questions that will sit in the back of your mind as we go through. Uh, today let's look at the next slide. So, to pivot off of don's open in story 1 way to establish psychological safety as a leader is through stories. Telling a safety story, and the 1st person can really help set that tone and set the tone that errors do occur to everyone, and that we can be transparent and proactive in our learning from this. So, in that vein, I'm going to tell you a story. So, I'm a registered nurse, and it was 2008, and I was on a travel in vale, Colorado. I was working in the recovery room and had gone down to the emergency department to transport a patient to surgery. As I walked past trauma, 1, I could see a team working on an older gentleman that stuck my head in just to see if I could help. The 1st thing that struck me was the patient's likeness to my grandfather, the patient's name was Bill, and he was desperately struggling to breathe in oxygen. Saturation was about 70% and the doctor was preparing to intubate Bill respiratory therapy, nursing lab. Uh, they were all present and busy with their respective task. Everyone was busy. That was the overwhelming sense that I got. I was looking at the fear and Bill's eyes and something told me to do a quick overview of the basics. The abc's. What I found was the oxygen tubing was connected to air instead of oxygen. The team wasn't familiar with stop the line like Don spoke of earlier. So they were very surprised when I rather allowed what he said, Tom out. He got everyone's attention, and I said the oxygen tubing is connected to air. The correction was made and Bill got better very quickly. Uh, the doctor was upset and started blaming respiratory therapy. I spoke up and said it was a simple human error that could have happened to anyone, a green connector or a Christmas tree was connected to the air regulator. Instead of a yellow 1, which usually would indicate air and that calls the air. It was a systems issue, because the had removed all the equipment to clean after the previous patient. And at 80 tech who had not been trained, set the room back up when Bill could talk again, he was so grateful to the whole team. But comment on how he felt, everyone was trying very hard, but it seemed too busy to really see him as a person. The eye contact that bill, and I made was very impactful on both of us. I felt the duty to speak up. And that speaks to HR value number 5. I felt compelled to take up for the respiratory therapy when he was blamed. And that speaks to HR, principal number 4 bounce back from mistakes. And the whole story speaks to HR pillar number 2, culture of safety. So, I hope that you found value in the story and hearing the story, tying it to HR principles and seeing the transparency and vulnerability of telling a story. It can really relate to people and help to establish that sense of psychological safety in your unit. So, thanks for, let me tell that story, let's move on to the next slide. So, the culture of psychological safety is created through mindful creation and fierce protection of the words, and tones and behaviors that create the feelings of trust that are necessary to effectively communicate. Especially when we disagree when we're under pressure or in a crisis. And in a time that we're very cognizant, and protective of our cultural diversity and disparity, we want to recognize that creating a psychologically safe environment is not a 1 size fits all approach. Um, and we really have to think about the words and the tones and the behaviors, uh, that that we promote. Let's look at the next slide. So when we think of culture 1 way to describe it is it's the way it fills to work here. And and it's the way I feel when I work here, that feeling doesn't just happen. It. It's created over time and it's the responsibility of leaders to cultivate and grow and we, the cultural guarding that they seek to build on their unit. Uh, in their facility and really throughout the system. It may be difficult or feel overwhelming at times to attempt to understand culture and and the Mini aspects, uh, that make up culture.Uh, you're you're part of this, this program and the score survey that you have a opportunity to participate in, uh, really offers, uh, use some very invaluable, uh, insights and data that you otherwise wouldn't have, uh, the facilities who participated in the 2 offerings earlier this year. They have that insight at their fingertips through the score summary report and the interpretive data. Um, if you were not 1 of those that participated, you will have opportunities in the future. And if you'd like to participate in the next survey opportunity, your partner can give you more information about that. And I encourage you to to better understand those opportunities. Let's look at the next slide real quick. Um. Let's see. So so this is the goal, um. With our work, and who would really would not want to be part of a team where, where no 1 is ever hesitant to voice a concern about a patient who wouldn't want to be part of a team where action is taken and feedback is reliably provided. Um, we're concerns are raised by the front line and caregivers are are taken seriously. And, and acted upon, and and again, who would not want to be part of a team were skilled caregivers, uh, playing by the rules, feel safe to discuss and learn from errors. I think everyone would want to be part of a team, uh, in this environment and I know as a patient I would want to be cared for, in in a place, uh, that that experiences, these types of things. Uh, donna's going to pick up with the next slide and talk to us more about leaders. Thanks, Jeff and what a great story that was and it really harking back to personal experience, from my perspective, that, uh, my, uh, my dad, when he had pneumonia was in the, and, uh, was, uh, uh, I think, uh, prematurely intimated, um, uh, not from the same clause, but similarly, and he wound up with a pneumothorax and a number of other things that I think were avoidable. So, uh, your story is is wonderful, and certainly resonates with me. So, thanks for that. It really, you know, here, we've got, uh, you know, an illustration that shows a new, a new day and I think as educators and coaches, it's our responsibility to be able to help, uh, either ourselves directly or delete or other leaders. We work with to be successful. Because leaders can either build or break culture, a leader who walks the talk and builds and supports a culture of trust respect and reliability. But a leader who makes decisions that aren't consistent with culture of liability, especially related to psychological safety can quickly undo progress that was built by other leaders. And so it's very fragile. Uh, people know what psychological safety is, but it can be destroyed quickly. So, uh, so be mindful of that leaders and. Or out, and I think it is best tended or watered if we think about a plant kind of situation by, uh, in fact acknowledging and thinking people for speaking up. Because it isn't easy knowing how to do. This is not something that most of us had as part of our formal training and I hope you can be open to updating how you think about and do things that will create a psychological safety. We'll talk more about the details in a 2nd, but please know that small things can have big impacts and that stories can spread very quickly. Hopefully good ones. So, let's get started on some of the tactical aspects of things or things to think about next slide. So, uh, the illustration on the ride has really got it right? Um, where, uh, what we have here, uh, is that the leader and leadership is in the center, uh, because it's between the heart and the head. Uh, so the leader has to be able to to do both doing just the, uh, head, uh, part of things, which is pretty common, because many of us feel more comfortable in the space of talking about things that are officially policies and actions and those sorts of things but the kinds of things that we're trying to illustrate today by telling you things that affect the heart are really important because those are the things that really generate traction and keep in mind that appreciation and unambiguous respect is the fuel for engagement. For motivation and connectedness between the leader and the team, and the care that's delivered by the team to his patients. Depends on these. So, leaders being accessible and visible on units, especially a lot of those directly. Have people to caring for patients see, them really makes good things happen, especially for the reluctant or skeptical. Related this speaking up or stopping the line, just presenting a policy without appealing to emotions isn't enough. How many of you would want your family member on a unit where a team members don't speak up this is what Jeff was sharing. I'm pretty sure that, uh, as you began to talk about, uh, psychological safety and emphasize its importance that question to the, to the staff is going to make people think and so that will hopefully get them to be more receptive to moving forward, keep in mind. What I call the Golden rule of healthcare that is that we only provide care that you'd like to be receiving. Using stories that exemplify courage and putting HR rule values and behaviors into action is very helpful. An example occurred in our organization, a member of the team was in the room when a procedure was being done in spoke up when the doc said that he was in hurry and not planning to do a timeout for the procedure. And after being reminded by the staff member, that this was really, probably something not to skip and government and think about the authority gradient there. A doc and the person working who is just in the room, cleaning it up. The doc said, you know, you're right. And that not only did the doc do it, but that story went viral and that was incredibly powerful. So, keep in mind this notion of how the heart can be motivated to do the right thing. Next slide so, as you begin to start asking for, you know, how are, uh, are you and your colleagues leading for improve culture and reliability? So, reflecting on some things is important, if you aren't learning about issues hearing ideas, getting input on improvement staff aren't speaking up about risks, then we hope that, uh, you'll lead by these things, which are listed here that is your actions and messages what you say, the statements, but at least as much through your behaviors, it's very important to be making sure that people think that what you say matches with what you're doing and that you're being authentic. Also, it's important to consider staff of color. What are you doing to avoid? Microaggressions and promote authentic inclusion recently released is a great Netflix series called Colin in black and white. That shows the high school life of the star of the NFL. Uh, who is a, who was the 1st to take a need during the national anthem and while every body may have very different thoughts about that action. But it's really good about this Netflix series is it shows him in a predominantly white, high school, and he has white parents, because he was adopted and he, uh, and so, the young actor that plays in is great. And it really kinda gives you a sense of what it's like. And I think it's certainly helped me and my wife and others who seen this, they have some good discussions about making sure that we're trying to do our best to be inclusive and avoid microaggressions. But even with the best that we might do, there can be things that can be happening on the unit that are holding it back from making progress in culture especially safety. So, what else might be going on? There might be not be obvious in terms of people speaking up to get in the way. Well, sometimes some staff are kind of bullying, you know, even they're not necessarily in charge, but it can be pretty noisy. And Raz folks are roll their eyes on rounds, uh, an exam. Something you might think about doing is, can you give me an example of someone who stopped the line or voice to concerned about safety on this unit? What happened. Uh, and I think you'll promote some really useful conversations. Next slide, so let's, let's take a moment to humbly take a look in the mirror and think about the situations that create anxiety, discomfort frustration, or a desire to withdraw for you as a leader because this is not easy stuff. And so I think it's important to pause and give give that some thought, I think I'd like to maybe encourage you to be thinking, at this point, if you have have an idea of the things that make you worry and not be confident about leading in this space, could you put something into the chat. That would be really great, uh, because I think it's, uh, we might get some things that we have time for discussion if, uh, if people would just say, hey, what is it that makes me feel uncomfortable about being able to, uh, to lead in this space. So, while, while you're doing that, I think 1 of the things I'd also encourage you to think about doing is getting feedback from other people, consider doing a formal or inform, you. Informal 360 evaluation, which is very powerful. It was for me, there were all kinds of things that I just totally didn't get on till people were able to provide, uh, candid, anonymous feedback. So, if you hadn't done that lately, give that some thought how approachable do people think you are to be doing the things that are important. A time inventory of your calendar very helpful. Are you spending more time with talking or listening? And are we. Are you spending time learning or or talking? It's really important to be just. Pausing and reflecting on how you use your time and and helping others to, uh. Carry the water, it's not all your job to do that. So, uh, in the slide, the reflection, uh, the suggested, uh, we have to learn and that is essential, so this is not something you're just born with, or not you develop this you learn about it uh, when the going gets tough after an event or a cultural problem on a unit takes some time to reflect to gain some insight and learn. Don't just move on to the next thing on your your day. Uh, really give some thought, or our parking lot some time to do. That if there are others who do this? Well, share a tough situation and get their advice or validation having a mentors incredibly helpful and I had 3 of them over the, my administrative lifetime and it was remarkably helpful to be able to bounce ideas off of them in a safe way. Uh, so some common local issues, though, that can get in the way or staff negativity, resistance, cynicism, noisy naysayers, who are kind of against everything or the know it all. So the devil devil's advocate. Oh, my gosh. Devil. When people say, I'll be the devil's advocate, you know, that just brings everything to a halt. So, uh, give some thought to finding ways to discourage that. So, in summary, uh, I think remember how you felt when you were new to a class, and you were in school about raising your hand to either ask or answer a question, how do you think of the teams that you're working with? Are they feeling safe? Or are they feeling worried so, and I think that's a key for you to be thinking about. Next slide it really a courage is defined by many as doing the right thing in a difficult situation. And we all have to have courage in our work. Do we, as leaders show courage by listening pausing and being present or do we kind of put on our professional armor? Where, uh, in a sense of what we do is protect ourselves and try to not allow ourselves to be vulnerable or unsure. And do we retreat from the problem? And, uh, and that's a very natural thing for people to do if they're not sure about it. But not good to do that, because the problem will still be there and often festers. So, uh, 1 of the things, though, that's important, is to avoid becoming defensive or provoking conflict by trying to prove that. We're right. This is not a time for when someone raises a concern or an issue for to be a demonstrating that you are. Right? And they were wrong. So, but it takes courage and patients to be able to do that. Next slide, and thank you for some of the things that are coming in in the chat and we'll, uh, we'll, uh, we'll for sure. Um, spend a little time as we work on, uh, finishing the section. And this is a long list, and I'm not going to go through it, but on the left are some really great, uh. Statements that are great advice for life in general and gosh, I wish I had done more of this when I started leadership work. I thought that being a leader had more to do with being smart and having the right answers. The things on the right are great ways to gently, but powerfully shape, important conversations to be inclusive. Handed hopeful and effective, not by trying to dominate or quickly push through things, but rather to be listening asking questions, these are these harness the power of what we call the, and rather than the the Nick negative impact of the but, uh, and doing using the, and opens or widens a space for learning these are approaches that are described in detail as part of some learning method called appreciative inquiry. And if you don't know much about it, I'd encourage you to to think about learning more because these are the kinds of things that, uh, really help promote break conversations things like showing that. You're curious. Tell me more about this. What might be the deeper thing going on here? All of those sort of things is saying, I don't have the answer, but we're gonna find the answer together. Jeff, what have we got in the chat so far. Uh, Tammy was reflecting that, that she can also be a better listener at at times. Um, it. But I think that's, uh, I think that's a great observation. Tmi thanks for sharing that. And for, uh, being candid about that. Um, I have to really work hard at that because I think, uh, in sort of my early life, I wasn't as confident. Um, and so I felt like I had to talk to prove that I deserve respect and I think, uh, listening is, uh, I think a, is something that's very important to to to do more of because it takes a little bit more time, but it's almost always, uh, more effective. So, there's also a kind of a tangent, uh, that you might be. Touch on force, you know, there, there's the healthcare team there's the patient and then sometimes there's the caregiver and creating psychological. Safety for the caregiver to to be able to be part of the team and voice their concerns. Um, you know, it is also. That's part of the thread, but it's also very important to, uh. To to consider that and keep that in mind that it's not just creating psychological safety for for each other in the health care team. But but for the patient and the, the caregiver. Absolutely, no, I think that's a really good point. And, you know, 1 of the things that I think we don't necessarily do. Um. My up. Patients to be speaking up, ask questions when we go in for rounds don't just be if you're not sure what's going on or why that's important. We need empowered patients because I can tell you that as a patient. Uh, I've had 2 situations where I had to let people know about some things that I was concerned, uh, weren't happening that should've. And, uh, and I turned out to me. Right. So, uh, and it's very easy to have patients just assume that everybody knows everything they need to know. So, I think making sure that patients and family are activated. I know that's all part of what we tried to do about being patient centered. But I think more specifically in empowering, then in rounds or to keep, uh, uh, uh, Part of the questions they're gonna ask when they make the really demonstrates that we all need to work together as part of the delivery team. Because the patient is certainly part of it. Thanks for reminding me about that. Let's let's move on. I think Jeff. This next slide is 1. yeah that'd be helping with. So so I was at a site last week and sitting down with the director of the, and I, I asked them. So if I went to ask your staff right now, um, whether they felt safe speaking out, what, what would I hear? And he said, well. You know, they would say, definitely that, that they feel safe speaking up. So we all think at our facility that our staff will speak up and feel confident speaking up and I'm sure everyone on this call is on the right side of that Bell Curve. Um, well, let's look at some of the national data and and I'll give you some insight knowledge that when I went and asked his staff, um. He would have been very surprised with the answers because most people. Told me very clearly that they are not safe, uh, speaking up so. 77% of the staff will speak up about things that may negatively affect patient care but that means 1 and 4 won't. And that's scary. Numbers, 63 per cent of staff are not afraid to ask questions. And that's great. That means that 4 out of 10 are afraid. And and 48% of our staff will ask questions and question the decisions of those with more authority. But that means greater than half won't do that. I'm a registered nurse and Don is a, is a physician, but he creates the psychological safety for me to ask questions and and to bring things up and challenge him. And. If he didn't create that that safety for me, um, and, and vice versa, then, then we, of course, wouldn't communicate very well and and be able to bring forward, uh, you know, many of these presentations for for y'all. So, let's look at the next next slide. So, what gets in the way of of us speaking up and it really comes down to 4 things uh, fear. Uh, I feel like there's gonna be some type of retribution or retaliation or criticism. I'm gonna look stupid. Uh, if I say what's on my mind um, futility. I don't think that it's worth the risk or the effort. Nothing ever changes when I, when I speak up anyway. Um. Powerlessness I'm new to the team. I'm new to my role. I'm an introvert. It's, it's hard for me to be noticed and uncertainty. I'm not really sure what to speak up about, you know, it's like, okay, there's 10 of us in this room. Surely. Somebody else is seeing the same thing I'm seeing and if it was worthy, you know, to say, then somebody else would speak up. Um, and that's just not the case. Um, there's a lot of things That'll keep us from from saying, what's on our minds and I can promise you the number 1 reason or the number 1 thing that happens when we are solid is patients are harmed. Um, and and we just don't want that we want people to fill 100 comfortable to speak up even if it's okay. I'm not really seeing what I think I'm seeing, but like Don said, I just a simple statement. I need some clarity around this before we move forward, uh, is a very safe phrase to use. Let's look at the next slide. So, here, we see some of the outcomes of an environment where people. Are made to feel stupid or incompetent and, and just plain bad, uh, when they speak up. Um, when they're made to feel stupid, they won't ask questions when they're made to fill in competent. Um, they want admit that they don't know things, or they'll hide errors. Um, when any 1 of us, like to work in this environment. Not at all. And what effect do you think this has. On safety for our patients, of course, it's gonna make a less safe environment. So, on the next slide, it flips it, flips it on its head. Uh, when there is psychological safety, the entire paradigm changes, when we feel safe, it. Things around, it encourages us to speak up and ask questions and admit errors and and challenge the status quo and continuously learn and improve. And that's the environment where safety happens where healing occurs. Um. It's the environment that everyone wants to work in, uh, Vanessa, who introduced us, uh, it, it's not. Health care, but but she, she has a team and she wants her employees her team to have the exact same feelings. So this is not isolated to health care. That this crosses all types of columns. So let's look at the next slide. And this is really where we start to understand as we build this environment where psychological safety is the norm. We see that people have an increased feeling of wellness and that. Burn out takes a dramatic decline and and why. Should we be concerned with that? You know, why do we want people to feel valued and have a voice and feel supported again? This may sound redundant, but what we're looking for is for people to feel like they have a sense of belonging and teamwork and communication. Uh, because as as we create that environment, no matter how stressful or how hard their work is their burn out levels start to go down. And as leaders, why should we be concerned about whether our staff they'll burned out or not? We're gonna find some of those answers on the next slot. Safe and reliable has the largest database around burn out of any industry and. Extremely intelligent data scientists who work for safe, reliable have studied and researched and publish their findings. And from this, we have the statistical evidence and correlations between burn out and many of the outcome measures that CMS is driving for the things that that keep you up at night. So, with a better sense of psychological safety, we create teamwork. We improve communication and culture burn out and our front line is reduced and the results can be seen clearly. And patient satisfaction is positively affected infections, go down medication errors are reduced and even mortality ratios are significantly normalized. So when we really need to start driving our outcome metrics, um, to be in the. The favorable core of whatever metric that the CMS is looking at. 1 key place to start is by looking at, at burn out and 1. Great place to start with burn out is by assessing the psychological safety of your hospital and your unit. And whether people feel safe to to really speak up. The next slide, so. So this is just a a quick reminder, uh, that. That we don't have to take an active role to contribute to a toxic environment, uh, bar silence. If we permit it, we are promoting it if we're allowing it, then we are encouraging it. And if we condone it, then we own it. Um, and on the next slide, it lists. Many, um, activities, many behaviors that none of us would want to participate in or be around. Uh, and these are just a handful of the behaviors that that seek to undermine the environment that we're trying so hard to to create. Any 1 of these by themselves may seem benign and and not harmful, but they do begin to erode the psychological safety of an environment. And when you permit these, when you allow these to happen. Uh, when you can down these, uh, you're just as complicit, uh, as if you practice these. And good people who want to work in a safe nurturing environment will leave this type of workplace. So, so, Don, and, uh, may may be having an interaction. Uh, that's, um. You know, between the 2 of us, but but if another person is there, uh, or or if. Let's say, Vanessa and are having this interaction that then Don can can actually step in and he doesn't have to just create psychological safety for for me or for us then he can step in and help protect Vanessa. Uh, and the psychological safety. If he sees me doing any of these behaviors towards towards Vanessa, and I think as leaders, we have that responsibility. Um, Don can pass it back over. You check in and really great points. Jeff thinks and we're beginning to get towards the end and I'm going to try to move a little quickly through some of these. So, we have a little bit of time for some of the good things that have come up in the chat at the end here. Um, I think it's, um. You know, when you're in the moment, when something like Jeff has just described is happening. Um, I think it's really hard, especially a, the toughest situation sort of. The tough situation is when a doc's involved. Um, and, um, and when you encounter those really important to do that pause and brief. Um, but 1 of the things I'll say is, but not too long. You just wanna do that long enough to let your your, uh, your sort of, uh, motion's not to get the better of you because it's making you mad. Um, or, uh, just to pause long enough to let that sink in. Um, but you don't want the opportunity to pass if it's a, if something happens in a group and the behavior, serious acknowledge hearing it and that this will, uh, we'll need to involve a follow up conversation. It's almost never something you can address right at the moment. But you can be place holding that there's going to be a follow on conversation, because it's important you saw it and it's a concern. So, and again, that's what people need to hear that, uh, the this kind of bad behavior that you encounter is something that again, you're not going to crash to fix it right away, but it's going to get addressed in this in dealing with difficult positions in particular. Um, there is the so called coffee talk conversation where, uh, there is the, uh, goal of having a, a conversation where, uh, against these things which are listed here. I'll just give you an example, which is to say, I heard there was some shouting in the Omar yesterday. Is that true? And then, uh, you know, the surgeon, you'll hear what comes out, usually it says, yes, but they were being done or something like that. And if true, find an area of foundational agreement, like, I'm sure we can both agree that yelling rarely gets things done and shows disrespect and then moving over to the goal, which is to say, since everyone deserves respect, we're committed to doing what's needed to have the team teamwork for good patient care. Was there anything, uh, any extenuating circumstances? Um, usually, this kind of behavior happens when people are struggling and getting that out on the table in case, you need to be doing that and this all happens in private. This is not the public discussion. This is what happens in private, but it's something that is not easy. And this is just trying to be a little bit of a blueprint for that talking about someone who, uh, you know, has is high on the authority gradient, uh, kind of thing. And, you know, after some productive conversation, and, you know, somebody probably admitting it was suboptimal is to is to, uh. Then be able to say, hey, you know, what do you think is going to be different about the next time the situation comes up and if it's a reasonable response, he would a great time to thank someone for a, in a sense agreeing to model professionalism and teamwork and to clearly, and then you share your hope that you won't have to have another conversation like this in the future. So, um, really, uh, again, that's just sort of the template for the coffee talk conversation. Very powerful and important skill for people who have to deal with powerful people. I'd also encourage you to read a book called the, uh, and forgive the, the bad language, but it's called the no a*** rule. Uh, it's a great and enjoyable read uh, written by dawn Sutton in 2007 it won the quilt. That relating to management, and it really helps people under. You just all right. Like, in a group, because it is poisonous, both, uh, what they do and the bad example that sets for others. So, next slide, uh, will, uh, again, the, uh, there's a whole lot in here, but I think the, uh, the bottom line is that, uh, is that we want to be, uh, these are tactics that can, uh, be used for you to teach others. Uh, and, uh, again to also be considering that all of us are not perfect and may, maybe we have a role in getting somebody agitated. So make sure you sort of look in the mirror and think about that too. And to be sensitive about special situations and keep your emotions out of it for heaven sakes, even if there's name calling, I'll never forget the day the North Beach trauma surgeon called me a Nazi for trying to get a policy to happen. And I'll tell you what it was easy, but, uh, you know, I, I think the goal he was trying to get under my skin and he did, but I wasn't going to grace that response with an aggressive response back, uh, and 1 of the test things when you're dealing also with, uh, physicians who may have poor behavior, is that much of this is evaluated in what's called peer review as, you know, a process privileged. So the non physician victims, a bad physician behavior should be encouraged to continue to report missed behavior, but they cannot expect that they're going to know what interventions are to try to get that position to stop doing it or what they may be or what the agreements are so it's important to set the expectations as leaders that you can't talk about the details, but if it's still happening, it matters please report it so that you care. But it's, uh, uh, we'll, we'll, it's going to have to get resolved. Next slide and finally, again, there's a whole this is really kind of a, what? I would call a self review checklist. I would encourage you to use it as good stuff there and, uh, to adopt desirable skills. But again, I, I would go back to the things. I've been mentioning before, which is look at ways you use your time in terms of how much what's the ratio of listening to talking telling people what to do versus shaping what's done? What issues once a month, sit down and think about what the issues have been focusing on this month? What How's that gone? Um, am I working on certain behaviors having those go but set aside a little time for you to self? Reflect on the things that you set as goals as it related to, uh, moving the needle on culture in general or psychological safety in particular. So, uh, and then making a decision then, what's the focus gonna be for the next month? Don't try to fix everything at once, in terms of yourself, um, pick a few things and work on those. Because again, that's a otherwise she's just doing a whole lot too many things means nothing gets done. Well, and I would encourage you also to be giving some consideration to who is around you who can support you can provide guidance and maybe even a colleague that becomes your leadership buddy, where you can be sort of bouncing ideas off of him or her. And he or she can bounce things off of things for you. So I think I'm going to stop there. We still have just a few minutes. Um, and, um, and perhaps we can, if people have questions, they want to put in the chat, um, i1 of the things that came up, which is really, uh, something that I'm very sensitive to these days is the issue of just the crushing volume of work that many people have, and seeming to have a sense that the leadership may not, uh, appreciate that, uh, whatever it can be done to, uh, help leaders to 1 appreciated and to be encouraging folks, either middle management or front line staff to let them know, what are the time wasters that maybe they can get off the the leaders can get off their plate. Uh, we, uh, had a specific program that emulate and Jim Collins, this line has stopped doing list and it was phenomenally helpful to find ways that. In fact, beaters had set up policies or actions. That were wasteful of frontline staff and mid level managers time. So, uh, but by the leaders empowering the staff to, uh, as we did, when we did it in our organization, we had a quarterly discussion. I wanted to hear, at least 3 things from every person that they thought were low value work that they could do less of, or stop doing. And it was my job to review those and try to get them off of their plate if at all possible. And we ultimately markedly improved morale in difficult times and it also gave a chance for delegation of authority to other people. So, what, uh, Jeff, what else should we be talking about before we sign off here? Don, I think you covered the, the thing that was in the chat. I know. We've just got 1 more minute left and I just want to give it back to Vanessa to, to wrap up. Thank you Jonathan about, uh, generally another great presentation and right on point. Like you said, with what's occurring. With our hospitals and our staff. Um, so thank you again for your expertise. On the screen, you'll see our URL for our TMF networks and, uh, a few of the. Then that works that we have on on the website, lots of free information and resources are available to you. So I encourage you to visit us. Um, if you have not done so already. This month's feature content is on opioid misuse uh, we do have a change packet and other resources available to you and to your organization that again are available and free for you to use. So, I wanted to highlight that. And let's see, and at the end of the webinar, you will be moved to another page. That is our. Um, survey for, um, for the event so, if you can take a couple of minutes, just to answer, um, a few questions, we'd love to hear your, uh, your input and your thoughts on the. On the events, so that we can improve and continue to provide you content that is of interest to you. So, again, thank you everyone for your attendance today. And thank you again to Dr Kelly and to Jeff. For their great presentation and that concludes our event. Thank you. You may disconnect.