Optimizing Intra-Team Communication in Patient CareProgram for Interpersonal Communication and Relationship Enhancement (I*CARE) Achieving Communication Excellence Lecture Series

R. Kevin GrigsbyAAMC Senior Director, Member Organizational DevelopmentJune 9, 2015

This session will help you to:

Understand the how rapid change in the academic health enterprise is effecting the way our teams work together

Understand how these rapid changes are effecting the way we communicate in the patient care environment

Understand how a climate of trust and accountability promotes intra-team communication

Understand how maximizing positive interdependence enhances individual and organizational performance

Understand how relational coordination enhances faculty vitality, a critical element of a positive organizational culture

Learning Objectives

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Complex, Adaptive Systems• Top-down leadership approaches are not effective with complex,

adaptive systems• Adaptation requires the integration of organizational components• Biggest risk? Diffusion rather integration

Silos . . .

Image courtesy of Vichaya Kiatying-Angsulee. www.freedigitalphotos.net3

VUCA Environments

• Volatile

• Uncertain

• Chaotic

• Ambiguous

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In the Past . .

Independence and individual accomplishments were rewarded within the culture of academic medicine and science

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Things Have Changed

Interdependence and collective accomplishments are now rewarded in the academic health enterprise

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New Leadership Models

Focus on how to:

• Extract the genius of others

• Amplify organizational intelligence

• Produce better organizational outcomes

• Develop existing talent in organizations

• Develop an orientation toward the future

• Promote succession development at all levels of the organization

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New Organizational Models

Focus on how to:

• Foster inter-dependence

• Harness organizational intelligence

• Remain oriented toward the future

• Develop strategic organizational succession development

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Relational Coordination

“A mutually reinforcing process of communicating and relating for the purpose of task integration”

“A powerful driver of performance when work is interdependent, uncertain and time constrained”   

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Relational Coordination Dimensions

© 2015 Jody Hoffer Gittell and Anthony L. Suchman. Improving work processes with Relational Coordination. Rochester, NY: Relationship Centered Health Care and Brandeis University.

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RC Survey

• The RC survey instrument is a validated and reliable tool that identifies the strengths and weaknesses of teamwork within and across functional and organizational boundaries.

• See: http://rcanalytic.com/survey-2-0/

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Relational Coordination Outcomes: Quality

Increased patient satisfaction with care

Increased patient intent to recommend

Increased postoperative pain/functioning

Improved quality of life for long-term care residents

Improved patient psychological well-being

Reduced family complaints

Reduced medication errors

Reduced hospital acquired infections

Reduced patient fall-related injuries© 2013 Jody Hoffer Gittell and Anthony L. Suchman

Improved quality of care for asthma patients

Strengthened decision support

Improved product development quality

Improved on-time performance

Reduced customer complaints

Increased internal audit effectiveness

Improved quality outcomes for heart failure patients

Improved quality of chronic illness care

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Relational Coordination Outcomes: Workers

Increased job satisfaction

Increased career satisfaction

Increased professional efficacy

Reduced burnout/emotional exhaustion

Increased work engagement

Increased proactive work behaviors

Increased psychological safety

Increased learning from failures

Improved internal audit risk management

More timely implementation of audit recommendations

Increased reciprocal learning

Increased professional satisfaction with care delivered by community health nurses

Increased equity of team member contribution© 2013 Jody Hoffer Gittell and Anthony L. Suchman

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Relational Coordination Outcomes: Patient/Family

Engagement

Improved family preparation for caregiving

Improved family engagement in evaluation, enrollment, retention

Increased patient trust and confidence in the care provider team© 2013 Jody Hoffer Gittell and Anthony L. Suchman

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Relational Coordination Outcomes: Efficiency

Reduced turnaround time

Increased employee productivity

Reduced length of hospital stay

Reduced total cost of hospital care

Reduced costs of chronic care

Reduced costs of product development

© 2013 Jody Hoffer Gittell and Anthony L. Suchman15

Shared Goals

Do share the same goals as the persons with whom you work?

Do the persons with whom you work know your goals?

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Shared Knowledge

• How much do the people with whom you work know about your job?

• How do they know about your job? Have they done it? Have they shadowed you? Or is their knowledge based on observation and assumptions?

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Mutual Respect

• How much respect do you get from the people with whom you work?

• And how much respect do you offer to the people with whom you work?

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Team Communication

Frequent• How often do you communicate?

Timely• Do you communicate when you need to?

Accurate• Is the information included in your communications with one

another accurate? Is it complete?

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Team Communication

Oriented toward problem solving• Do you remain “solution-focused” in your communication with

one another? • Or do you place blame? Endlessly criticize and fail to solve

the problems? Avoid conflict by “talking around the problem?

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Keep Conversations Solution-Focused

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Use a Solution-Focused Approach to Close the Knowing-Doing Gap

1. Keeps conversations away from blaming

2. Keeps conversations away from whining

3. Keeps the focus on problem solving and away from making the error of thinking that talking about something is the same as doing something – it’s not the same!

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The Solution-Focused Model

Criticism alone can be irresponsible, as it does not lead to solving problems.

Agree that when criticizing, one must present a possible solution.

If you do not have a proposed solution, be brave and admit you have no solution, but are willing to keep working with the group to find a solution.

Be willing to compromise.

Be prepared to accept individual responsibility.

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Remain Solution-Focused

When engaged in a conversation and the other party offers criticism, but no proposed solution, prompt them by stating “I understand your comments and feel some of them are valid criticisms. But please tell me, “What is your solution?”

Agree that if no solution is offered, the group will stick to a solution that has been proposed OR will continue to work to find a better solution

Pfeffer & Sutton, 2000.

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Relational Interventions

1. Create a safe space

2. Assess the state of current relationships

3. Engage and facilitate in dialog

4. Role modeling

5. Coaching

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Structural Interventions

1. Select for skillsets and perspectives

2. Train to work as team members

3. Create shared rewards

4. Hold one another accountable to create trust

5. Clarify roles through job shadowing

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Generous Listening:A Core Management and

Leadership Tool

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Strategies for Improving Your Communication Skills

• Increase your self-knowledge

• Increase your knowledge of others

• Be willing to “really” listen – improve your listening skills

• Change your behavior 28

Generous, Authentic Listening

• In difficult conversations, we tend to stop listening

• We are formulating a rebuttal and do not hear what the other person is saying

• Learn to “turn off” the inner dialog and truly listen generously and authentically

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Three Levels of Listening

Level 1:

Listening for me

Level 2:

Listening for content/information

Level 3:

Listening with your head and heart for the speaker

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Good Listeners

Listen with more than their ears:

• Make eye contact• Pay attention to posture and proximity• Head nodding helps• Concentrate on the message• Avoid immediate assignment of emotion

Don’t judge too quickly Don’t let anyone hijack your amygdala

– https://www.youtube.com/watch?v=A0VOgGPUtRI

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How to Make Critical Comments that Result in Changed Behavior (Grigsby, 2015)

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What is a “Behavioral Protocol?”

• A statement describing a consistent set of actions to be taken in similar situations

• They guide our behaviors and get us beyond “knowing” about something to “doing” something

• Ultimately, protocols lead us to being and acting as positive examples

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It is “All About You”

o It is NOT about the other person, it’s about YOU and your response/reaction to another person’s behavior

o Keep the focus on you and the effects of the behavior on you

o It’s not about being “right” – it’s about behavioral change

o Be willing to negotiate

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Start Your Conversation With “I” Not “You”

• Starting with you creates defensiveness as you have identified the person as the problem

• It’s the behavior, not the person!

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Don’t Follow It With “Always” or “Never”

• Hyperbole doesn’t serve a useful purpose

• Often increases the drama in the exchange

• It’s probably not true anyway

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Follow “I” with “am,” “was,” “feel,” “felt,” “found myself”

• Remember, it’s about you and your response/reaction to behavior

• It’s about behavior affecting you: physically, emotionally, cognitively

• Own your feelings or they will own you

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Use the Term “when,” Not “because”

• Use of the term because may lead others to become defensive

• Persons may feel they have been identified as “the cause”

• Determining the cause is complicated and isn’t fruitful in most situations

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Describe the Behavior Explicitly

o Use terms related to the senses

o What did the person do that you saw, heard, smelled, tasted, or touched?

o When did it occur?

o Was it once or has it occurred more than once?

o If more than once, how often? 39

Offer or Suggest an Alternative - Describe the Desired Behavior

− What is the ideal from your perspective?

− Describe other behaviors the person can enact

− Ask if the person has considered alternatives

− Be sure to listen and be willing to consider all alternatives

− Making a list of options can be helpful40

Critical Comments to Change Behavior

Put it all together:

“I was troubled when you criticized the proposed changes in curriculum – and did not offer any alternative or solution. Offering

critical comments is important, but doesn’t move us forward. Offering proposed solutions moves the process forward. It will

help all of us if you propose a solution in addition to your criticism.” 

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To Foster Interdependence

• Invite reflection

• Withhold judgment

• Ask open ended questions

• Generate hypotheses without making conclusions

• Describe – Don’t prescribe

• Offer formative rather than evaluative feedback

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1. Articulate a clear, shared purpose

2. Follow an agenda that keeps the focus on meaningful, interdependent activities

3. Shape persons understanding of their roles

4. Articulate explicit norms that minimize politics and maximize attention to strategy

5. Coach others deliberately and competently

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Demonstrate Leadership Presence (even if you aren’t the leader!)

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High-Power, Non-Verbal Displays:

• Cause neuroendocrine changes

• Cause behavioral changes for males & females • High-power posers experienced

• elevations in testosterone • decreases in cortisol • increased feelings of power • increased tolerance for risk.

Cuddy, Wilmuth, Carney, 2012.http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are?language=en

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Reframe VUCA: VUCA Prime

• Vision

• Understandable

Lawrence, 2013.

• Clarity

• Agility

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ReferencesCuddy AJC, Wilmuth C, Carney DR. The benefit of power posing before a high-stakes social

evaluation. Harvard Business School Working Paper, No. 13-027, Sept. 2012.

Grigsby RK. Enhancing the Behavioral Science Knowledge and Skills of 21st Century Leaders in Academic Medicine and Science. J Org Behavior Management. 35(1-2):123-134, 2015.

Hoffer-Gittell J. High Performance Healthcare. McGraw-Hill, 2009.

Hoffer-Gittell J, Suchman AL. Improving work processes with Relational Coordination. Rochester, NY: Relationship Centered Health Care and Brandeis University, 2015.

Lawrence K. Developing Leaders in a VUCA Environment. Chapel Hill: UNC Executive Development, 2013. Available for download at: http://execdev.kenan-flagler.unc.edu/developing-leaders-in-a-vuca-environment

Pfeffer J, Sutton RI. The Smart-Talk Trap. Harvard Business Review. 1999, 135-142. Reprint 99310.

Pfeffer J. Sutton RI. The knowing-doing gap. Boston: Harvard Business Press, 2000.

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