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Code blue: Hospital-patient communications

March 28, 2017

hospital-1806111_1920My dad was released from the hospital today after a month of ups and downs. During that time, my sisters and I spent plenty of moments at his bedside trying to keep track of which specialist was which and how the diagnosis and the plan were evolving daily, sometimes hourly. I thank God that he has come through a life-changing and harrowing experience. At the same time, I’m puzzled at how critical communications are delivered in a hospital environment.

Why do doctors speak to patients during 6 a.m. rounds? Patients are half-asleep, drugged and potentially hearing scary information for the first time. Of course, that’s when the doctors are available, but is it the optimal time for patients? Can patients be expected to make good decisions under the circumstances? They don’t have any family there at that time of day. Who helps people who have a language barrier or a cognitive impairment? Who makes sure they have understood properly?

Why don’t hospital patients receive any written information to refer to later or to discuss with family members? Every communicator knows that people need to receive information several times through different channels before the information can be fully understood and acted upon.

When companies announce layoffs, they do it face-to-face and provide a printed hand-out containing key information. It’s well established that when people receive difficult or shocking information, they don’t hear everything that follows. The brain is overwhelmed with emotion and rationality falls away.

A friend recently told me that when she and her mother accompanied her father to his cancer diagnosis, they left that meeting with three distinct perspectives. Her father was thinking “Shit, I have cancer.” Her mother was thinking “How do we manage this?” Finally, the daughter who works in healthcare, was thinking about the diagnosis and the course of treatment. Cancer patients leave their meeting with a huge binder of information. Where’s the well thought-out, plain-language information and resources for hospital patients?

Don’t get me wrong. I understand that things change very quickly, often dramatically, in a hospital setting and that doctors can’t be bound by a document that could be stale as soon as they leave the room. I understand there may not be time to write everything out for every patient, especially where stays are very short. But surely there can be a solution that takes time, accuracy, resources and liability into consideration.

I have to say, my dad received excellent care and his doctors and nurses were very good about updating us when we asked. Not being there for 6 a.m. rounds, we relied on them to check the chart and to provide updates; but it all felt very discrete – hour by hour or day by day – as opposed to a holistic person and a holistic plan. My sisters and I exchanged the updates, at least our understanding of them, and pieced together different specialists’ feedback. Eventually, we requested a family conference with all the specializations in attendance. That helped immensely, but again, we initiated that meeting and we took our own notes.

Definitely, hospital resources are stretched, but Canada’s population is aging and more people have complex healthcare needs. Improving patient communications might help reduce the workload of doctors and nurses who have to answer questions frequently.

For example, people who are isolated for potential hospital-borne infection are currently told they are being tested and then moved to a new room. Why not provide a one-page handout that explains what is suspected, what is happening and the expected treatment? What about a short video? It would help families and visitors understand what’s happening without bothering the nurses. It could provide information about how to switch tv and phone without bothering the clerk. It might also impress upon visitors to that room the importance of handwashing and of minimizing exposure.

I am definitely not asking doctors or nurses to do more. I am suggesting that we consider the most vulnerable audiences and challenge the communications status quo in hospitals, especially for very complex cases.

Shake the giant on #IWD2017

March 8, 2017

As I write this on International Women’s Day, I am not feeling particularly optimistic for
my gender. Women in Halifax are protesting the acquittal of IWD quotea cab driver who raped an intoxicated, semi-conscious woman. There are simultaneous inquiries into missing and murdered indigenous women, into uninvestigated sexual assault cases, and into rampant sexual harassment in the armed forces. It seems women can’t feel safe in a cab, on the street or in their workplace.

This past year in Alberta,  women running for political party leadership quit after being subjected to vicious online attacks. South of the border, an open admission of sexual assault by a presidential candidate did not result in retribution, rather it was chalked up to ‘locker-room talk’ and ‘boys will be boys.’ The thin veneer of civility is dissolving. Vulgar language, attitudes and behaviours are making a comeback in “polite” society. It’s not just the president, plenty of men feel perfectly free to harass female journalists – especially sports reporters- while they are trying to do their jobs.  If you haven’t already seen it, take four minutes to watch #MoreThanMean Women in Sports Face Harassment.

Beyond these examples, the gender pay gap persists and inequality is almost universally present in boards and C-suites. On Monday, Tavia Grant wrote in the Globe and Mail:

At the current rate of change, the global economic gender gap won’t be closed for another 170 years, the World Economic Forum says. Canada has also tumbled down the forum’s global rankings, to 35 th place, due to factors such as wage equality, earned income and the share of women in Parliament. – Tavia Grant, Globe and Mail

Progress is slow and the problem often seems intractable. In Lean In, Cheryl Sandberg refers to the Heidi/Howard study where identical resumés are judged more favourably for Howard than for Heidi. On identical qualifications, Howard is more “likeable” than Heidi. Sandberg also refers to research that shows when men don’t take on additional work to help a colleague, people understand that they are already too busy, and respect him for setting boundaries. However, people resent it if a woman doesn’t pitch in when a colleague asks for help. How do you navigate that?

In The Lady Vanishes, the first episode of Malcolm Gladwell’s new podcast, Revisionist History, Gladwell explores the phenomenon of tokenism and its resulting backlash. He uses two examples to illustrate his point. The first is English painter Elizabeth Thompson whose painting, Roll Call, was widely celebrated in 1874 – a time when women were not admitted to the Royal Academy. Despite having Roll Call prominently displayed, viewed by hundreds of thousands of people, losing admission to the Royal Academy by just two votes that year and producing two more brilliant paintings, Thompson was never admitted to the Royal Academy. She married and disappeared entirely from the art world. It was 1936 before a woman was admitted to the Royal Academy.

Gladwell attributes this to moral licensing, a phenomenon where you allow one outsider into the tent, congratulate yourself for your broad-mindedness, then give yourself moral licence to discriminate even more against the same group. (I believe a similar thing happens with poor food choices after people exercise.) He writes: “You open the door to one outsider and that gives you permission to close the door to the others.”

Gladwell’s second example is former Australian Prime Minister, Julia Gillard, who faced virulent sexism during her tenure. After she called out the leader of the opposition in a speech in the House of Representatives for “Misogyny. Sexism. Every day from the Leader of the Opposition” and providing a litany of examples for support, Australians elected him as their next prime minister. (Of course, I know, there were certainly other factors involved. My point is there is no penalty for misogyny.) Her hope, of course, is that the road is smoother for the next woman to hold the office.

 

The source of my frustration on this IWD2017 is that, apparently, statistically, you’re damned if you do and you’re damned if you don’t. I feel this way and I am an educated, middle-class, middle-aged white woman. What about women of colour? Women on the margins? What about women in other parts of the world? What will change the system? What do we do about young women who think the battle is won while their paycheque slowly slips behind that of their male counterparts? How do we encourage women my age who are just so tired of this bullshit?

I will borrow a page from Malcolm Gladwell’s The Tipping Point. I think we need to wake – no, shake –  the giant, the majority of men who support women. They want equality for their wives, sisters and daughters. They need to understand the biases that exist, but more importantly, they need to help change gender norms, to call out unacceptable behaviour and to send the bullies packing.

Women who are comfortable need to shake off their complacency and help one another. We need to keep charging up that hill, and it will help to know we have more players on our defensive line. This is not Sisyphus endlessly pushing a rock up a hill only to have it roll down again. This is not a damsel in distress scenario. This is a tipping point.

Respond to the global trust crisis: 12 Weeks To Trust now updated

March 1, 2017

A “global trust crisis, ” a “global implosion of trust” declared the 2017 Edelman Trust Barometer in January. The annual global survey found declining trust in government, government leaders, business, media,  NGOs and corporate leadership, which fell in every country studied and hit an all-time low at a measly 37 per cent.

The bottoming-out of trust is a serious risk management and societal issue, but two trends are even more concerning. First is the universality of the decline in trust. In previous years, “informed publics” had more trust in the system than general respondents – not anymore.

The Trust Barometer found that 53% of respondents believe the current overall system has failed them—it is unfair and offers little hope for the future—while only 15% believe it is working, and approximately one-third are uncertain.

Even the elites have a lack of faith in the system, with 48% of the top quartile in income, 49% of the college-educated and a majority of the well-informed (51%) saying the system has failed. – Edelman Trust Barometer

Second, the Trust Barometer identifies the cycle of fear that fuels distrust and the polarization of opinion as people seek out information from peers that validates their existing beliefs. Edelman calls this the “echo chamber.” Leon Festinger called it cognitive dissonance. Whatever you call it, this alarming trend replaces fact with opinion and information with ignorance.

Beyond the usual circles, this barely caused a ripple.  This is stunning.

Trust is a bottom-line, risk management issue. It’s a clarion call for immediate action. So let’s not wring our hands. Let’s take big, bold action to build trust.

This updated series, based on my MA research, draws on marketing, ethics, business strategy and economics literature to provide empirically sound advice on building trust within and between organizations. Find out how formal and informal governance mechanisms can help your organization build trust with employees, between departments, with suppliers, distributors, community partners – anyone.

Distrust is very expensive. It limits opportunities, increases legal, monitoring and communication costs and decreases productivity.  Distrustful environments are more unpleasant to be in since humans are pre-disposed to trust. And, a negative spiral of distrust is extremely difficult to reverse. The costs of distrust are significant personally, organizationally and socially. Leaders urgently need to understand and implement trust-building mechanisms that go way beyond the usual platitudes.

Start by taking a look at the Trust Barometer findings. Dive into 12 Weeks to Trust, and send me your questions. Let’s tackle the trust crisis together.

The 12 Weeks to Trust series

 

  1. Intro: Respond to the global trust crisis
  2. 15 Facts about Trust: Definition, types and perspectives
  3. 5 reasons trust is key to a successful partnership
  4. 22 Benefits of inter-organizational trust
  5. Ethics: goodwill at the heart of trust
  6. Using formal governance mechanisms to build and maintain trust – Part A:  Hierarchy, monitoring & contracts  and Part B: Transaction Specific Investments
  7. Using informal mechanisms and relational norms to build and maintain trust – Part A: Common norms, values & goals; Part B: Joint planning & problem solving; Part C: Bilateral communication
  8. The role of reputation
  9. Do you trust boundary-spanners or the organization itself?
  10. 12 downsides of trust & Mitigating the downsides of over-trust
  11. Can an organization have solid inter-organizational trust without organizational trust?
  12. Practical applications for leaders

 

Re:Solution … Make a plan not a promise

December 19, 2016

I originally wrote this post in 2012 but it still holds true. Now though, I would also refer to the year when my resolution was to refresh my underwear drawer-best resolution ever. It took one day, one shopping trip and… voilà, resolution kept!

Bonne année to you and yours.

Accolade Communications

There’s no shortage of posts, articles and tweets debating the pros and cons of making a New Year’s resolution. It’s a silly debate because it’s not about the resolution, it’s about the outcome. People aren’t averse to setting goals, they’re afraid of failing. So instead of making a promise, make a plan.

In her column, Take a Flying Leap, in the January O Magazine, Martha Beck points out: “The leap from your mind to your calendar is the moment of commitment.” So if you want to see friends more often, pick up the phone now and book three dinner parties… voilà, resolution kept.

While my archive post below speaks to small steps, Beck’s got me thinking about loftier goals. Had the Mayans been right, I’m not sure I would have loved my last day on earth. It’s time for me to set the next big goal. (That’s going to make my husband really nervous!) As Beck writes…

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10 ethical decision rules to bullet-proof business

November 28, 2016

ethics-dan-masonMany years ago I was shocked to learn that ethics is not a mandatory class in most business schools. Surely, if they quantified the cost of ethical lapses like mortgage bundling, Enron, sexual harassment suits, etc. they would see that ethics are about the bottom line? Surely, they could see that a proactive ethical practice can create value? Attract and retain employees?

Apparently, I am an incorrigible optimist.

Recently, I was chatting with a university finance professor who told me he wasn’t sure there would be enough content for an ethics course lasting an entire semester. I  couldn’t believe it so I pressed on a bit. How could he say that when there are PhDs in ethics? He countered that that is more philosophy… not business. Undeterred, I asked him couldn’t ethics be taught along with critical thinking? decision making? value creation for sustainability? He seemed unmoved.

At the heart of the matter is the perception that ethics is just “doing the right thing” or signing a code every year – sometimes more for the protection of the organization than the alignment of behaviours.  Yet ethics are a habit – a systematic assessment of all aspects of your business. They involve self-interest, risk assessment and economic efficiency as much as goodwill. At a minimum, you should find ethical discussions at the board table, at senior management meetings, in human resources, compliance, risk management, and in the public relations department. Shouldn’t there be a common framework that reflects the values of the organization to guide these discussions?

An ethical practice applies to every aspect of business.

In 1995, Larue T. Hosmer[1] synthesized ten decision rules established by the great moral philosophers that – applied in sequence – provide deep insights for organizations. By systematically taking into account the legitimate interests of all stakeholders, you can identify opportunities to build trust in your organization. The analysis does not require funding or elaborate strategies. Just the discipline and the courage to start asking the right questions. Wouldn’t an exploration of these rules along with case studies (the news is full of them) be sufficient for business students?

Ready? Explore Hosmer’s ten ethical principles.

  1. Self-interests (Protagoras). Do your actions in the long-term serve your interests and those of the organization? Where does short-term thinking create pitfalls? Is immediate activity balanced with progress on long-term plans? Does compensation reward short-term performance and long-term accomplishments? Are funds frittered away at the expense of larger long-term investments? What could improve?
  2. Personal virtues (Plato and Aristotle). Are your actions honest, open, and truthful? Are there any actions you wouldn’t want to see reported in the media? Do you report regularly on meaningful metrics? Do you share information freely? Do you encourage constructive feedback? What barriers exist to greater openness with all your stakeholders? How could you overcome them?
  3.  Religious injunctions (St. Augustine). Are your actions kind? How do you treat your employees? Describe your community relations. What actions show kindness to your customers? Can you identify opportunities internally or externally to be kinder? Are there people or communities that need your services that you are not serving? How could this change?
  4. Government requirements (Hobbes and Locke). Are your actions legal? Are you complying with the bare minimum standards or do you strive to meet the full intent of legislation and regulation? Where do you see room for improvement?
  5. Utilitarian benefits (Bentham and Mill). Do your actions result in greater good than harm to society? Do your operations cause harm in any way? Do your actions benefit many or few? How sustainable is your organization? What could you do to enhance wellbeing among employees, customers, communities and other stakeholders
  6. Universal rules (Kant). Would you be willing to see others in a similar situation take the same actions you are taking? Take the perspective of an employee, a customer, a supplier, a partner or a competitor: Do you like how you’re treated? What could change?
  7. Individual rights (Rousseau and Jefferson). Do your actions respect the rights of others? How diverse is your board? Your leadership team and workforce? Are jobs and premises accessible for people with disabilities? Do you respect intellectual property? Where could this improve?
  8. Economic efficiency (Adam Smith). Do your actions maximize profits – within legal and market constraints? Do you take into account external costs? Are employees engaged and eager to find savings and improve processes? Does everyone know how they contribute to results? What impedes maximum efficiency?
  9. Distributive justice (Rawls). Do your actions harm the underprivileged in some way? How are profits and rewards distributed? How are promotions handled? Does your success alleviate or exacerbate inequities? Externally, are some profiting at the expense of others? Does the community benefit from your presence? Where do “fairness gaps” exist? How could they be addressed?
  10. Contributing liberty (Nozick). Do your actions interfere with the rights of others for self-development and self-fulfillment? Are employees being coached to their full potential? What development opportunities do you offer? How do you encourage uniqueness? Creativity? How could your organization contribute to the self-fulfillment of employees, customers, investors, or other stakeholders?

Taking a deep dive on ethics not only builds trust within and beyond an organization, it can create new relationships, engage employees, improve processes, enhance your reputation and spark innovation. Are we only giving lip-service to these critical dimensions of business?

In this era of “post-truth” (I hate to even write that), where we favour fake news rather than real journalism, we need to vastly improve our understanding of ethics and its importance to business. We can start in the class room.

Do you have an example to share? If so, please leave a comment.

[1] Hosmer, L. (1995). TRUST: THE CONNECTING LINK BETWEEN ORGANIZATIONAL THEORY AND PHILOSOPHICAL ETHICS. Academy Of Management Review, 20(2), 379-403. doi:10.5465/AMR.1995.9507312923

 

 

Language, leadership and setting norms

October 15, 2016

“High thoughts must have high language” Aristophanes

If this is so, then we are in big, I mean huge, trouble.

I can barely stand to  listen to the news these days because the Presidential race has debased itself so much. I am shocked at how easily news outlets repeat inappropriate language – or people at the water cooler for that matter. It’s so prevalent, people feel brave yelling “F- her in the P-” to female reporters when they are broadcasting. It has become a strange source of pride.

Let’s be clear, it’s not that I’ve never heard bad language or that I am a prude. The reason I am concerned is I believe in the power of words to inform, to persuade and to create emotion. More importantly, I believe that the type of language used and accepted establishes norms around what’s ok to say to people, to think of them and to do to them. It is very well established that action follows language. If I think of you as an “it” or an “other” then I can justify treating you in a way that I would ordinarily find appalling.

So at the same time as people are normalising “p—y” there is backlash on the use of Indigenous slurs for sports team names. So misogyny is ok but racism is not. Can you imagine a presidential candidate using the N-word in 2016? Why don’t we just say no to both?

And, instead of empty hand wringing, diminishing bad language by calling it “locker room talk” or deflecting by saying there are larger issues that need attention, leaders need to call it out and put a stop to it. In the RCMP, in the Canadian and US military, on university campuses, in organisations and families everywhere  we need to denounce language that demeans. Period.

I found this image on quoteschart.com. It provides a far better conclusion than I could and frankly… I am speechless. We need to alter where we are going and quickly.

language-quotes-meme

source: http://www.quoteschart.com/language-quotes/

Drop the negative. 8 ways to move from can’t to can.

September 18, 2016

cn-tower-clip-art

People consider the CN Tower climb and say: “I could never do that.” So they don’t try. It’s such an imposing sight they don’t realise that the average climb takes 30-40 minutes. I can tell you that I am no athlete and I’ve done it twice in 24 minutes or so. In fact, the time you spend in line waiting to climb the stairs to the CN tower – or waiting for the elevator down- is likely longer than the time it takes for the actual climb.

So why do challenges loom larger in our minds than they are in reality? This applies to fitness goals but also to projects that we’re dreading or difficult conversations we keep postponing.

How do we overcome that?

Here are 8 ways to move from can’t to can.

  1. Drop the negative. I could never do that.” “I can‘t run that far.” Little changes make a big difference. You can try.
  2. Just start. Invariably, the obstacle in our mind is larger than it is in reality.  As my husband’s favourite Christmas movie song says “Put one foot in front of the other…” Prepare if it helps you feel confident but. just.start.
  3. Look at your barriers.
    • Don’t have time? Hire a sitter, a housekeeper, delegate tasks or reprioritize. Are you watching TV? Then you have time.
    • Don’t have the experience? Volunteer to learn how. Take a free course on line… Google it! Talk to your employer about professional development if it’s a career goal.
    • Don’t have the money? Can you reallocate your budget? Raise money? Barter?Volunteer? Look for a scholarship or free services in your community.
  4.  Establish a system. An article I read in the Huffington Post this week really resonated with me.In  Forget about setting goals. Focus on this instead, James Clear offers great advice about setting up systems to get you to your goal. He suggests that rather than setting, for example a weight loss goal, you establish a system of going to the gym three times a week. You have control over that. In a similar vein you can’t get an A if you don’t study so studying is the system and the grade is the result. Remember that your system is not set in stone. Fine tune it as you go.
  5. Maximize your time. Can you listen to a podcast while you drive or in the shower? Work out with friends so you’re not giving up social time? Get paid while you are learning something? We all have 24 hours in the day. Just like it’s a good idea to eat high value calories – how can you make your time count – for what matters to you?
  6. Tell others. In his book Influence: The Power of Persuasion, Robert Cialdini explains why people don’t like to back away from commitments – especially those they make publicly. Psychologically, we want to be consistent. He also highlights this next point.
  7. Ask for help. No one knows everything – period. Asking for help gets you closer to your objective and is flattering for the person you approach. When someone helps you, even in a small way, they become invested in your success.
  8. List your other successes. Where have you succeeded before? When have you surprised yourself? What are you proud of? Carry that feeling of “I did that” in your heart and apply it to other places in your life.

Carry that feeling of “I did that” in your heamudderellart and apply it to other places in your life.

No one is perfect at this. But you can’t grow without stretching. Trying something new is great for your brain, your self-esteem and it helps develop new relationships. So the next time you look at the CN Tower and someone suggests taking the stairs, lace up!

What’s your next challenge going to be? Write a book? Run for office? Speak in public? Run a 5K or more? Go back to school? I’d love to hear from you.

Here’s me this summer at Mudderella. Not my natural environment but I did it and loved it. I met a new group of women. I was inspired by the strength and courage of many women around me and it only took a few hours. Now that’s a good investment. And we’re definitely doing that again.

To quote Ricky Martin: “Nothing can hold you back if you really want it.
I see it in your eyes. You want the cup of life. Now that the day is here
Gotta go and get it… Here we go: Allez, allez allez!”

 

 

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