Ted Audio Collective Hi there, we are not Mona Chalibi and this is not am I normal?
But we hope you'll stay with us.
I'm Ann Morris and I'm Francis Fry and here is something a little different an episode of fixable our new show in the Ted Audio Collective We hope you enjoy it if you do you can find and follow fixable wherever you get your podcasts.
Thanks for listening This is a new segment we like to call Ann and Francis's favorite icebreakers We do a lot of work with teams and we try to get them to start communicating honestly very quickly So we think a lot about what are the questions at the beginning of meetings?
That's really create an environment people can have an honest dialogue a Low stakes one I often use is tell us about a piece of art that means something to you Oh good I'll tell you the one that moves me the most and it's a photograph that our dear friend Emmy took when she was visiting us and Our oldest son was two or three on the weekend We took him to the classrooms at the Harvard Business School Not break into the classroom not break it.
I mean, it's really Find our way into the classrooms which have just magnificent layers and layers of boards and we would rearrange the furniture a little bit So that he could stand on it and draw such a light for friends No, I never knew we were there But there's this one particular picture where he's standing on the desk that's pushed up against it and he's drawing and his head is tilted as if He is an experienced artist looking up at the work like he's appraising it But we can only see him from behind but we can see you and I from the side and we're also joining him in In the gaze and so all three of us are sharing a gaze and I don't know why it's so powerful to me But it is my favorite piece of art So thank you Emmy for that and thanks for letting me think about that.
I love it too All right, I'm Ann Morris.
I'm a company builder and leadership coach and I'm here with my wife and that would be me I'm Frances Frye and I'm a professor at the Harvard Business School and you're listening to Fixable This is a podcast where we work very hard to fix work problems fast and by fast we mean hopefully in less than 30 minutes That's the goal many of our listeners know that this has been a dream of ours for years to have a pot podcast and excuse to talk to each other It's a date Once once a week I'm so excited to dive in with our first fixable caller who is she her name is Kelly She's a nurse in a cardiovascular acute care unit at a teaching hospital We won't say which one but it's a very high stakes job takes a lot of work and a tremendous amount of Commitment and generosity.
Oh my goodness such important work Do we know what Kelly's calling about?
Yeah, so Kelly says patient care It takes a ton of coordination as you can imagine between lots of different people and teams and she's really feeling like the Communication among all these people and teams is really suffering right now I work in a place where you've got doctors you've got nurses you've got a whole bunch of people and sometimes there's really poor communication and It beats to resentment and animosity and Ultimately it comes down to Quality of patient care if the people who are making life altering decisions for these people are not all on the same page These people aren't going to receive good care and it's going to be extremely frustrating and I just I want to know how to help foster an Environment that that can be overcome Well patient care I mean over the last two years.
This is the most important Industry on the planet and so I look forward to Diving in and finding out how do we fix Communication problems that could have real health outcomes.
Yeah, I mean communication is it's a universal problem in organizations Made more difficult by hierarchies which we sometimes have to put in place particularly in environments with high stakes Outcomes and some super motivated to try to be useful here.
I'm super excited as well Kelly, thank you so much for doing this with us of course.
Thank you for reaching out to me Yeah, we're really we're really thrilled.
We're really thrilled and let me start there with What would make this conversation most useful to you?
So I were gonna unit where lots of the patient population that I have they are cardiac specific patients in the hospital I work at they are the sickest people I can work with without being in the ICU so the issue that I really have is that You've got doctors got nurses you got nursing assistants and then like X-ray text and Flabotomus just all these different teams and everyone needs to work together to be this cohesive group But a lot of the time the nurses end up being the middle man for everybody and they're trying to manage their own specific things and Really just poor communication is what it comes down to specifically between nurses and doctors that leads to poor patient outcomes Ultimately When you think about where communication is breaking down most frequently Is there a specific level or is it happening at all of these levels?
I think it happens at all levels.
There's also often a disconnect if you have a patient's who has different teams consulting you know whether that's the Heart failure team and we have a surgical team and we have an infectious disease team and all of these people might be consulting on a patient and Someone's putting in orders from one team But the team I'm supposed to talk to about this patient specifically who's managing their care Is not aware of what's going out of not aware of these orders changing so communications between those different teams is really important That sounds like a really complicated issue.
Can you give us an example of how this shows up?
I had a patient once who they put in that she couldn't eat anything she couldn't drink anything Which usually means someone's gonna go for a test some type of test some type of procedure and I went to the doctors and I said what are we doing and There's one attending I've had who he said I have no idea Let's go talk to the patient together, which is a very earth shattering thing for an attending to do he has my utmost respect So we went and talked to the patient together and found out a whole different team put in that order had planned for a test Not communicated that to the patient and she was very anxious about going for any type of procedure And so things like that can really increase a patient's anxiety when there's a doctor somewhere in hospital putting in orders for this patient and not telling them What it is that they're getting Francis before we jump into Figuring out this problem and how we can make progress if you were gonna do it somewhere of what you're hearing is the Problem where does your beautiful operations mind go That I do think that the diagnosis that it's a communication problem is right I would say that part of the communication is transparency So why are we doing it?
And I think if the patients knew why if you knew why so that's one part of it And then the other part of it is the let's make sure one one person says it we all hear it Right, so I think there's a breakdown in the number of people that are hearing and I think there's a breakdown on Transparency and so the question is that a foster communication in a very complicated system Where you're not at the top of the hierarchy, but how do you do it from the middle and I think Many more of us face that situation than being at the top of the hierarchy All the decision rights How common when you think about the problem with that framing how common is this challenge?
Oh so a phrase that our colleague and friend Amy Edmondson who studies teams she uses a word teaming and Teaming is when a group of people comes together Around a patient, but it could be a different group of people around another patient and another so it's not like there's an intact Team that all covers each one that's inherently more complicated.
I think anytime there's that level of complexity This is going to be at the center of it.
It makes me think in fast moving environments in tech for example when there's fast moving and we're coming together For this or we're coming together for that anytime.
There's a temporary coming together.
I think this applies Mm-hmm And I also find myself thinking about hierarchy here because Hierarchy gives us a lot of comfort in the complexity because you know, there's it's clear who outranks who is is super clear But there are very material trade-offs and one of them is Communication unless the systems are impeccable.
Yeah, I'd probably stunned if hierarchy is part of our solution Alright Kelly back to you.
So first of all before we jump in does does that summary of the problem resonate?
Yeah, yeah, yes, okay. There were moments of light and truth and beauty in some of the relationships between doctors and nurses in this system yeah, and What's happening with those that are distinct from what's happening with the relationships that aren't working?
You know, I work with my older brother my older brother and I work on the same unit We went to nursing school a few years apart and there's one Physician assistant who I work with who he got wind of that my brother and I work together and whenever I work a weekend shift with this provider He's always like are you going to Sunday dinner at your moms with your brother?
Like he just he wants to get to know who I am as a person not just sees me as one of the nurses like he knows me and Whenever I take anything to him and I say hey, I've got this problem with this patient Their heart rhythm is showing this we need to get on top of this made to give them this medication to get ahead of this before things deteriorate He immediately is like yep, I hear what you're saying.
Let me go check on the patient make sure they're okay And then we're gonna do x, y and z to make sure that they're okay And I think that that has so much Strengthened our ability to work together for these patients is that we Know each other as people and not just Another Member of the group.
Yeah, why did this particular relationship have the oxygen For you guys to get to know each other or the space or what happened differently here?
um I think that it's a personally, you know a personality thing I think also that a lot of the doctors a lot of the teams when it comes to Like sitting down and doing their charting and their computer work they go back and hide in an office and He's he's one tool kind of hang out at the nurses station and do a lot of his stuff at the nurses station And there's a lot of chit chat at the nurses station.
That's where we all kind of Talk about our days and see how the others are doing and talk about our lives outside of the hospital And that's where you can learn the oh these two random nurses who work together and are always hanging out or actually siblings Like I think it's just important to To have environments where we're able to get to know each other outside of our jobs as health care workers So I want to start there in the fixable portion I want to start in that sandbox princess if that works for you so One place my head is going is is there a possibility in this system to not rely wholly on the personality and social competence of The physicians for that moment to happen right one thing we learned from academia if I can channel like your freshman year And the awkward ice cream social yeah moment like would it be even structurally possible to introduce some kind of Formality for new doctors like new providers coming on new nurses to say okay Here's what you do in your first week to get to know your colleagues in this system You know, we're gonna make the implicit explicit instead of going back to your room.
We're gonna tell you what to do We want you to do this work out here in the open air where this kind of informal and organic get to know you can happen So let me just get your reaction to that is that it okay And cuz I'm gonna push on it.
I'm gonna push a lot harder if there's any traction there I think I think absolutely that can make a difference for people to get to know each other that way That makes much less of a divide Because here's what we see happen all the time and I'm gonna use my wife who's an introvert total intro I'd be back in with no disrespect I would be back in the office with the light to low with the light to low.
Yeah, if no one told you You have to come interact with the humans your default reaction would be to wander away.
Yes So now for You for me right I would be super energized by like who are my new colleagues.
I'm super curious. I want to get to know them You know, I'm gonna say I'm more likely to be in option a definitely of the of the doctor who finds out sooner or later that you're working with your brother And thinks that's the coolest thing in the world.
I'll work with you for 30 years and not know it right And I'm also more likely to be the human in the system that watches you go to your like enclosed little office space Which I don't have and sit there and do your important work Which you're deciding is more important than mine.
I'm not deciding right I'm more likely to make a negative attribution to that behavior.
You're totally gonna make a negative actry In fact, we haven't even done it and you're making a negative attribution to me right now I'm already mad at you and I haven't even done anything.
I'm not even I'm not even a physician So there is this category of can we shake up this entry moment and say okay This is just what we do on this floor.
We're gonna lower the stakes We're not gonna require approval from the higher ups We're just gonna say this is how things operate on this floor or in this unit is that the first week you're on the job You do the following five things you do your work out here in this open space you have one on one like Rapid dating meetings with all of the nurses on the team.
We're gonna use a different metaphor You go to lunch over the first three months you like go have a cup of coffee With everyone you're working with like pick the five things lower the stakes don't look for anyone's approval Stay within the zone of the things you can control But really go after this variable that you identified that I think is so important and we see happen all the time of the human's the Flood multi-dimensional human beings having a chance to get to know each other as fellow flawed multi-dimensional human beings Right, I would so love to see that happen um I feel like the pushback would be that we don't have time for an ice cream social Um, but I think that if it's going to make communication better The between the nurses and the doctors then I don't think it's that big of a price to pay Yeah, where I would suggest starting is pick one idea that you think is within the realm of possibility in the system and brainstorm with two other people who are as frustrated as you are About you know, what could we do proactively to introduce one element That creates the space and structure where this thing that's so important that we're relying on organically spontaneously Person you we're relying on the personalities of the physicians, which is random and out of our control Can we introduce a little bit of of structure and control into this scenario And if you don't have the power To introduce such an idea To figure out who do you think would be the most likely ally in the system and could you use their power to do something like this right Hold that thought we'll be right back after this quick break I I love the diagnosis that when you're given a great personality and somebody with great Social competence.
This isn't an issue, right?
So the issue is when the when the physicians don't have either the personality or and or the Social competence.
So I love the narrowing down there.
And what do you do? So what we just heard is something you can do by giving a secret memo to the doctors like telling the doctors what to do I want to look at it from what can you do?
So it doesn't require telling someone else But what might you do and here's what comes to mind to me?
How might you welcome them?
So you know, I mean Assign like Welcome, Francis.
Welcome Francis on your you know first day on the floor Uh, we're thrilled to have you like so instead of relying on their noticing our humanity We're gonna notice their humanity I love the whole structure But my mind and you can say which one is better my mind is what can you do with superior personality and social competence?
And this is talking to someone who's on the inferior personality and social competence side And so that's that would that would be the only thing I would add to it And my wife loves a good competition So she's gonna I'm gonna want to know which one you like she's gonna frame us as an either or But I think there's a actually quite a beautiful blend Where you're still accomplishing this goal of creating the space for our shared humanity You're just doing it in this beautiful form where you have total control This is a nurse driven initiative And it's really centering and celebrating the the physicians And I I love your example Francis and these are small things that I'm hearing you propose totally small You know small bits of welcoming bits of welcoming like let me show you around the floor like you know Making that a meaningful moment adding a little bit of time and space and joy to that moment.
I love that. Yeah What's your reaction to that?
So one interesting thing is I've been thinking about this um In a teaching hospital other than like the attendings and some of the doctors who were just like a little bit of below them The residents and the interns the one who's who I'm really interacting with They switch out every couple of weeks if not every week like they'll all get to know them and it's like peace out I'll probably never see you again um And I have I have one co-worker who I watch her Every couple weeks.
There's a new resident on the service and she goes up and she says hey This is my name What's your name?
Where'd you go to medical school?
Where are you from and I have noticed that she does tend to Have better relationships with the doctors because of it and I think that incorporating that into my own practice personally um Would make a big difference for me and I think The informality of your suggestions Francis.
I like that something I can manage With my social expertise energy Yeah I love that Kelly and I just went for the record.
I want to say that Francis has won this round She's gonna want to hear that on the recordings.
So it's please not edit this out And what I so love about this as a focus of your energy is you're back in the zone of things that you have total control over Yes, which is your own behavior Now I am gonna push you To experiment with one or two things That are a little bit outside of your zone of control Because I want to start firing up the muscles of how do I start to influence this larger system around me That could be as simple as You know talking to this colleague of yours and saying first I want to learn from what you're doing I notice it.
I want to do it The other opening that gives you is also can you have a conversation with this one other colleague about things you might do together To make this practice more infectious.
I Kelly, where's your head going?
Yeah, where are you? No, I got more ideas.
We're gonna keep swinging No, I really I really am like miss.
I feel like These are definitely things that I can manage and I'm grateful to have a manager who I feel like I can take these ideas to him and be like hey I want to foster a more cohesive Environment on this unit Can't fix the whole hospital can't fix health care, but I feel like At least maybe the cardiology we can say let's let's make things a little better We've got a lot of moving parts.
These are sick people This is a little thing we can do to maybe improve things worst case scenario We all get along a little bit better like maybe it won't affect patient outcomes But at least they'll make come into work a little less miserable But it might affect patient outcomes right which is where we started this conversation I think is a beautiful frame to bring into this conversation You have observed a really clear pattern that when there's this kind of connection and trust patient outcomes improve and some of those Really powerful stories that you shared where Disconnection and miscommunication got in the way of outstanding outcomes.
I think our beautiful illustrations of what you're trying to achieve here I think that's a it's just a beautiful example and framing for this type of conversation right with someone in the system who does have a little bit more Power than you do.
Yes for sure All right, so how are we doing on the helplessness powerlessness?
We're gonna restore some agency challenge I know I think that going back to work next week.
I'll look at things a little differently with the way I approach Physicians much your first move on Monday morning introduce myself.
Yes. Yes. Yeah I love it.
I love it Thank you so much.
Thank you, and please keep us posted Kelly and say hello to your brother All right Francis.
What do you think about this larger issue of communication breakdowns in organizations?
So if we use this as an example part of a communication breakdown is that we didn't give the why Mm-hmm right so we just didn't give enough transparency that is we just gave you the tip of do this But we didn't tell you do this because of someone so and if this changes do that So the do this putting people into order-taking role is actually gonna require your effort all day every day It's an exhausting way to do it But it feels like less time in any given moment and then the second thing is Process was just shouting to me throughout this whole conversation How do we make sure in a teaming context that when one person says something everyone hears it?
Well word of mouth is okay, but we are really advanced species now Let's figure out a way and perhaps even a technologically enabled way Mm-hmm to do it.
So Transparency and that everyone gets to hear it seemed to me to be the two The two ways there and a lot of the transparency is the why Yeah, I was thinking about where you started your academic career in operations and that the outcomes here where there is Reliable miscommunication.
There's a reliable breakdown in communication is entirely 100% predictable based on the way the system has been designed And but because of the way it's designed where there's such a scarcity of time and And space for the operators within it to actually reflect this problem is not being surfaced and it's not being dealt with and The system is relying on the kelias of the world to make incremental progress when it's begging for Really a top-down solution to meet the the warriors in the middle Who are working working bottom up?
Yeah, and so if this were the person with a different Perspective on this calling in Giving them the fix to that would actually be straightforward It's organizations that surface problems that have faster rate improve it have faster rate full stop and what's happening here is that problems are getting sublimated And what I mean by that is that when problems aren't surfaced when we push them down We have no chance of improving and so we want to Elevate problems and and enjoy the experience of elevating problems because those problems when surfaced are Precisely our improvement opportunities and the more problems that are surfaced the faster we improve Amen And so it would be super fun to talk to that person hopefully if you're listening call All right, that's it.
That's our show Thank you all for listening and for being part of this We want to hear more stories.
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Thanks everyone You Fixable is brought to you by the Ted audio collective it's hosted by me Francis fry and me and Morris This episode was produced by Isabelle Carter Our team includes Isabelle Carter Constanza Gallardo Lydia Jean-Cott grace Rubenstein Sarah Nix Jimmy Gutierrez Michelle Quint Corey Hageham Alejandro Salazar Ban Ban Chang and Roxanne Highlash Ben Chino is our mixed engineer We'll be bringing you new episodes of fixable every week So please make sure to subscribe wherever you get your podcasts and also please leave us a review particularly if you like the show See you soon
