Communication

Hello good afternoon and welcome back to today's HRO education series. Today will be covering culture communication teamwork and collaboration.

My name is Victor Gonzalez. I'm a quality improvement specialist and I'll be your host, uh, today excited to welcome you back.

If this is old hat for you uh, we're going to cover just a few housekeeping issues. This is 1 of my favorite subjects and, uh, the presentation today is going to be phenomenal. Of course, in healthcare, it's important for all of us to be good communicators.

I feel like I'm a good communicator. Surrounded by bad listeners, so I think I'll probably get a lot out of this call today and look forward to sharing the information and introducing our speakers.

So, let's go ahead and get started, uh, want to cover a few things for you to make sure that you're comfortable in the WebEx environment. Today. We want to be sure that you have, uh, an ability to participate with us in this conversation.

There are 2 ways to do that 1 of those is by selecting Chad and entering your comments into chat. In fact, we're going to be.

Asking you to do that throughout the presentation, so be sure that the chat feature is turned on and added to your participant panel you can click on the bottom, uh, towards the bottom, right hand corner. You'll see the little chat bubble click on it. Uh, it will, uh, be added to your panel and you can follow along there.

The other way that you can participate is to join the discussion verbally throughout our presentation. We'll take a little break here and there to see if there are any Chatty Kathy’s in the audience like myself, I like to participate. Verbally. You'll have an opportunity to do that by clicking to the right of your name. You'll see a little hand icon. There. Click on it. I'll find you.

Unmute your line, and you'll be able to join the conversation there. We're also going to have a moment for questions at the end of the presentation. So definitely jump in. We'd love to hear from you.

All right, well, these are 2 familiar faces if you join us before and we're excited to have them back.

We're joined by Donna and novella, and she is an experienced health care, and patient safety expert who spent her clinical career in pediatrics in the emergency department.

She spent the last 15 years dedicated to quality and patient safety and health, several operational leadership roles where she designed developed and implemented patient safety programs, using high reliability concepts for both.

Standing and academic children's hospitals in Connecticut and Donna’s most recent role in his director of patient safety and quality for the Connecticut hospital association. She implemented a large scale, statewide improvement projects in all.

Of acute care hospitals across Connecticut she received her bachelors of science and nursing at Sacred Heart University, and her masters of science and nursing from Yale University. Currently. She lives in beautiful Sandy Hook, Connecticut with her family.

She has joined today by Dr. Kennerley. Dr Kennerley is a physician leader who has focused half of his 40 year career on improving the quality and safety of patient care after medical school and residency. He was a full time faculty member in internal medicine at University of Texas, Southwestern Medical Center where he taught students in residents, did basic science research, and implemented a patient centered disease management program for 20,000 patients with asthma, seeing both the power and failings of health care led to executive work at the Baylor health care system, where he developed patient safety program across its 10 hospitals and many outpatient clinics, he developed and published methods to measure patient injury and let other improvements as chief quality officer after leaving executive work Dr Kennedy has spent the last 6 years sharing lessons learned with consulting clients committed to delivering care that we all would want for our own families. He has published 50 papers. Book chapters received a variety of national awards and grants and help found 2 patients centered nonprofit organizations. Welcome to today's com, Donna and Dr. Kennelly. It's a pleasure to have you on today. Well, it's really a pleasure for me to be joining you again today and, uh, I would guess that most of you were, uh, in, uh, in the, uh, Texas and Arkansas areas are having to, uh, endure the hot. And I am sorry about that. And I will be thinking hard about your air conditioning continued to be successful, because we certainly are, depending on ours. So thanks for taking some time to, uh, to join us today. And we're going to be talking. Victor said about communication and I love this comment about having that he does.

Well, and just as bad listeners, and Tom was going to spend actually some good, good part of her presentation talking about the notion of the different rules of people, and how people are sometimes better listeners and sometimes people just are from different generations and that sort of thing, so we're going to really try to be practical in the things that we share with you today.

Next slide Victor so again, this is the, uh, this is the topic and we'll be covering that.

Uh, and, uh, really, it's a, if the and we'll shift to the next slide, just, uh, which will show you the something you've seen before and we're just going to remind you about that again, is that, uh, as part of high reliability, our goal is to achieve outstanding outcomes, and we do so by trying, uh, at least for part of ours.

For to be failure, free over a period of time, in what we do clinically, operationally and culturally and in order to, uh, to do that.

Uh, there are some things listed in the bottom left, but I just want to focus on 1 element of things, which is complexity.

And when you look in the graphic in the upper, right we have people who are working to deliver care to other people.

And so care is at the center of what we do here and whether it's people who do direct care or indirect care, because the people in hospitals are there to be able to make sure that, uh, as Victor said, people are getting the kind of care that we don't want for ourselves, but when humans interact with humans and humans, interact with systems, it gets complex and things can go wrong. And 1 of the most common ways that things go wrong.

Is for people to have misunderstandings and so we're going to be talking today about ways to try to avoid misunderstandings. And, uh, there are a variety of pretty practical things that we hope to leave you with.

That will, um, will help to prevent that from happening in your organization next time.

So this is again, another slide that you've seen before this is what we referred to as the framework for high reliability and again, we have care in the center.

But now we've divided it up as you've seen into domains and leadership, culture, knowledge and learning, and we will be focusing on the, uh, teamwork and communications that are part of collaboration, which the next slide shows sort of emphasizes.

Next slide, so we're in the upper right quadrant here these are parts of culture.

So, we think that again, this is the best place for communication and collaboration with people, because communication involves a need for somebody to know something that, you know, or for you to get information from them that you need to know. And.

That that's an essential element of being successful. So we're going to be working in the, in the culture domain and in the teamwork and collaboration, uh, sub domain. Excellent.

So again, 1 of the things that is key in this teamwork and collaboration that we're going to be talking about today, we've talked about this before. So this should be familiar to you. And, but it's important to emphasize that the purpose of these things is to have situational awareness to have dialogue and communication. So everybody is on the same page and that in doing.

So we, have respect for 1 another and try to avoid, but certain conflict, but if there is conflict, we try to resolve it quickly and thoughtfully.

And, uh, the TE, that we've talked before about team activities, like, planning forward and reflecting back. But, in order to do that, we have to communicate right?

I mean, we can't plan forward if we're not communicating about what we're going to do and why, and reflecting back on what happened recently, uh, requires that we be communicating.

So, again, all of this is in service of teamwork and collaboration, but communication is really the glue that holds all that together. Um, next slide. So, let's, uh, let's get started here. We're going to be starting on, uh, really the, uh, the teamwork component here and, uh, this just, uh, it shows again.

There will be, uh, our goal is to have, uh, have everybody have a happy face and a knowing face. That is we know what we've just talked about and can leave the interaction. Uh, not only happy because it's been pleasant. But because we know what we need to know. So, uh.

Let's look at the next slide. This is kind of a funny slide here, but we, we show that I love the term and a number of folks have used it. Well, before me. But you've likely heard it too. That teamwork makes the dream work.

And, uh, and I think it's always something good to be reminding teams of people that really, uh, what we do to enhance teamwork, including communication, makes it work.

So you can see here that these fellows are kind of interested in somebody getting out of this.

Then, um, and it may not be the guy on the bottom, but they have to work together. And so as a result, uh, they have to be thinking about what's the broader mission here?

Well, I guess it's to get out and, uh, and they have to feel empowered and know who's leading and and celebrate the, uh, the differences amongst people on the team. And so clearly having a team where everybody.

Feels good about each other knows. The game plan feels empowered to execute the game plan and knows who's in charge in the event that things need to change, uh, crucial and, uh, and celebrating the diversity, which we refer to as donna's going to explain. Uh, not just in, in what might have to do with sort of our, uh, our skin color or history or age.

But there are many different kinds of people in terms of the way people communicate. So we will be spending a lot of time on that next slide.

So, let's talk a little bit about situational where. And, uh, the note, we've talked a little bit about this before and so it's important for all of us to be aware of what's going on in the moment that we're doing our work. And so clearly understanding the goal. And how what we're doing fits into that. Having a plan to be achieving that is a good idea, knowing the risks and, uh, and then knowing and then staying in touch with what's really going.

So here, we have a picture of a photographer who clearly is interested in getting it really nice picture of this baby gorilla and, um, and so I'm guessing that, uh, although the, you know, the mom, they're standing really close behind and looks like she's maybe a little concerned about what's going on here and I really hope that that photographer either has a relationship with this gorilla, or alternatively kept track of the fact that there is a risk and even more concerning is you can see the silverback that's behind the mother gorilla and I’m sure that he's going to have no patience for the mom being upset so here's a situation where potentially someone is getting a little maybe getting a little off track as far as their situational awareness that they haven't been monitoring okay. And that's why situational awareness is time dependent. It's not just something, you know, 1 time and that's all. It's something that we have to work on all the time.

So, next slide, uh, begins to separate the idea of individual versus team situational awareness and many of you have known the story here of the of the blind or blindfolded individuals that are asked to say what it is that they're, they're touching and you can see a that they are trying to describe what they are experiencing, um, that.

In fact, from their perspectives, they, they feel like they're right, they have no clue that what they're touching is really connected to something bigger.

And so, 1 of the really important aspects of things is that we have to work on having not only individual situational awareness, but group situational awareness and the way we do that is through communication. So we have to be sharing with each other. And these folks have.

This year what they're all experiencing, and then to try to guess what it is that they had, what is going on, based, on their part of the information.

So think about the idea that when you're if you're a nurse working on a, with a patient, you may know a lot of what's going on with the patient. But the doc may know some other things, the radiology.

People may know some other things. The family may know some other things and it. What really matters is that really everyone comes together to have an understanding of what's going on and without communication uh, you're sure to have misunderstandings that will affect care.

So, again, the idea now is to, to work on not only individual, but collective situational awareness mix on.

So here, we want to encourage you again to own it, not only the accountability of good patient care, but to own success, as it relates to good communication and so you can certainly be successful at saying something. And then this Victor pointed out, he feels like he may have said what he needed to say, but perhaps some people didn't get it and the actual definition of communication. Is not that just that somebody says something uh, it is that in fact, the person who is receiving the communication understands what it is that the individual who is speaking is trying to convey.

So, uh, that is so what's really important is that for each of us to own, not only what we say, but a responsibility.

To be reasonably sure that the person who is hearing us is getting what they need from that so that they have the right picture in mind as far as, uh, the information that they that they need.

And, uh, and I think really, it's 1 of the, the things that I encountered is the patient safety officer, uh, in the Mailer system was that, uh, there are so many.

Patients where people bad things would wind up happening as we began to look deeper into that we found out that or we heard what I call the dreaded 3 words, which was, I just assumed.

And so it's not that you can't assume anything, but it's really important not to assume things unless you're pretty sure that you have heard enough to convince you that you and this the other person are really on the same page.

That's what's really key as far as that's concerned. So, um, and the idea being that if you're not sure it is about what you. Heard and what you're supposed to do it's really important for the listener to own that they need to say something

So, that they need to be saying, wow, could you repeat that? I'm not sure. I really understood exactly what you had in mind and especially if it's in a high risk situation.

Because a lot of what we do can have a really significant, uh, you know, could create significant injury if we had the wrong idea of what we're supposed to be doing.

And so, 1 of the things we really, uh, encourage is some level of repeating back things for example, if they say, well, the patient in 32 needs to have go down to radiology. Well, you know.

That's fine, but maybe it would be better to say, Mrs. Smith who is in 32, and then the person say, okay, I've got it Smith in 32. So, that there's now there's been a, what we call a closed loop communication where people have, in fact, uh, let you know, that. Know that but they, what they've heard is really what you wanted them to hear because who knows maybe the listener was in the middle of something else and or thinking about something else.

And so, as a result, this closed loop communication is important, and it's up to the listener to make sure they really have what they need.

And if they have a concern about anything that may be, it's off track that they, in fact, um, bring that up.

Um, hey, you know, I thought this patient was a DNR. I'm not sure. I understand why we're doing this.

Uh, that's a really important thing to say and if there are differences in opinion of what's going on clarify, em, before, uh, doing anything, not any thoughts about what, uh, I've said so far.

Yeah. I just want to I just want to convey a story that about kind of close the communication, how we can get caught in errors because I.

I'm recalling an event where a patient had a low potassium, and when the nurse asked.

The receptionist or the front desk person to read the lab result she read it.

But the nurse misheard and thought that doesn't sound right? It seems. Really low, so she said I'm going to get someone to recheck it so they had the library checked. And when she asked again, the person responded, it's the same. And so she was verifying an incorrect assumption.

So, that closed loop communication, where you actually repeating information for clarity is extraordinarily important.

So saying things like, it's the same, or I got it or whatever is not closed loop communication. You have to repeat back key pieces of information to make sure that people are understanding.

Pending and both parties own that right? So, if someone, if you're communicating to someone and they're like yeah, I got it or it's the same you're required then as the initiator of the communication to say, no.

Repeat that back to me, you know, just make sure you I want to make sure you heard me correctly. So it's, it's really, really important.

And there's, as we know having been in the patient safety world for a while these are these are these like, very small slip up communication, slip ups that can lead to really devastating results.

Absolutely, and and again we take this, um. To some degree, from the military, I mean, when, uh, the, uh, air traffic control people are talking with the, uh, the flight group they talk about a number of key pieces of information, and, you know, that they repeat back all of those things. Because, uh, it is essential that they are totally on the same page as just too important.

And 1 of the things about owning it is, in a sense not is, is doing it for the purpose is we just talked about, but the next slide is, uh, we'll emphasize a different aspect of it, which is by you're saying these things you're influencing others.

You're showing them the best practice and when they say, well, why are you doing that? You say because it's safer.

And, uh, and so, as a result, uh, although we, we unfair factor are greatly influenced by our leaders. We are at least as influenced by our colleagues. And when a colleague starts doing something that, uh, is a safer act, and then again, they will, uh, and does it and other people will adopt it.

Because we learned at least as much from our colleagues and so, as a result remember that you are leaders for your colleagues maybe not officially, but you are absolutely leaders and you were showing them what good practice is. So, uh, I think it's, that's why we want to emphasize the importance of you having good communication practices so that you can share those with others and they can start with a small number.

Number of people, this doesn't have to be a giant program. It just it needs to get started. Excellent. So this is just this is again, these are kind of things that are a little on the financially side, and I'm not going to go through the details. But what happens is that our brains are taught to see things in the simplest way.

And so, as a result, what we see on the left is, it looks like, well, that must be just a peculiar car that, uh, you know, is black on part of it and then has writing on it. But it's really 2 cars. And, uh, so our brain.

Actually tries to simplify, so, as a result, we just have to understand the 1 human factor is to be is that we tend to simplify rather than to necessarily pause and really take a hard look at things. And on the right is a brain teaser that I won't go through, but it's kind of fun. I encourage you to take a closer look at that. And you'll see that there are some people in a dog and a, that actually make up something that people initially tend to think of as.

A person an older gentleman, so that's just kind of for fun. Next slide, so, as I mentioned, communication is is really a found foundation of effective interactions amongst members of the team.

And, uh, and so, as a result, uh, if we really aren't going to have good outcomes, if we don't have good, uh, communications. So, uh, and that really is important that we do and this slide points out that, in fact, not only will.

Do not succeed if we don't communicate. Well, but 1 of the major problems is we think we've done it. Meaning.

We said something and we we quote just assume that the person got what we wanted them to know they didn't repeat it back. Um, and so, uh, as a result.

Just saying something, just cause you said something that doesn't mean the communication is finished, it needs to make, you need to have some certainty uh, have I contact make sure you, you know, that you're not just sort of talking to somebody over their shoulder while they're doing 6 other things.

Does that make sense? So, you know, I think it's just really is important because it's very easy to assume that we had done what was necessary just by saying something and that is not sufficient. Excellent, so this is where we're going to I'm going to turn this over to Donna for the next little while anything else you want to add, besides a great example you had done.

I think we're going to just dive right into this portion of a presentation around effective communication and I just want to say, just exactly, you know, repeat what Don said because I think it's pretty important that, you know, the biggest myth about communication is that it happened uh, communicating is not talking or lecture.

Or training, it's, it's an exchange of information it's having everyone leave with common understanding and it's nuanced. It's not it's not as straightforward always as it seems. So we're going to talk a little bit about why that is.

 

We can go to the next slide. So, there are 4 examples, um, here of styles of or types of communicators and maybe people as we go through. The slide could put in the chat.

What type of communicator they are um, there's the analytical communicator. That is exactly what it sounds like. It's a person who wants numbers facts and the facts, only not a lot of fluff.

There's intuitive communicators that are less about the numbers and more about the feel of the big picture. They don't want to get bogged down in details, just giving them the highlight reel. The overreaching purpose. That's me. I'm more of an intuitive communicator. Um, there are the personal communicators, and those are people who are really focused on the person.

Their goal is to connect with people and understand how they're feeling and then there's the functional communicator and they're really kind of just down to business with a well, thought out planned communication with a process. That's been practiced and a timeline. So I'm going to ask you guys who are listening to please put in the chat. What type of communicator you think you are of these 4 an analytical and intuitive a personal or a functional.

Kathy puts in functional Thank you, Cathy. And we oh, we got intuitive, functional. That's great.

Awesome Thank you. Guys for that. Oh, more kind of analytical. A combination that absolutely, depending on the situation I hear that for sure.

Lots of intuitive communicators. Great. Awesome Thank you. Guys we can go to the next slide. Please. And so, this is pretty amazing. You guys this is the 1st, time ever in history that we have 5 generations, working side by side. It's amazing. It's wonderful. And it's challenging. Right?

And we have a lot a lot to learn from each other in terms of communication. And how people verbally communicate, how they take information I think the important piece to this slide really is not to pigeonhole somebody based on their about the kind of communicator you think they might be um and that withhold judgment on that and based on generations and really get to know the people individually um you know I have um I have six kids and there's a big chunk of them that are that are in uh in Gen Z most of them are in jersey and um they are um they are forty characters or less communicators they do not want a big story they want the little

Soundbite of information, with the exception of 11 of them once every last detail and wants to talk about it and wants to really get an explanation.

So, um, you know, you have to really kind of assess who you're talking to and kind of appreciate and understand where the kind of communication style and the communication sort of venues that they were raised in and appreciate that.

Next slide please and then, you know, um, there's personality pieces that go into this and how your personality impacts, how do you prefer to be communicated with.

Or how you prefer, people communicate to you so, um, it's, you know, it's. It's important that we understand our own communication styles, our own personalities, and then be able to sort of assess who we're talking with and communicating with and that really will make you the most effective and how you communicate with your leaders as a leader, your teams, and your colleagues.

So we're going to go to the next slide. And, um. This is a really good example, Victor, we're going to go ahead. And, um, while I chat about what this is going to be, we'll have you convert us over to the video. We're going to watch a video on effective.

Communication is obviously a little bit exaggerated, but I think that speaks to the point of matching the style of communication of your communication with the person you are communicating with. Fun morning moms.

It. Yes, it is. You're so pretty in the morning.

Your mom and I need your breakfast. Oh, so you guys are getting along.

Yes, are very different people, Howard so, communications a little tricky?

Yeah, yeah. Sorry, butter, butter flavor to.

What's the 1? Well. I don't need any buffer. I won't get you.

I guess I'll cut these by myself. Mm. Hmm.

So, it was buffering a little bit. I'm not quite sure you can appreciate it, but you could see.

How his girlfriend. Was communicating with his mother, which was quite different than she was communicating with him. So exaggerated version. Um, but meant to really illustrate that was really how she was connecting with his mother was.

Sort of speaking back to her in the way that she was speaking with him with her. So we'll go on to the next slide.

Okay, as far many of you may be very familiar with thus far I love as far. I think it is an awesome communication tool for both written and verbal communication.

And I think we talked about in a previous a previous educational series. But I think it's, it's important to go over it again. Um, a couple of a couple important things about is that, um I recommend and it is recommended that when you are using you say each word to frame your thoughts so um so you would say the situation is uh the background is and that really helps guide the listener or the person who's receiving the written communication this is very good for sort of a situation that's got kind of a little bit of a complex.

You know, situation surrounding it, it's also very effective in transmitting information when you don't really know the person you're communicating with.

So, a very good example is if you're calling a physician about a patient at night, and you don't really know that on call person.

This is a really clear way of communicating without necessarily needing to understand their communication style, because you're really setting it up within this framework. I use this for email. Often, especially when I have a situation where I need someone to, like my boss to weigh in on a situation that I would like to be able to try to resolve and I can put my recommendation there and then ask if there's an agreement with that recommendation Don, did you want to add anything about.

Yeah I think it's incredibly helpful and in fact um one of the things there are a couple of things one is if um if people aren't as haven't had a lot of experience with it um what I would do is just think about trying a couple of situations that before you call that doc at three zero p m um you know who is likely to be grumpy and perhaps a little confused is to is to just practice it

And again, you don't have to do that every time, but once you become an Pro, it'll just happen.

Um, but if you haven't done it before, I'd really encourage you to practice it but it is we actually had rolled out as far a number of years ago and a couple of units and, uh, and when we talked to the Docs, um, they really appreciated it. And they realized it, it becomes much more, um, efficient.

Because, in fact, they don't want to see, but what about this? So, what was the potassium you know, is this also is Dr. Smith saying this patient they're less likely to interrupt.

Because they know that there's more coming and, moreover, it actually, I think respects when you're in that kind of situation, the nurse's, uh, Opportunity and to be able to say my thinking is that this chest pain is probably a schema of heart disease. And I'm inclined to get a steady kg.

You know, and what do you think. So, I think what it does is it helps keep the ball rolling and it, you know, it's. And it's very powerful. Also an administrative communication is done, pointed out because it's so easy for people to lose, you know, to not get the message.

Great, thank you. Done. I used to use this to communicate with staff. If there was like, a staff announcement, you could use this pretty like, you know, a pretty is pretty simple framework to sort of give people an understanding of, you know, the situation.

Why it is. And then what actions they need to take so I think it's a great tool for both written and verbal. So try and check it out. Try it out.

Thank you don for the suggestion to practice. I think that's important as well. Okay next slide please.

And then, you know, really looping back to communication and how it relates to communicating in a high reliability environment. Really? What the goal is, is that everyone understands the process to escalate an issue or concern.

 

So, can you be certain that the people you work with, or the people on your team, or the people you are a leader of could articulate to you exactly what they would do to escalate an issue or concern.

And if the answer is, you're not quite sure, then that's an area that you really should focus on. That's part of our culture domain, and its part of just culture, and as part of psychological safety.

So these are all really important concepts. The 2nd is, it's a safe that you create, or you are in a safe environment for by directional communication. We talked a lot about this during this section that communication is in both directions. Right? And that.

If you're having a conversation and somebody is not participating in that conversation, you have to really kind of rethink what's happening because you, you don't want to be just talking at someone you want to be talking with them and that the information is presented in a manner. That's appropriate for the recipient.

We talked a little bit about this around those generational ways that people, um, people receive information or present information as well as the kind of communicator you are. Um, I also think this.

Can be applied to, you know, when you're talking with a family at health care, folks are not always great at take stepping away from the healthcare lingo and putting it into words that people understand or not user a 1000 abbreviations that people don't understand. So really?

As a whole making sure the information is presented in a way that's appropriate for the recipient for people to understand. And then we talked about the repeat backs efforts are made to validate.

The information was received as intended this is a big big piece of communication, making sure that, again, the way you're communicating and what you said has been received in the way that you intended it to be received and that's that ownership that responsibility that Don talked about earlier. Done any comments on that i think that that's a spot on i think it's just really all those things are key to be thinking about how we communication contributes to a high reliability environment and it is i really i think we don't overstate it by saying it's kind of the glue that holds a lot of the concepts together because communication is how you show respect it's how you show what your priorities are by having eye contact by listening carefully and not being distracted. All of those things are enormously important.

Thank you. All right. I'm going to hand it back over to Don. Now, on the next slide to cover, um, teams. Yep. Okay sounds good. So, uh, what we're going to do this is, um, so if we go to the next slide, Victor, that'd be great. And this is just again to, to remind you that as we think about things.

We, we talked initially about individual situational awareness and then group situational awareness, right? Our team situational awareness.

Now, we've, we've heard about, uh, things that we would do and think about.

In terms of our individual communication, but now we can think about how we approach communications that involve a larger numbers of people that is the team. So let's go to the next slide.

So, there are lots of ways to potentially get this wrong. Um, but and so what I want to emphasize is that, uh, 1 of the things that, I think is probably, um, a theme that is, uh, that kind of runs through a number of these things is that, uh, we often tend to try to communicate too much information and now enough detail.

Is important being succinct is very important, but frankly, hey, you know, many of us just kind of when you have the, when, you know, it's your turn to say something, you know, lots of people, including myself in some situations, wind up sort of just it's hard to decide that you're done and you just keep talking and so keep in mind. Uh, you can be communicating.

Patient and so it'd be about whether that next thing you're thinking about saying is really necessary.

So that's part of it that is in a sense over if it's overly complicated or, uh, if you don't speak clearly, if you don't tie back to the why people start thinking well, why am I hearing this this doesn't really have to do with this particular, uh, issue that that I need to know about and if you don't get.

To that pretty quickly, people are going to stop listening or at least be distracted. So so, 1 of the things that I really encourage you to do is to be thinking about these things and to, and will. This coupled with something that we'll share in the next slide, but we're not ready to go. There. Is, is.

In order to practice and get better at this. Think about just taking an interaction you've had in the day and asking yourself.

Hey, did they give it the right amount of information was a sensitive to the learning style or listening style of the person I was talking with a did I get their get their attention uh, and, uh, and did I say at the end hey, this does that make sense, or did you know do you have any questions.

And that gets passed this note of a problem of having a no mechanism for course corrections or unclear how to provide feedback. If you don't invite somebody to say, well, you know, thanks for that information.

But, you know, it didn't get this part of it. It's better. If you invite them. To be able to say, you know, I just have 1 thing I need to clarify so be sure that you help them to be a successful listener by trying to provide, uh, the opportunity for them to give you feedback and also really trying to avoid the hints and hope issue. Oh, my gosh. I mean, you know, and that tends to happen in hierarchical communications where you're talking with, you know, a doc or an administration. Later and rather than say. I really I'm concerned, we're kind of off track on this and here's why, you know, you just go say, well, you know what I mean, some people are a little unhappy or, you know, I'm just not sure this is working very well and, you know, it's, it's actually disrespectful to people. To not be sufficiently direct now. Direct doesn't mean obnoxious. It just means trying to make sure that you had the information you need and to ask for it when you don't.

So, it's and but on the other hand, if you're kind of a little worried, because Dr Smith is kind of grumpy and seems like he's in a hurry uh, that's again. That's that's disappointing. But that doesn't. But it is not a good idea to decide to soften the message because he may not get what you. Want him to know. If you don't make it clear, so don't just be hinting at it, be direct if necessary use parts of thus far when you're doing that.

And, uh, and again, if you're making general communications, if you have a leadership role, uh, you know, it's not up to the communications department to be writing what needs to be done. If you have a 1 pager that you need to get out there.

I mean, they can help, but, hey, this is all of us need to be communicating every day. This is not a sub special. I mean, this is like not like neurosurgery. This is the idea that we all can get better at communicating and we need to practice. Now, 1 of the things that is really important to show them the next slide. Which is that has to do with a couple of things 1 is feedback. Um, I think 1 of the things that I hope you get some benefit from when you have, uh, reviews from, um, again, your, um, your leadership is feedback about how you are, what kind of communicator are you, but you can also be asking people about that. And, you know, if you've got a trusted friend, you can, in fact, be a sort of saying, hey, you know, I felt like I maybe sort of.

What's the point in this? You know, how am I doing in my communication? I'm kind of working on it and trying to do better on the right is a checklist. That is a very detailed and I'm not going to be going through it. Um, today I really encourage you to think about printing it out and using it, you know, at least once a week to just be asking yourself about that particular conversation you just had, you know, and it has literally.

Really a checklist of how well you did it and that way when it's still fresh in your mind, you can sit down. And in a sense, this is a way where you coach yourself by taking a look at those things and see. Whether those were something that you actually did, but when you, when you give unsolicited feedback is very important to be kind and respectful to do it not 2 weeks later.

You know, when the issue is no longer meaningful, but to do it in a in a timely way and to be very specific and use a lot of I words, not you did this or whatever, but you can say this is what I Experience I heard this, or I maybe didn't understand it. Well, uh, when you put a lot of things in the, you didn't, or you did it just it tends to put people back on their heels.

So, um, again, try to be constructive about the feedback that you provide each other, and you might want to pick a buddy.

You might take alert, you know, having a learning buddy as it relates to communication and just who you work with often and say, you know, maybe once every month or something, we'd sit down and talk about it.

How we're doing, because we're trying to get better. So, um, that way, uh, again you can, uh, you have a way to improve over time. And I think the, uh, checklist on the right is a good way to give you some sense of how you doing. Don, can I just interject really quickly for anybody that's, like, really thinking about, uh, wanting to improve their communication style or just learn more about, uh, communications in general Renee brown.

You'll see her name on that quote, has tons of YouTube videos. Ted talks, she's a psychologist a researcher. She's awesome. And quite entertaining actually. So she's like a, like, you can list on your ride home from work and it's like a really.

a valuable way to spend that time um it's uh she's fun but practical the other thing that i wanted to just say is that there's a big emphasis in healthcare right now on you know there always has been on you know being um you know

Nice and respectful and nice to each other and kind and, you know, which I absolutely 100% agree with. But giving honest feedback is not unkind. It's actually the kindest thing you can do for someone you're working with.

So, if you're working with somebody who's really difficult, or is reacting in a way, that is just kind of not in alignment with the values that you hold for your unit or your hospital. Your hospital not giving them feedback is actually. Unkind and, and kind of being brave and saying, I'm going to dip my toe in this and and respect this person this work colleague enough to let them know that what they're doing is agree and I don't want them doing that around someone else. That's that is mutual respect and kindness, so it's not easy but once you do it a couple of times, it gets easier. Actually. Um, and so I just wanted to say, um, that.

A couple of things done, um, and just again just recommend Renee brown as sort of a really interesting way to learn about communication and about feedback and about emotions. She's just great. Someone great to listen to very entertaining.

Absolutely, no, she's wonderful. And, uh, the TED talks are fabulous. Um, and, you know, 1 of the things too, I didn't mention it earlier, but if you, um, not so much, just if you have something that's important.

Like, you're going to give a short presentation or something um, 1 of the things you might think about is actually just with your iPhone is just recording and then a, in a practice session and listen to it back. How does it say?

Most of the time, I think I'm being, like, really clear, but when I listened to what I've said, I realize that maybe not so much. So, uh, that's not something you do for every day kinds of things. But, uh, but it's just something to think about.

Okay, let's go on to the next slide, uh, Victor, and, uh, we're going to shift into now talking about team activities and this is where we're now talking about groups that are not only kind of working, uh, within themselves, but it may interact with other groups as well, so, next slide shows, uh, different ways in which, uh, W, this is complicated, but let me just try to simplify things a little bit.

We really encourage. Encourage organizations to have a daily safety Huddle.

Um, and, I mean, presumably, it would follow having the morning huddle that people would have with their, uh, their colleagues to say, how are things going what issues happened last night are the things we need to fix are the things people need to know about. But then someone from that Huddle would go, uh, to, uh, participate.

In a relatively brief meeting with the, uh, with others, uh, from other units and it wouldn't just be, uh, you know, the nursing units.

I mean, it would be radiology and lab and facilities management, uh, it all those people go.

And, um, that way, everybody can hear what went wrong in the last little while.

File if the local people can fix it. That's great. But now you've got somebody who has heard fresh information that needs to be worked on. So someone can say I got that.

I'll work on that and get back to you in this afternoon. So a safety Huddle or operations huddle, and they can be blended in a small organization. Some of the operations huddles, or we have this many discharges.

Today in this many patients who, uh, uh, you know, and we have a staffing problem, so we can only have this many beds and so, um, that operations, how it can be merged with the safety huddle as well. But in a sense, it brings people up to date on the status of the unit and, uh, any issues that happened in the last 24 hours that needed attention and hopefully bringing them to the attention of people who are in a position to help. Uh, and the other departments and, uh, to your colleague, or, uh, departments or units that go. Wow. You know, that could have happened to my unit too. I'm going to talk about this, uh, tomorrow and with my group.

So that's a classical sort of place to start. And what we mean, by, uh, the traditional communication on the left is the leaders tell, uh, you know, their, uh, uh, subordinates what they want. And then this Gordon is sort of parallel.

 

Teams what to do, and it's just all very directive if you will, it's not interactive and that's a pretty common. And it's but really a tiered huddle approach is where information not only goes down. You hear what the priorities that the organization or, you know, where the financial, uh, you know, sort of status is.

But then you put information back in that goes back up the food chain if you will. So that the leaders.

Now, have a better awareness of what's going on in the front line and it's really important that they have that understanding about what's going on at the front line. And so that would be the next step after having the having a local Huddle is for those people.

Then to be a, it might get pushed up from the department, lead to the senior executives and then back down. So, just so that this is a way to encourage BI, directional indication of groups sharing need to know information not nice to know information but need to know information.

Next slide, and all of this is incredibly dependent on having psychological safety. So we, the goal and psychological safety isn't just like, having the light switch on or off it.

It goes in in levels and it's it is more successful some places than others. But we want everybody to feel like they can contribute to the conversation and share concerns. So, uh, this nice virtual.

A circle here where people aren't hesitant, they speak up the right people know what's important. Errors are fixed and action is taken and the unit gets better and every time the circle, the cycle is done, the unit gets better and everybody starts feeling more confident in what's going on and feels proud of the kid that they're gone. They get because they've fixed all these things and so, errors become less frequent.

A whole lot less of the, I just assumed kind of situation so really important to if, you know, communication is, is the glue certainly psychological safety is a component of the blue so really encourage you to work on that next slide.

And we'll sort of just wind up on this, which is just to be saying, hey, you know, the reason people want to stay in a unit and not go someplace else. Is because they feel good about working with their colleagues who show them. Who have created psychological safety? Ah, are improving all of the things we've talked about today are things that contribute to retaining staff.

And not having them go someplace else in this very tough time. So, uh, uh, really, uh, again, hope that, uh, this has been helpful, but, uh, they will ask for any questions on anything else.

You want to add in the last minute or so we have no, I mean, I think this is really this presentation is, you know, a snippet of what you kind of what you need to know and master around communication.

I encourage people to, uh, research a little bit on their own.

On some of these topics, um, and, uh, it is really a core to leadership as Don said to patient safety, uh, to psychological safety.

So, um, it's a, it's a huge topic and I hope we were able to give you guys enough of a flavor that you walked away with some practical. Um. Things you can use, um, moving forward so thank you. Everybody.

Thank you, thank you. Dr. Kelly and Donna. We do have 1 minute, and we certainly want to maximize your expertise if we can squeeze in a question guys, this would be the opportunity to do it.

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So, I think Dr. Kennelly and I think Donna again for their expertise and insight, it was a pleasure having all of you on. This wouldn't be possible without your participation. We'll look forward to hosting you again in, in the near future.

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