We know what needs to be done, so why are we not doing it?
Healthcare has no shortage of measurement and data points informing hospitals and care providers of the challenges to their delivery of care. As an industry, we have acquired a vast wealth of data concerning the patient experience which reflects back to care providers the patient's perception of their care.
This point was driven home this past week in Boston, MA at The Patient Experience Symposium by Denise Wiseman in a panel aptly titled "Why a Ruckus is Needed to Transform Healthcare". Wiseman, a self-proclaimed "ruckus maker" herself, opened with the thought-provoking observation that the publicly reported HCAHPS scores which hospitals use to measure patient experience "have not made positive national improvement since 2016. Regardless of the growth in the number of PX professionals, the addition of CXOs, extensive surveying, many consultants, and overall expenditure of time, money, and resources."
A similar theme was echoed throughout the conference as speaker after speaker heralded the idea that the status quo was not acceptable, behaviors and processes must change, and that trust must be at the core of the experience. Trust. If we are to create real improvement in healthcare, we have to start with creating a space where those doing the work feel empowered to make "discretionary effort", a term used by speaker Rick Evans of New York Presbyterian.
In the same vein, in the LinkedIn newsletter "Let's Make A Ruckus", Wiseman recently asserted that what it will take for the needle to move is "the courage to step out of our comfort zones and embrace calculated risks, even if it means risking failure."
This quote encapsulates an essential component that distinguishes a highly effective team from a mediocre one: the fostering of a psychologically safe environment. In a world where competition is rife and the pressure to perform is omnipresent, stepping out of one's comfort zone becomes not just an act of individual courage but also a test of the collective emotional climate within a team or organization.
This article explores inter team communication in healthcare, why it matters, and how to foster it.
INTRA VERSUS INTER RELATIONAL DYNAMICS
Within a work environment, employees have two converging relational dynamics. One, the intra relation, is to the work itself. This is the concept often referred to as "employee engagement". The employee's own relationship with the job they do, their commitment to it, and the intrinsic reward value they derive from it.
The other relational component is among those with whom the work is done. Inter relational dynamics refer to an employee's interactions with other team members.
In an organizational setting, these intra and inter dynamics can also be used to define and observe relational communication among teams and departments. Intra team communication is the sum total of the interactions within a single department or work group. Inter team communication occurs across departments and with others outside of the work group.
In each case, whether within a single team or across departments, inter team communication is the foundation upon which psychological safety and collaboration are built.
WHY INTER TEAM COMMUNICATION IN HEALTHCARE MATTERS
At first glance, "psychological safety" might seem like a buzzword, a nice-to-have that could easily be buried under the pile of pressing tasks and tight deadlines. However, multiple reports affirm its value.
"Annual Perspective: Psychological Safety of Healthcare Staff", an article published by the Agency for Healthcare Research and Quality (AHRQ) in March of 2022, determined that the ability to speak up without fear optimized care by increasing overall safety. In short, when people are willing to speak up, outcomes improve.
Speaking up to voice an unpopular opinion, question a process, or offering a new solution to an operational challenge are all acts of courage. Environments that foster courageous inter communication are a potent force.
The idea is simple, yet profound: When people feel safe, they are more willing to take calculated risks, to innovate, and to admit when they don't know something or have made a mistake. They possess "the courage to step out of their comfort zones," not because they are sure of success, but because they are not afraid of failure. They trust that their environment is forgiving of mistakes and receptive to learning.
Creative problem solving and effective decision making are hallmarks of teams with strong inter relational group dynamics.
THE COURAGE TO FACE FEAR AND FAILURE
Stepping out of our comfort zones to embrace calculated risks often begins with what we say and how we say it. The act of speaking up—whether it's sharing an unconventional idea, flagging a concern, or admitting a mistake—is a form of risk-taking.
In environments that lack psychological safety, people would rather hold back their thoughts and questions, avoiding the potential for criticism or judgment. The absence of these insights and queries, no matter how seemingly insignificant, can result in a costly collective ignorance.
Supportive communication provides the bridge between individual courage and collective psychological safety. It encourages the 'speaking up' culture and provides the soft landing for those who do venture to step out of their comfort zones.
Coincidently, the same conditions are needed to develop a healthy data culture. Intellectual curiosity, innovation, and iteration require a space to try, to possibly fail, and to try again.
CULTIVATING A PSYCHOLOGICALLY SAFE SPACE
It's crucial for leaders and team members alike to understand that psychological safety doesn’t emerge out of thin air. It is cultivated through deliberate actions and consistent communication behaviors. These range from the simple acts of acknowledging and validating other people’s contributions, to more complex behaviors like demonstrating empathy and active listening.
In the sections to follow, we will delve into key principles of supportive communication that help in fostering psychological safety within a team. These principles are not just theoretical constructs but actionable steps that can transform the very DNA of your team’s culture.
DEFENSIVE VS SUPPORTIVE COMMUNICATION BEHAVIORS
In a supportive climate, team members encourage each other, care about each other, and treat each other with respect. On the other hand, a defensive climate emerges when members try to control, manipulate, and criticize each other. If the inter team communication is defensive, members prioritize protecting themselves from further psychological assault over the goals of the group. If your goal is to improve the patient experience, it cannot flourish in anything other than a supportive climate.
The following are examples of supportive and contrasting defensive communication behaviors.
Evaluation vs Description
Evaluation fosters defensiveness through the use of “you” language. Judgment and disapproval are indicated through words and tone of voice. “That’s a pretty dumb idea!”
Description minimizes defensiveness by seeking to understand the other’s point of view without making the other person wrong: “Tell me more about how your idea would work.”
Control vs Problem Orientation
Control is an attempt to dominate or change a person by insisting that things be done your way: “I want to do it this way, so that’s what we’re going to do.”
Problem orientation is an honest attempt to search for the best solution without having a predetermined idea of what the solution should be: “What ideas do you all have about how we might solve this?”
Manipulation vs Assertiveness
Manipulation is an attempt to use ambiguous or deceptive communication to achieve your own goals: “Don’t you really think that it would be better if we did it this way?”
Assertiveness is reacting honestly, openly, and freely: “I really like that, and here’s something else we could do….”
Indifference vs Empathy
Indifference is having little to no regard for the feelings or welfare of other group members: “We don’t have time to hear about your job issue right now; we have work to do.”
Empathy is communication that demonstrates, through word and action, care and concern for others: “You’re having an issue with your job? Is everything okay? Is there anything we can do to help?”
Superiority vs Equality
Superiority is communication that maximizes power and status differences by pulling rank: “Well, I am your supervisor, I believe I can make the final decision about how we do this.”
Equality communication minimizes power differences by treating all members of the team equally: “I know that I am your supervisor, but the solution belongs to everyone on the team. Don’t give my ideas any more weight than anyone else’s.”
Certainty vs Provisionalism
Certainty is dogmatic, know-it-all communication that indicates no debate is warranted because your way is the correct one: “I know exactly what we ought to do here, so I’ll take care of it.”
Provisionalism is being open to considering other’s suggestions fairly by being tentative in expressing your own opinions: “I have an idea I think might work….”
Healthy, supportive inter team communication in healthcare is necessary to cultivate the trust that leads to viable changes in the delivery of care. In the end, the courage to step out of one’s comfort zone is not merely an individual attribute but a collective asset. By leveraging supportive communication, we can make it easier for every team member to take those calculated risks that drive innovation, learning, and growth.
Just as importantly, we create an environment where everyone feels heard, valued, and, ultimately, safe. Courage and communication, it is a transformational combination.
Roseanna Galindo, ECBA, CAVS
Roseanna Galindo is Principal at Periscope Business Process Analysis and a champion for data literacy, the human experience in healthcare, and leaders of volunteers everywhere. Learn more about Roseanna and her blog, The Periscope Insighter, by reading the opening post, Venn The Time Is Right