Beth Boynton, RN, MS is an organizational development consultant and author specializing in communication and collaboration. As a nurse consultant and avid blogger, Beth has agreed to provide insight on Medline’s blog.
When taking a scientific approach to patient safety, it can prompt us to develop different ways to control everything we possibly can. In a complex healthcare world it makes perfect sense. However, if we are willing to acknowledge that we can’t control everything, like other peoples’ expressions or behaviors for example, and that to some extent patient safety is an emergent property, we can look at patient safety through a different lens; the art of safety. Doing so inspires three vital questions and discussions; how are people skills involved in sentinel events; what makes them challenging to develop, and what kinds of teaching methods will help to build them?
How are people skills involved in sentinel events?
It is common knowledge in healthcare circles that the leading root causes of sentinel events fall under the following categories per the Joint Commission: human factors, leadership and communication. Close examination of the subcategories reveals a striking prevalence of ‘people skills.’
- Human Factors Subcategories: Staffing levels, staffing skill mix, staff orientation, in-service education, competency assessment, staff supervision, resident supervision, medical staff credentialing/privileging, medical staff peer review, other (e.g. rushing, fatigue, distraction, bias)
- Leadership Subcategories: Organizational planning, organizational culture, community relations, service availability, resource allocation, leadership collaboration, standardization (e.g. clinical practice guidelines), directing department/services, integration of services, inadequate policies and procedures, non-compliance with policies, performance improvement, medical staff organization, nursing leadership
- Communication Subcategories: Oral, written, electronic, among staff, with/among physicians, with administration, with patient or family
One of the biggest challenges that frontline nurses and leaders face when it comes to staffing levels is ensuring that there is enough staff to provide safe care, and that it’s affordable. But this isn’t a simple numbers game because what one RN can do Monday morning may be different than what that same RN can do Friday afternoon. Cumulative stress, fatigue, concerns at home or new clinical experiences are likely to influence a different work capacity. Not only that, but who are the other nurses on the team and how are they getting along? Are they delegating effectively and able to ask for, offer or refuse to help each other safely and collaboratively? Does the individual nurse have the self-awareness to acknowledge he or she is too tired to provide safe care? Will, “I’m too tired to work overtime safely today,” be respected by others on the team and in the culture? No wonder managers and senior leaders scratch their heads in trying to predict staffing levels that consistently work.
This same logic can be applied to many of the other subcategories. Consider how staff orientation, medical staff peer review, performance improvement or oral communication with/among physicians will be affected by the ‘people skills’ employed by and between all stakeholders.
What makes ‘people skills’ challenging to develop?
There are two main reasons why ‘people skills’ are challenging to develop in healthcare settings; they involve emotional risk and require behavior change. The true collaborative work necessary for patient safety requires that all voices be respected, spoken and heard. Yet speaking up for one’s self may mean risking judgment, humiliation or retaliation. It also requires being more accountable for ideas, limits and needs; i.e. taking on more power. Not only do these factors underlie our abilities to lead and follow, but they are crucial for the decision-making and versatility required to shift between the two seamlessly and in the moment. The surgeon who is directing the operating room team with a clear and authoritative demeanor and at any given moment is able to take in feedback and say, “Thanks for speaking up. I could have made a huge mistake,” is an example.
And we KNOW in healthcare, that behavior change is extremely hard to accomplish, just think about how patients (and ourselves) struggle with smoking cessation, increasing exercise and healthy eating! Behavior change involves motivation, skill and knowledge, along with a safe and receptive environment. Further, developing new behaviors requires practice. Toxic cultures and relentless and stressful workloads represent common barriers to developing these essential skills.
What kinds of teaching methods help to build ‘people skills?’
Healthcare professionals need experiential learning opportunities individually and with team members. Processes like leadership coaching and interactive workshops such as constructive feedback, medical simulation experiences that include elements of communication and collaboration and a newer process called medical improv or applied improvisation are helpful because they can include real life situations and relationships. It is extremely powerful for frontline nurses to learn assertiveness skills with physicians and other leaders who are learning to be better listeners.
In summary, the healthier the ‘people skills,’ the healthier the relationships, the systems and the outcomes will be. Learning the skills and practicing the behaviors is not easy, especially under the high-stakes, high-stress world of healthcare. If we want to provide the safest, highest quality and most cost-effective care possible, we must focus on both the science and art of safety.
The Joint Commission. Sentinel Event Data Root Causes by Event Type 2004 – 2Q 2014.http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2Q_2014.pdf Accessed March 4, 2015
Boynton, B. Confident Voices in Heatlhcare Blog (2013). Shifting to collaborative behaviors with help from medical improv-the innovative bridge to positive patient experience, safe care, and rewarding work.http://www.confidentvoices.com/2013/06/29/shifting-to-collaborative-behaviors-with-help-from-medical-improv-the-innovative-bridge-to-positive-patient-experience-safe-care-rewarding-work/ Accessed March 4, 2015