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Case Study: Difficult Conversation Between Peer-Level Teams.

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.

Thanks.”

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:

“Hi guys,

Sorry to have this conversation by email, but there was a situation last night that I think we need to address.

First, I want to say I know there’s been a lot of tension between us, and I am truly sorry for my role in that. I know I don’t communicate as effectively as I should – or would like to – and FYI, I’m going to start working on that. I also want to apologize if I’ve ever given you the impression that I don’t appreciate what you do or respect your work, because of course I do. I think you do a great job, and I know you only want what’s best for the patients – as we all do.

Which brings us to last night. There was a patient [ who was transferred to our unit without you briefing us on the case ].

I know we’ve talked about this sort of thing before, but I just don’t feel it works 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. It makes things very awkward, and, more importantly, raises real concerns about patient safety. We really need to get that information directly from you, especially when there are unstable patients or urgent situations.

I know it can be difficult to find the time – or even remember sometimes –  to page us, but that’s the only way I know for us to get the information we need. And, by the way, if you have any other suggestions how we can help improve these situations, please let us know. But for now, if you can please remember to page us, that will make a huge difference in our ability to quickly provide the level of care we both want for your patients.

As a reminder, you can call the central operator (x-xxxxxx-x) and they can promptly connect you to us.

Thanks for your help!”

Note that the facts themselves are presented identically. But everything else has a completely different tone. There’s empathy and humility. It calls them all to a common purpose rather than being adversarial. Most important, it addresses the relationship issues first.

The result? One person wrote back and said, “No problem, I’ll try to be better about paging you guys.” The other, more problematic individual said he wasn’t aware of the tension, had never felt a lack of respect, and was very appreciate of the work they did, too. (Nice surprise!) So the email laid the groundwork for them coming together and finding a solution that worked for everyone. Success!

Now, this case was a very specific situation. But I had a couple of other conversations around the same time that each spoke to the same primary recommendation:

In any communication – especially those with tension
involved – make sure you lead with the relationship.

What that means is, whatever state your relationship is in with the other person, address that first before you get to the actual content of your message. If the relationship is tense, as in the above example, talk about that. If it’s fine, just lead with some normal inter-personal conversation. Whatever the situation, tend to the relationship first, then get to the message itself.

Why? Because it’s a great way to be heard. The fact is, the quality of your relationship with someone dictates how open they are to what you have to say.

Think of it this way: The message you want to communicate is like a hot, fresh pizza. You’re the delivery person. The other person is in their house, and the relationship is the door. If the relationship is good, the door opens, the pizza is received. (Yum!) If not, the door stays closed. No pizza. Very sad.

Don’t let those pizzas go to waste! Take the time, plan out what you’re going to say, and as much as possible, lead with the relationship.

Tags: Communication, communication training, leadership, leadership development, leadership training

This entry was posted on Tuesday, May 25th, 2010 at 8:06 am and is filed under Communication. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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