Investing in Conversation Skills at MaineGeneral Health
Spurred in part by the Joint Commission’s patient safety goals, hospitals are establishing processes to help encourage more dialogue among staff and between caregivers and patients. Checklists, reminder sheets, and other communication tools can come in handy, especially during clinical handoffs. For instance, many hospitals are adopting the SBAR technique (Situation-Background-Assessment-Recommendation) to help clinicians discuss a patient’s condition and set appropriate goals.
More May Be Needed
However, not all critical conversations can be guided by a checklist or a form. Certain emotion-ridded situations, such as a disgruntled patient or a disrespectful coworker, call for staff who have the ability to manage powerful feelings (their own and the person they are addressing) and to clearly articulate messages in a way that will be understood.
These are not skills that are typically taught in school, and some organizations—such as MaineGeneral Health—are finding it worthwhile to provide formal communication training to staff.
Employee satisfaction reports and exit interviews at MaineGeneral Health showed that more than 20 percent of employees did not feel that conflict was handled openly in the organization. In 2004, the health system embarked on an initiative with a consultant to improve how employees handled conflict on the job.
Staff Training Staff
Administrators chose a train-the-trainer approach using the organization’s internal resources. They selected 12 high-level, well-respected leaders—only two of whom were professional trainers—to lead two-day seminars on building better communications skills. These leaders took part in a two-day course led by corporate trainers from the consulting firm. The course was designed to spread better communication skills throughout the health system—quickly. After learning the skills, the 12 designated MaineGeneral trainers delivered the training to staff on their own.
Using structured role-plays, the course was designed to cover some of these communication topics:
Knowing your real motives
Your style under stress
Creating safety (i.e., if people don’t feel safe, they won’t talk)
How to make your point
Getting others to talk
One goal was to train staff in crucial conversation skills. The term “crucial conversations” is adopted from the popular book, Crucial Conversations: Tools for Talking When Stakes Are High and the training product of the same title. The authors define a crucial conversation as “a discussion between two or more people where the stakes are high, opinions vary, and emotions run strong.”
For example, nurse managers are often called upon to resolve conflicts between employees. Take, for instance, a nurse who thinks her colleague is too slow to respond to call bells. “This can have far-reaching implications on safety, morale, and teamwork,” says Michelle Binotto, RN, MS-HSA, a patient financial services manager at MaineGeneral Health and former nurse manager on a medical-surgical unit. Nurses at MaineGeneral are encouraged to speak calmly and respectfully to colleagues whose behavior may be unwarranted, unsafe, or unprofessional.
Binotto does a lot of coaching for employees who aren’t certain how to address a situation with a colleague. One point she stresses with staff is that it’s OK to say you’re sorry. “Giving an apology means that you are sorry that something happened, not that you were wrong,” says Binotto. (Click here to access more conversation tactics for nurse managers.)
Raising the Bar
Over the past four years, MaineGeneral Health has trained close to 1,000 employees—one-quarter of the employee population—on crucial conversations at a cost of about $150 per person. Every hospital employee is invited to participate. Since 2003, employee satisfaction surveys show improvements on 41 of 42 questions. In one assessment, managers who took the course showed an 85 percent improvement in speaking up about poor teamwork, a 66 percent boost in addressing poor initiative, and a 42 percent improvement in addressing incompetence.
There’s also been an impact on safety. “It is no longer acceptable to look the other way when one witnesses disrespect, poor initiative, or even the smallest safety error,” says Patrice Putman, director of employee development. “This training has affected patient safety in a direct and vital way. It has helped us raise the bar on everything we do.” Putman also knows of at least one critical care nurse who decided to stay with the organization because she learned how to handle conflict at work.
“Bad behaviors that had been tolerated for years are being turned around, and whole department cultures are changing for the better, all because people are finally having the hard conversations that they avoided for years,” says Putman. Turnover rates remain low—less than 15 percent systemwide, which includes five long-term care facilities, home care, hospice, and numerous physician offices.
With the training in place, employees feel empowered to take accountability for the quality of their relationships, says Putman. MaineGeneral was recently named one of the state’s “Best Places to Work,” an honor that staff say is due, at least in part, to the communications training.
This article originally appeared in The Business of Caring, a newsletter dedicated to helping nurse leaders develop business and management skills. Learn more.