Speaking Up: Finding your voice when it matters most

One of my favourite movies is called “Little Voice”. It’s the story of an extreme introvert whose only outlet is through her exquisite singing. Toward the end of the film she is finally pushed to “speak up” to her selfish, domineering mother who has earned the rage that is unleashed.

Sadly this scene plays itself out (in not so extreme forms) in workplaces everyday. Conflict and debate are ever-present and necessary but the skill, confidence and cultural support to make disagreements productive are frequently absent. And instead of healthy debate there is often silence, or its ugly counterpart - anger.

In the corporate world, the inability to have healthy, respectful debate and to hear all voices regardless of position can result in lack of innovation, longer project timelines, errors and other potentially negative impact on business results.

Now imagine you are a nurse, respiratory therapist or another clinician and the “Little Voice” in you is afraid or unequipped to speak up. Imagine you work with a new team as frequently as every ten minutes in crisis situations. Imagine that the well-being of patients depends on every member of their care team sharing their viewpoint and adding their input to dialogue.

In healthcare, the stakes are high and the ability to speak with conviction can literally mean the difference between life and death.

“Adverse Events” is the term used in hospitals to identify “unintended injuries or complications that are caused by health care management, rather than by the patient’s underlying disease”. In the most recent Canadian study (Baker, Norton, et al) found that 7.5% of patients admitted to acute care hospitals experience an adverse event and 36.9% of those were deemed to be highly preventable.

Find full report at this link: http://www.cmaj.ca/content/170/11/1678.full#sec-7

In the U.S., “current research indicates that ineffective communication among health care professionals is one of the leading causes of medical errors and patient harm.” http://www.ahrq.gov/downloads/pub/advances2/vol3/advances-dingley_14.pd

And the Canadian Patient Safety Institute agrees: “Effective teamwork and communication are critical for ensuring high reliability and the safe delivery of care. Teamwork and communication techniques can improve quality and safety, decrease patient harm…” http://www.patientsafetyinstitute.ca/en/toolsResources/teamworkCommunication/Pages/default.aspx

Recently, Jack and I worked with a group of health care professionals who recognized the need to develop skills to ‘speak up’ when patient safety issues are at stake.

The skills are largely the same ones that we work on with corporate clients:

  • Building personal credibility by networking and developing relationships

  • Demonstrating confidence through body language, voice, and language choice

  • Speaking respectfully but assertively

  • Being present and ensuring everyone’s viewpoint is heard

The urgency in healthcare situations also informs the need for some standardized structure and language that can be easily implemented and recognized. The SBAR and CUS tools developed in the U.S. by the Agency for Healthcare Research and Quality are a few examples.

  • SBAR (Situation, Background, Assessment, Recommendation)

  • CUS (I am Concerned, I am Uncomfortable, This is a Safety Issue)

At our last workshop with healthcare practitioners from across Canada we had an ‘aha’ moment when one person asked us…”what if I do all this and they still don’t listen?”

Of course, giving people the skills to speak up is only half the equation. The rest needs to be built into the system:

  • Hospitals must work to shape cultures that encourage people to speak up, to respect everyone’s opinion, and truly listen to each other and their patients with empathy.

  • The training to develop communication skills and instil common and clear language must start early in every clinician’s schooling and be refreshed on a regular basis.

There is no place for “little voices” in healthcare.

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