Thursday, February 8, 2018

Healthy Organizations

This week we were asked to complete a couple of self-surveys. To be honest, I didn’t feel like either were true to who I am on these subjects. However, I am more closely associated to the Thomas-Kilmann style that I resulted into. The Anger assessment showed me split between a spewer and a leaker. I felt like neither of these really fit, I am not explosive, nor am I passive aggressive. I am somewhere in the middle. I think this test has missed the boat with me. That is alright though. I get that some people do fit into those categories. In the Thomas-Kilmann quiz, I was shown to be compromising, which fits better, though I admit to being a problem solver as well. I am always looking to find common ground, it helps to get to “yes”. However, I have a rule that if I am going to complain about something I dislike or find unfair, I offer a solution. I don’t think it has to be THE solution, but a solution jumping-off point. I want to show that I know I am in disagreement, but am open to finding a new way. I am not a griper just to gripe. I think this is one of the reasons that I am not a fan of having the split anger score. It makes me feel like this…


Healthcare relationships are so important. We don’t actually know who or what we are dealing with. Non-compliance can be a result of being obstinate, ignorant (in the literal sense), or circumstance. Dave Moen (2009) spoke from the heart on this subject about seeing the person, hearing what they are saying, and not alienating them from their own care. When he saw the woman, whom he knew was being abused, he recognized her shame. He knew that he needed to ask her about what she needed rather than lecture her (that didn’t turn out well for him the first time). That woman was able to feel comfortable and she was helped. If she didn’t feel comfortable, she would have shut down, and may have left. I have seen this in my practice in many versions. The one that stands out in my mind and heart, is one that has shaped my beliefs.

I had a family who brought their 4 week old daughter in to our hospital, because she had been sick and had a fever for several days. We all know that a newborn with a fever is no bueno. By the time the family brought their baby in, the baby was full-on septic. I was the nurse taking care of this baby when she began to deteriorate further. I called a rapid response, and the baby ended up being transferred to the PICU. I will never forget watching the providers tell this family that the baby was very sick and might not survive. The mother was sobbing, doubled over in her sorrow and guilt the dad was stunned, holding his wife and staring into space. You see, this family had waited to bring their baby in on purpose; they were in the US illegally. Because of their fear of being deported, they held back on the treatment of their newborn. The baby did not make it. I will never forget this story. Not ever. We often shake our heads and say things like “Why would you wait to bring in your baby?” or “Well, you can’t fix stupid”. The fact is, we needed to look at that family and say, “we want to help your baby, please tell us how long she has had a fever.” We need to see their humanity and not mistake their fear for ignorance or stupidity. We needed to give them grace.

Patient experiences are as unique as the patient. I often think of my dad when I think of unique patients. Fred Lee (2006) spoke of how we can put our patients at ease. My dad kind of forced his nurses/Dr’s to put him at ease. Even after several rounds of unsuccessful Chemo, when he filled out his patient forms, under “Questions for the Dr” dad would pick a theme “Why do we drive on a parkway and park on a driveway?”. These things are what made those tough conversations easier. It put him at ease when they laughed and joked about whatever his topic of the week was, he loved to make people smile and laugh. It allowed those providers to give that special customer experience. I agree that we need to do better at putting to rest the fears of our patients. Some patients are easier to engage than others, but that is a challenge that we all face with each interaction we have.

Speaking of crucial conversations…and millennials. Those two topics are kind of blended in my mind currently. I feel like I have had more conversations on the importance of communication lately with millennials. Communication is the key, to…well… it all. Without effective communication we don’t know where the other is coming from, or where we want to go. I had a young woman interview for a job opening last week. She was planning on starting nursing school in the fall and informed me “Well…they say I can only work until I start nursing school, then I have to quit”. This is a topic that I find very amusing. Let me give you a glimpse of my perspective. I went through an accelerated nursing program, while being a single mom, and working full time. Boom…mic drop.

I feel like more people these days want to do their own thing, on their own terms. So why would being told that they HAVE to do something mean they would/should start doing it now? If they WANTED to work and do school, they would. I also find that they have a thought processes that they deserve to be hired without experience, because….well, they just do. More times than I can count, I have heard nursing students lament to me over “not getting interviews because ‘they only hire from within’”. My response is usually “well go get in”. When they say “we can’t work and go to school” I give them my history. They usually look at me blankly and say “why did you do that?”. I always respond “I wanted to work here, I knew people here, and I never had to work nights, because I was already here”.  It usually takes some time to sink in.

Back to my interview last week. I had the opportunity to have a conversation with this young nurse-to-be. She looked at me and said “So, you think work ethic is more important than school?” I told her “I think work ethic is more than a good GPA, it shows your level of commitment, not your level of regurgitation.” As she left, I realized that I had just described emotional competence as a value over strictly IQ. I also realized as I was going over presentations that this is why it is important to de-toxify my team when the emotional competence level is low. It all blends together. This is our chaos model. 


-Joleene
References

T. (2012, August 09). The future of patient-centered care: Dave Moen at TEDxUMN. Retrieved February 06, 2018, from https://www.youtube.com/watch?v=hUsyuloD198

T. (2011, April 06). TEDxMaastricht - Fred Lee - "Patient Satisfaction or Patient Experience ?" . Retrieved February 06, 2018, from https://www.youtube.com/watch?v=tylvc9dY400

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