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Crucial Skills Newsletter Volume 4 Issue 5 - Confronting Medical Mistakes - Crucial Conversations

About Crucial Skills Newsletter Volume 4 Issue 5 - Confronting Medical Mistakes

Previous Entry Crucial Skills Newsletter Volume 4 Issue 5 - Confronting Medical Mistakes Feb. 10th, 2006 @ 07:45 am Next Entry
  • News: Silence Kills One-Year Anniversary
  • Call for Stories: Before and After
  • Q&A: Confronting Medical Mistakes
  • Crucial Applications
  • Where Can I Learn More?
  • Contact Us
  • NEWS
    "Silence Kills" One-Year Anniversary

    VitalSmarts will today release new data from leading healthcare organizations across the U.S. which demonstrates that being skilled in holding seven specific crucial conversations has a disproportionate impact on quality of care, patient safety, and employee engagement.

     Organizations including Intermountain Healthcare, Sutter Health, St. Jude Children's Research Hospital, Spectrum Health System, MaineGeneral Health, and others have used Crucial Conversations training to drive dramatic improvements in patient safety, quality, and work environment.

    Selected results from MaineGeneral Health related to employees' willingness to speak up:

  • 88 percent improvement when they see someone take a dangerous shortcut
  • 107 percent improvement when they see someone show poor initiative
  • 83 percent improvement when they are concerned about someone's competency

    For more information, read the full press release, "Silence Kills, Dialogue Heals," online.

    Before and After: Call for Success Stories

    Have you turned around a negative situation (whether it was a failing marriage, business, personal relationship, etc.) by using your Crucial skills? We want to hear about it.

    E-mail us your stories.

    The winner may get his or her story published in an upcoming Before & After column and will receive a free Crucial Conversations Audio CD Companion, as well as a signed copy of one of our bestselling books. Please include your contact information (name, address, e-mail, phone number).

    See our complete submission guidelines online.


    Crucial Conversations
  • 2/21-22 Toronto, ON
  • 2/28-3/1 Irvine, CA
  • 2/28-3/1 New York, NY
  • 3/7-8 San Francisco, CA
  • 3/21-22 Miami, FL
  • 3/21-22 Houston, TX
  • 4/4-5 Washington, DC
  • 4/18-19 Portland, OR
  • 4/25-26 Los Angeles, CA
  • 4/25-26 Minneapolis, MN

  • Crucial Confrontations
  • 2/7-8  Washington, DC
  • 3/28-29  Irvine, CA
  • 3/28-29  Chicago, IL

    Crucial Conversations
  • 2/8, 9:00-10:00 AM MT Silence Kills Anniversary: Creating Cultures of Safety
  • 2/8, 11:00-12:15 PM MT  Overview
  • 2/16, 11:00-12:15 PM MT
    Healthy Work Environment for   Healthcare
  • 3/9, 11:00-12:15 PM MT  Overview

    Crucial Confrontations
  • 2/15, 11:00-12:15 PM MT  Overview
  • 3/16, 11:00-12:15 PM MT  </b>Overview

    Register today by contacting your VitalSmarts representative by calling 1-800-449-5989 or by clicking here.
    Questions, feedback, or information you would like to see? E-mail us at editor@vitalsmarts.com.

    Submit your question online to the authors of Crucial Conversations and Crucial Confrontations.

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    "If there is any great secret of success in life, it lies in the ability
    to put yourself in the other person’s place and to see things
    from his point of view—as well as your own.."
    – Henry Ford

    Confronting Medical Mistakes

    About the Author

    Joseph Grenny is coauthor of the New York Times bestseller, Crucial Conversations: Tools for Talking When Stakes Are High.more

    Dear Authors,

    Working as a respiratory therapist, I frequently notice common, yet avoidable, mistakes that can cause major issues if not resolved.

    One of our daily tasks as a Respiratory Team is to check the oxygen of all patients in our areas of the hospital. Frequently, I find problems.

    There are two specific instances that come to mind. Both times I entered the room to find the patient's oxygen saturation low. I immediately turned up the oxygen only to find that the poor saturation was due to employee error. One patient's tubing was sitting on the floor, left there from when he had gotten up to walk laps. The other patient's tubing was plugged into the air outlet in the wall, so the patient was getting only room air, not oxygen. The outlets are clearly marked—oxygen is green and air is yellow.

    Both instances could have been prevented had the nurses paid better attention. I didn't confront the nurse taking care of either patient because I felt like my emotions would have caused me to say something I would have regretted later. Had I not done oxygen rounds at that time, I wonder how long it would have taken someone else to notice that there was a problem.

    How can I appropriately confront people I work with without causing an uncomfortable situation? I believe my patients deserve better care.


    Dear Unplugged,

    First of all, let me acknowledge you for even asking this question. Our Silence Kills study of healthcare organizations across the U.S. found that 84 percent of healthcare workers regularly see things like you've described. And yet fewer than one in ten speak up about it.

    And here's the first point I'd like to make: the biggest reason people don't speak up is that they believe it is not their job to do so. This belief is a critical problem we must solve in healthcare if we are ever to make significant improvements in patient safety and quality of care. Why? Because our research shows that the best healthcare is delivered in organizations where anyone can speak up to anyone who would benefit from feedback. So, thank you for recognizing that you have a responsibility to speak up about the problems in your hospital.

    Let me share with you four pieces of advice that might make speaking to your colleague easier:

    First, master your story. You were self-aware enough to realize that speaking up when you were angry or offended may not have been productive. Now it's important you realize that your upset emotions were something you produced. You were not angry because coworkers made obvious mistakes. You were angry because of the story you told yourself about why they made those mistakes. You may have quickly judged, for example, that they did it because they were stupid, or lazy, or thoughtless, or all three. This is a common thing we do when others let us down—we leap to judgments and conclusions that escalate our emotions and make us less effective at confronting problems.

    The first thing you need to do before speaking up is try to see how a reasonable, rational, and decent person could have made such a mistake. You may, for example, consider that the nurse may have been distracted or called away while trying to reconnect the tube, or he or she may not have been trained sufficiently, etc. Does this kind of mental redirection mean you'll tolerate the mistake? No! It just means you'll approach the others involved as reasonable people who deserve understanding and civility. If you approach them as anything less than this, they are likely to respond defensively and you'll be ineffective.

    Second, create safety. Contrary to popular belief, the person you are about to approach is not destined to become defensive. Most people believe that anyone who is confronted about a mistake will become defensive. This is largely incorrect. People don't become defensive because of what you're saying to them; they become defensive because of why they think you are saying it. The problem is not the feedback. The problem is the lack of safety. Help others feel safe by assuring them of your positive intentions and of your respect for them—in a truthful and appropriate way.

    For example, you might start with a show of respect by asking permission before offering feedback: "I know I'm not a boss here or anything, but I noticed something with one of your patients that I think you might want to know about. May I tell you about it?" Then reassure them of your intentions and respect, "I'm sure I miss things now and again and I hope you'd return the favor if you ever notice. I also don't want to be presumptuous or act like I'm perfect at everything. But I noticed that . . ."

    Next, share the facts. Many people make mistakes in giving feedback by mixing their judgments or conclusions with facts. This is because they may, without even realizing it, have mixed motives. They want to give helpful feedback. But they also want to express irritation and punish the other person for creating the problem to begin with. Strip away that motive entirely and focus on the facts.

    Here's what not to say: "You were a bit careless in reattaching the patient's oxygen tube. You should know that the green is oxygen and the yellow is regular air." Instead, try, "When I was making oxygen rounds I noticed two of your patients whose oxygen levels were low. I became concerned and found that one of them had detached oxygen tubing and the other's tubing was connected to the yellow air outlet rather than the green oxygen outlet."

    Finally, invite dialogue. If you've gotten your emotions in check by checking your story, started with safety, and then shared the facts, odds are the other person will be listening reasonably well at this point. The final thing I'll advise you to do is end with a question that encourages open dialogue. For example, "Can we talk about what might have happened?"

    Obviously a great deal might go right or wrong from this point forward, but if you continue to approach things in a safe and respectful way, while being honest in sharing your opinions, you are likely to have a positive impact. And if you encourage more people to do the same, you'll be well on your way to having a positive impact on quality of care in your hospital.

    Best of Luck,

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    For Patients: Turn Worries Into Words
    By Joseph Grenny

    A VitalSmarts survey found that of 150 patients who experienced problems or mistakes in their healthcare, fewer than half stepped up to the crucial conversation at the moment it could have made the greatest difference. Unfortunately, the times patients need to speak up most are also the times they usually feel least equipped to do so—when they're worried, irritated, or upset. The most common reason people keep quiet is that they worry about being seen as "problem patients" or about offending the caregiver. So, next time you're a patient, what should you do? Set a goal now to speak up when it matters most and do so in a way that leads to better outcomes. Here are five tips to make sure you get the best healthcare:

    Listen to your emotions. Your emotions are clues to your thoughts. When you feel worried or upset, it's often a sign that you're uncomfortable with what's happening. This is the time to stop, slow down, and prepare to speak.

    Take the lead. Remember that you are the expert about what's happening inside you. Realize that you have important information about your past experiences and your current symptoms that your medical professional desperately needs to make informed decisions. You are the expert. Don't assume the caregiver knows everything.

    Show respect. Don't worry about offending your doctor or nurse by speaking up. They won't be offended if you show respect for their expertise and professionalism. Before describing your concerns, start by affirming this respect. For example: "I'm grateful for your attention to me and want you to know that I value your experience and skill in treating me. I also have a concern that I'd like to share." Then share the concern.

    Share the facts. Caregivers have a hard time with vague statements like, "Are you sure that's right?" or accusations like "I don't like the way you're talking to me!" Stop and think about what's happening that is making you uncomfortable. Look for the concrete facts that will help the caregiver understand clearly what is bothering you. For example, "The last time I took this medication I was given a white tablet to take twice a day. This time it says four times a day and it's a yellow tablet. That has me worried."

    End with a question. Show once again you are interested in the professional's point of view by ending with a question. "Is this correct?" or "Why should I not be worried here?"

    For more details visit www.SilenceKills.com.

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