How to Be a Better Human - Fixable: “How do I deal with a communication breakdown?"

Episode Date: July 3, 2023

This is an episode of Fixable, another podcast from the TED Audio Collective hosted by Anne Morriss and Frances Frei.Kelli is a nurse at a leading teaching hospital where communication issues are not only leading to resentment – they could also be affecting patient care. After hearing from Kelli about the larger problems at play in the healthcare space, Anne and Frances discuss the link between communication and transparency and guide Kelli into taking matters into her own hands. This is an episode of Fixable, another podcast from the TED Audio Collective hosted by CEO and author Anne Morriss and Harvard Business school professor Frances Frei. If you want to be on Fixable, call our hotline at 234-Fixable (that’s 234-349-2253) to leave Anne and Frances a voicemail with your workplace problem. To hear more episodes on how to fix your work problems, fast, follow Fixable wherever you're listening to this.You can listen to Fixable wherever you're listening to this. Transcripts for Fixable are available at go.ted.com/fixablescripts. Hosted on Acast. See acast.com/privacy for more information.

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Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone XS or later required, charge time and actual results will vary. Hi, everyone. Chris Duffy here. Today, we've got something a little bit different for you. Instead of a new episode of How to Be a Better Human, we have an episode from a new show from the TED Audio Collective that's called Fixable. In each episode of Fixable, business leaders Anne Morris and Francis Fry

together move fast and fix stuff by talking to guest callers about their workplace issues and then solving those problems fast. Both the listeners and the guests are gonna receive actionable insights to create meaningful change in the workplace, regardless of where they sit on the company ladder. I think you're gonna love this show

and I think you're gonna really enjoy this episode, which you're about to hear. If you do enjoy it and you want to hear more, you can find Fixable Now wherever you're listening to this. This is a new segment we like to call Anne and Francis's Favorite Icebreakers. We do a lot of work with teams, and we try to get them to start communicating honestly very quickly. So we think a lot about what are the questions at the beginning of meetings that's really create an environment people can have an honest dialogue. A low stakes one I often use

is tell us about a piece of art that means something to you. Oh, good. I'll tell you the one that moves me the most. And it's a photograph that our dear friend Emmy took when she was visiting us. And our oldest son was two or three. On the weekend, we took him to the classrooms at the Harvard Business School. Not break into the classroom. Not break in. I mean, it's really an overstatement. But find our way

into the classrooms, which have just magnificent layers and layers of boards. And we would rearrange the furniture a little bit so that he could stand on it and draw. Such a light footprint. No one ever knew we were there. But there's this one particular picture where he's standing on the desk that's pushed up against it and he's drawing and his head is tilted as if he is an experienced artist looking up at the work, like he's appraising it. But we can only see him from behind, but we can see you and I from the side and we're also joining him in, in the gaze. And so all three of us are sharing a gaze and I don't know why it's so powerful to me, but it is my favorite piece of art. So thank you,

Emmy for that. And thanks for letting me think about that. I love it too. me think about that. I love it too. All right. I'm Anne Morris. I'm a company builder and leadership coach, and I'm here with my wife. And that would be me. I'm Frances Fry, and I'm a professor at the Harvard Business School. And you're listening to Fixable. This is a podcast where we work very hard to fix work problems fast. And by fast, we mean hopefully in less than 30 minutes. That's the goal. Many of our listeners know that this has been a dream of ours for years to have a podcast, an excuse to talk to each other.

It's a date. Once a week. I'm so excited to dive in with our first fixable caller. Who is she? Her name is Kelly. She's a nurse in a cardiovascular acute care unit at a teaching hospital. We won't say which one, but it's a very high stakes job, takes a lot of work and a tremendous amount of commitment and generosity. Oh my goodness,

such important work. Do we know what Kelly's calling about? Yeah. So Kelly says patient care. It takes a ton of coordination, as you can imagine, between lots of different people and teams. And she's really feeling like the communication among all of these people and teams is really suffering right now. I work in a place where you've got doctors, you've got nurses, you've got a whole bunch of people. And sometimes there's really poor communication and it leads to resentment and animosity. And ultimately, it comes down to quality of patient care. If the people who are making life altering decisions for these people are not all on the same page, these people aren't going to receive good care. And it's going to be extremely frustrating.

And I just, I want to know how to help foster an environment that can be overcome. Wow. Patient care. I mean, over the last two years, this is the most important industry on the planet. the most important industry on the planet. And so I look forward to diving in and finding out how do we fix communication problems that could have real health outcomes? Yeah. I mean, communication, it's a universal problem in organizations made more difficult by hierarchies, which we sometimes have to put in place, particularly in environments with high stakes outcomes. And so I'm super motivated to try to be useful here. I'm super excited as well.

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Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone Xs are later required. Charge time and actual results will vary. Kelly, thank you so much for doing this with us. Of course. Thank you for reaching out to me. Yeah, we're really thrilled. We're really thrilled. And let me start there with what would make this conversation most useful to you? So I work in a unit where lots of the patient population that I have, they are cardiac specific

patients in the hospital I work at. They are the sickest people I can work with without being in the ICU. So the issue that I really have is that you've got doctors, you've got nurses, you've got nursing assistants, and then like x-ray techs and phlebotomists, just all these different teams. And everyone needs to work together to be this cohesive group. But a lot of the time, the nurses ended up being the middleman for everybody. And they're trying to manage their own specific things. And really just poor communication is what it comes down to specifically between nurses and doctors that leads to poor patient outcomes, ultimately. When you think about where communication is breaking down most frequently, is there a

specific level or is it happening at all of these levels? I think it happens at all levels. There's also often a disconnect. If you have a patient who has different teams consulting, you know, whether that's the heart failure team and we have a surgical team and we have an infectious disease team and all of these people might be consulting on a patient and someone's putting in orders from one team, but the team I'm supposed to talk to about this patient specifically who's managing their care is not aware of what's going on, not aware of these orders changing. So communications between those different teams is really important.

That sounds like a really complicated issue. Can you give us an example of how this shows up? I had a patient once who they put in that she couldn't eat anything, she couldn't drink anything, which usually means someone's gonna go for a test, some type of test, some type of procedure. And I went to the doctors and I said,

what are we doing? And there's one attending I've had who he said, I have no idea. Let's go talk to the patient together, which is a very earth shattering thing for an attending to do. He has my utmost respect. So we went and talked to the patient together and found out a whole different team put in that order, had planned for a test, not communicated that to the patient. And she was very anxious about going for any type of procedure. And so things like that can really increase a patient's anxiety when there's a doctor somewhere in the hospital putting in orders for this patient and not telling

them what it is that they're doing. Francis, before we jump into figuring out this problem and how we can make progress, if you were going to do a summary of what you're hearing as the problem, where does your beautiful operations mind go? I do think that the diagnosis that it's a communication problem is right. I would say that part of the communication is transparency. So why are we doing it? And I think if the patients knew why, if you knew why. So that's one part of it. And then the other part of it is the let's make sure when one person says it, we all hear it. Right. So I think there's a not at the top of the hierarchy, but how do you do it from the middle?

And I think many more of us face that situation than being at the top of the hierarchy. With all the decision rights? Yes. How common, when you think about the problem with that framing, how common is this challenge? When you think about the problem with that framing, how common is this challenge? Oh, so a phrase that our colleague and friend, Amy Edmondson, who studies teams, she uses a word teaming. And teaming is when a group of people comes together around a patient, but it could be a different group of people around another patient and another. So it's not like there's an intact team that all covers each

one. That's inherently more complicated. I think anytime there's that level of complexity, this is going to be at the center of it. It makes me think in fast moving environments, in tech, for example, when there's fast moving and we're coming together for this or we're coming together for that. Anytime there's a temporary coming together, I think this applies. And I also find myself thinking about hierarchy here, because hierarchy gives us a lot of comfort in the complexity because, you know, there's, it's clear who outranks who is super clear, but there are very material trade-offs, and one of them is communication, unless the systems are impeccable. Yeah, and I'll be stunned

if hierarchy is part of our solution. All right, Kelly, back to you. So first of all, before we jump in, does that summary of the problem resonate to you? Yes. Okay. There were moments of light and truth and beauty in some of the relationships between doctors and

nurses in this system. And what's happening with those that are distinct from what's happening with the relationships that aren't working? You know, I work with my older brother, my older brother and I work on the same unit. We went to nursing school a few years apart and there's one physician assistant who I work with who he got wind of that my brother and I work together. And whenever I work a weekend shift with this provider, he's always like, are you going to Sunday dinner at your mom's with your brother? Like he just, he wants to get to know who I am as a person, not just sees me as one of the nurses, like he knows me. And whenever I take anything to him and I say, Hey, I've got this problem with this patient. Their heart rhythm is showing this. We need to get on top of this. We need to give them this medication to get ahead

of this before things deteriorate. He immediately is like, yep, I hear what you're saying. Let me go check on the patient, make sure they're okay. And then we're going to do X, Y, and Z to make sure that they're okay. And I think that that has so much strengthened our ability to work together for these patients is that we know each other as people and not just another member of the group. Yeah. Why did this particular relationship have the oxygen for you guys to get to know each other or the space or what happened differently here? Um, I think that it's, uh, partially, you know, a personality thing. I think also that a lot of the doctors, a lot of the teams, when it comes to like sitting

down and doing their charting and their computer work, they go back and hide in an office. And he's, he's one who will kind of hang out at the nurse's station and do a lot of his stuff at the nurse's station. And there's a lot of chit chat at the nurse's station. That's where we all kind of talk about our days and see how the others are doing and talk about our lives outside of the hospital. And that's where you can learn that, oh, these two random nurses who work together and are always hanging out are actually siblings. I think it's just important to have environments where we're able to get to know each other outside of our jobs as healthcare workers.

So I want to start there in the fixable portion of this conversation. I want to start in that sandbox, Frances, if that works for you. So one place my head is going is, is there a possibility in this system to not rely wholly on the personality and social competence of the physicians for that moment to happen. Right. One thing we learned from academia, if I can channel like your freshman year and the awkward ice cream social moment,

like would it be even structurally possible to introduce some kind of formality for new doctors, like new providers coming on, new nurses to say, okay, here's what you do in your first week to get to know your colleagues in this system. You know, we're going to make the implicit explicit. Instead of going back to your room, we're going to tell you what to do. We want you to do this work out here in the open air where this kind of informal and organic get to know you can happen. So let me just get your reaction to that. Is that it? Okay. And cause I'm going to push on it. I'm going to push a lot harder if there's any traction there. I think, I think absolutely that can make a difference

for people to get to know each other that way. That makes much less of a divide. Because here's what we see happen all the time. And I'm going to use my wife, who's an introvert. Total introvert. I'd be back with no disrespect. I would be back in the office with the lights low. With the lights low. Yeah.

If no one told you, you have to come interact with the humans. Your default reaction would be to wander away. Yes. So now for you, for me, right. I would be super energized by like, who are my new colleagues? I'm super curious. I want to get to know them. You know, I'm going to say I'm more likely to be in option A. You are definitely. Of the, of the doctor who finds out sooner or later that you were working with your brother and thinks that's the coolest thing in the world.

I'll work with you for 30 years and not know it. Right. And I'm also more likely to be the human in the system that watches you go to your enclosed little office space, which I don't have, and sit there and do your important work, which you're deciding is more important than mine. I'm not deciding that. I'm more likely to make a negative attribution to that behavior. You're totally going to make a negative attribution. In fact, we haven't even done it, and you're making a negative attribution to me right now. I'm already mad at you.

And I haven't even done anything. I'm not even a physician. So there is this category of can we shake up this entry moment and say, okay, this is just what we do on this floor. We're going to lower the stakes. We're not going to require approval from the higher ups. We're just going to say, this is how things operate on this floor or in this unit, is that the first week you're on the job, you do the following five things. You do your workout here in this open space. You have one-on-one like rapid dating meetings with all of the nurses on the team. We're going to use a different metaphor. You go to lunch over the first three months. You like go have a

cup of coffee with everyone you're working with. Like pick the five things, lower the stakes, don't look for anyone's approval, stay within the zone of the things you can control, but really go after this variable that you identified that I think is so important and we see happen all the time of the humans, the flawed multidimensional human beings having a chance to get to know each other as fellow flawed multidimensional human beings.

Right, I would so love to see that happen. I feel like the pushback would be that we don't have time for an ice cream social. But I think that if it's going to make communication better between the nurses and the doctors, then I don't think it's that big of a price to pay. Yeah. Where I would suggest starting is pick one idea that you think is within the realm of possibility in the system and brainstorm with two other people who are as frustrated as you are about, you know, what could we do proactively to introduce one element that creates the space and

structure where this thing that's so important that we're relying on organically, spontaneously, we're relying on the personalities of the physicians, which is random and out of our control. Can we introduce a little bit of structure and control into this scenario? And if you don't have the power to introduce such an idea, figure out who do you think would be your most likely ally in this system? And could you use their power to do something like this? Right. Hold that thought. We'll be right back after this quick break. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever,

making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest charging Apple Watch, getting you eight hours of charge in just 15 minutes. I love the diagnosis that when you're given a great personality and somebody with great social competence, this isn't an issue, right? So the issue is when the physicians don't have either the personality and or the social competence. So I love the narrowing down there and what do you do? So what we just heard is something you can do by giving a secret memo to the doctors, like telling the doctors what to do. I want to look at it from what can you do? So it doesn't require telling someone else.

But what might you do? And here's what comes to mind to me. How might you welcome them? So, you know, I mean, a sign like, welcome Francis, welcome Francis on your, you know, first day on the floor. We're thrilled to have you like, so instead of relying on their noticing our humanity, we're going to notice their humanity. I love the whole structure, but my mind, and you can say which one is better, my mind is what can you do with superior personality and social competence? And this is talking from someone who's on the inferior personality and social competence side.

And so that would be the only thing I would add to it. And my wife loves a good competition. So she's going to frame this. I'm going to want to know which one you like. She's going to frame this as an either or. But I think there's actually quite a beautiful blend where you're still accomplishing this goal of creating the space for our shared humanity. You're just doing it in this beautiful form where you have total control. This is a nurse driven initiative and it's really centering and celebrating the physicians. And I loved your example, Frances, and these are small things that I'm hearing you

propose. Totally small, just small bits of welcoming. Bits of welcoming. Like, let me show you around the floor. Like, you know, making that a meaningful moment, adding a little bit of time and space and joy to that moment. I love that. Yeah. What's your reaction to that? So one interesting thing is we've been thinking about this. In a teaching hospital, other than like the attendings and some of the doctors who are just like a little bit below them, the residents and the interns, the ones who I'm really interacting with, they switch out every

couple of weeks, if not every week, like they'll get to know them. And it's like, peace out. I'll probably never see you again. And I have, I have one coworker who I watch her every couple of weeks. There's a new resident on the service and she goes up and she says, Hey, this is my name. What's your name? Where'd you go to medical school? Where are you from? And I have noticed that she does tend to have better relationships with the doctors because of it. And I think that incorporating that into my own practice personally would make a big difference for me. And I think the informality of your suggestions, Frances, I feel like that's something I can manage with my social-

Expertise. Energy. Yeah. I love that, Kelly. And I just want, for the record, I want to say that Frances has won this round. She's going to want to hear that on the recording. So let's please not edit this out.

And what I so love about this as a focus of your energy is you're back in the zone of things that you have total control over. Yes. Which is your own behavior. am going to push you to experiment with one or two things that are a little bit outside of your zone of control, because I want to start firing up the muscles of how do I start to influence this larger system around me? That could be as simple as, you know, talking to this colleague of yours and saying, first, I want to learn from what you're doing. I notice it. I want to do it. The other opening that gives you is also, can you have a conversation with this one other colleague about things you might do together to make this practice more infectious? Right. Kelly, where's your head going? Yeah, where are you?

No, I- Because we got more ideas. We're going to keep swinging. No, I really am like, I feel like these are definitely things that I can manage. And I'm grateful to have a manager who I feel like I can take these ideas to him and be like, hey,

I want to foster a more cohesive environment on this unit. Can't fix the whole hospital, can't fix health care. But I feel like at least maybe the cardiology department, we can say, let's make things a little better. We've got a lot of moving parts. These are sick people. This is a little thing we can do to maybe improve things. Worst case scenario, we all get along a little bit better.

Like maybe it won't affect patient outcomes, but at least it'll make coming to work a little less miserable. But it might affect patient outcomes, which is where we started this conversation. I think it's a beautiful frame to bring into this conversation. You have observed a really clear pattern

that when there's this kind of connection and trust, patient outcomes improve. And some of those really powerful stories that you shared where disconnection and miscommunication got in the way of outstanding outcomes, I think are beautiful illustrations of what you're trying to achieve here. I think it's just a beautiful example and framing for this type of conversation with someone in the system who does have a little bit more power than you do. Yes, for sure. All right. So how are we doing on the helplessness, powerlessness? We're going to restore some agency challenge. I know. I think that going back to work next week, I'll look at things a little

differently with the way I approach physicians. What's your first move on Monday morning? Introduce myself. Yes. Yes. Yeah. I love it. I love it. Thank you so much. Thank you. And please keep us posted, Kelly, and say hello to your brother. Anyway. All right, Frances, what do you think about this larger issue of communication breakdowns in organizations? So if we use this as an example, part of a communication breakdown is that we didn't give the why, right? So we just didn't give enough transparency. That is, we just gave you the tip of do this, but we didn't tell you do this because of so-and-so and if this changes, do that. So the do this, putting people into order-taking role is actually going to require your effort all day, every day. It's an exhausting way to do it, but it feels like less time in any given moment. And then the second

thing is process was just shouting to me throughout this whole conversation. How do we make sure in a teaming context that when one person says something, everyone hears it. Well, word of mouth is okay, but we are really advanced species now. Let's figure out a way and perhaps even a technologically enabled way to do it. So transparency and that everyone gets to hear it seemed to me to be the two ways there. And a lot of the transparency is the why. Yeah, I was thinking about where you started your academic career in operations

and that the outcomes here where there is reliable miscommunication, there's a reliable breakdown in communication is entirely 100% predictable based on the way the system has been designed. But because of the way it's designed, where there's such a scarcity of time and space

for the operators within it to actually reflect, this problem is not being surfaced and it's not being dealt with. And the system is relying on the Kellys of the world to make incremental progress when it's begging for really a top-down solution to meet the warriors in the middle who are working bottom up.

Yeah, and so if this were the person with a different perspective on this calling in, giving them the fix to that would actually be straightforward. It's organizations that surface problems at a faster rate, improve at a faster rate, full stop. And what's happening here is that problems are getting sublimated. And what I mean by that is that when problems aren't surfaced, when we push them down, we have no chance of improving. And so we want to elevate problems and enjoy the experience of elevating problems because those problems when surfaced

are precisely our improvement opportunities. And the more problems that are surfaced, the faster we improve. Amen. And so it would be super fun to talk to that person. Hopefully if you're listening, call. All right, that's it. That's our show. Thank you all for listening and for being part of this. We want to hear more stories. We want to hear from you. We want to hear more stories. We want to hear from you. We want to hear your story. Let us take a swing at fixing your problems together. Email us at fixable at ted.com

or call us at, thank you, Francis, for delivering on the phone number 234-FIXABLE. That's 234-349-2253. We didn't used to have a number that ended in fixable, but that problem was fixable. Like so many. Give us a call. Thanks, everyone.

Fixable is brought to you by the TED Audio Collective. It's hosted by me, Frances Fry. And me, Anne Morris. This episode was produced by Isabel Carter. Our team includes Isabel Carter, Constanza Gallardo, Lydia Jean Cott, Grace Rubinstein, Sarah Nix, Jimmy Gutierrez, Michelle Quint, Corey Hajim, Alejandra Salazar, Banban Chang, and Roxanne Heilash. Ben Cheno is our mix engineer.

We'll be bringing you new episodes of Fixable every week. So please make sure to subscribe wherever you get your podcasts. And also, please leave us a review, particularly if you like the show. See you soon. If you're at a point in life when you're ready to lead with purpose, we can get you there. The University of Victoria's MBA in Sustainable Innovation is not like other MBA programs. It's for true changemakers who want to think differently and solve the world's most pressing challenges. From healthcare and the environment to energy, government, and technology, it's your path to meaningful leadership in all sectors. For details, visit uvic.ca slash future MBA.

That's uvic.ca slash future MBA. The Apple Watch Series 10 is here. It has the biggest display ever. It's also the thinnest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-nest Apple Watch ever, making it even more comfortable on your wrist, whether you're running, swimming, or sleeping. And it's the fastest-charging Apple Watch, getting you eight hours of charge in just 15 minutes.

The Apple Watch Series X. Available for the first time in glossy jet black aluminum. Compared to previous generations, iPhone Xs are later required. Charge time and actual results will vary.