Q: What kinds of factors lead to fear in a healthcare setting?
Dr. Wyman — In most hospitals, the nurses will tell you, this is really a doctor-run organization, and the doctors will tell you, this is really a nursing-run organization. The question is who's really running the organization. People feel powerless and there's a lack of trust. Because of that, there's fear running rampant through operating rooms.
Q: Is that the "cycle of fear" you sometimes refer to?
Dr. Wyman — The cycle of fear is that it's human nature to make assumptions about people's actions. We don't really see reality. We see our interpretation of reality. We assume we know people's motives, but we don't. And unfortunately we often attach negative emotions or ulterior motives to people's actions and respond accordingly. Then that person sees you respond in a negative fashion, and they start having negative thoughts, and that cycle just keeps spinning.
People always say patient first, but I think patients come second. I think it's about your employees.
Q: How can you break that cycle?
Dr. Wyman — You have to spend time together working as a team. This is something we don't do well as organizations. Departments of surgery have their own meetings, and departments of anesthesia have their meetings, and nursing has their meetings, but when does everybody ever get together to talk and practice as a team? We've known for 20 years that it's all about teamwork. But the dirty little secret is that for the most part, people don't operate as teams. For the most part they operate in silos.
Q: Can OR teams be expected to function effectively if they're not on the same wavelength?
Dr. Wyman — We know that when people don't communicate well, errors happen. And sometime they're tragic errors. If you look at all the Joint Commission Sentinel Reports, 99% of them involve failures to communicate. How is that possible in an industry with some of the brightest people in the world? Everybody in the OR comes with good intentions. They all have the patient at heart. But they're all looking at things from their perspectives, and sometimes those perspectives rub against each other. If you don't know how to handle conflict constructively, there's a breakdown in communication and people don't want to talk to each other.
Q: How can you overcome that silo mentality and lack of communication?
Dr. Wyman — Great teams know you have to practice together as a team, because you have to learn how to anticipate each other, you have to understand each other's body language and you have to understand how people are thinking. Great athletes don't practice on their own. They practice as a team. And great musicians practice as a team. The whole point with great sports teams and great orchestras is they work together so they can function effectively as a team. We don't do that in health care.
Q: Isn't some amount of conflict inevitable?
Dr. Wyman — You want to have conflict. Conflict is essential. People are going to have different opinions, but you've got to be able to handle conflict constructively to come to consensus, because in the absence of consensus there's no accountability, and without accountability you're not going to have results.
Q: So what are the first steps toward achieving the results you want?
Dr. Wyman — People always say patient first, but I think patients come second. I think it's about your employees. If your employees are happy and they feel it's a safe environment, and they trust the people they work with, they'll be engaged. And once they're engaged all the other parameters, such as service excellence to patients, quality, safety, finance, growth — all those fall into line. It's a bit of a leap of faith, but I believe that. If you look at really great organizations, it's because people are happy and they feel psychologically safe.
Q: How do get people to feel safe?
Dr. Wyman — There are great programs out there that help people learn how to speak to others respectfully and handle conflict effectively, but you can't just give people a course. You've got to do something on a regular basis. Maybe once a year take your entire OR staff somewhere and work on communication skills, and then maybe come back together as a group once a month and practice, and work through issues, practice doing dialogue. Create scenarios and give people positions and have them work through how to do conflict. It helps to have a facilitator who can provide feedback.
Q: That sounds like a big commitment for a small facility
Dr. Wyman — I think the payoff is going to be phenomenal. In surgery centers, every minute and every dollar are important, but the key is still volume. What's going to help maintain volume? You want to have staff that really enjoy being there. If they feel motivated and enjoy being at work, and they have a lot of trust, and it's a great work environment, the rest will fall into place.