Archive for May, 2010


Case Study: Difficult Conversation Between Peer-Level Teams.

Tuesday, May 25th, 2010

I had a conversation this past week with a physician/administrator who needed to address an on-going problem with another team. Here’s the email she was planning to send:

“Hi guys,

There was a patient last night [ who was transferred to our unit without you briefing us on the case ]. If you would like help in managing these cases, you need to page us. It’s not acceptable or safe to expect the nurse who wasn’t present for the case to try to relay the message of what happened and what needs to be done. In general, if you want us to see any of your patients we would appreciate a page, but especially when there are unstable patients or urgent situations. If you call the central operator (x-xxxxxx-x) they can promptly connect you to us.


Based on the facts, she seemed to have a reasonable position. Also, this was not the first communication on the subject, so there was a certain amount of frustration on her part, which I think you can hear in her note.

But, to me, her email had real problems. It was antagonistic, judgmental and condescending, even calling into question the other team’s commitment to patient’s safety. Bottom line, if I had received the note, I would have felt attacked and likely dug in my heels, and been even less open to anything she had to say in the future. In other words, her note would have had the opposite effect of what she wanted.

As we talked about the situation, it seemed to me the biggest problem was the tension in their work relationship. I didn’t feel she was going to be heard on her main points until she first addressed that reality. In addition, I thought the points themselves would be more effective if presented in a more inclusive, respectful, and non-confrontational way. Here’s what we came up with as an alternate: (more…)

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