Tag: attitude

Personality Conflict: An Excuse Great Leaders Never Use

Sibling RivalryDon’t ever:

Tell someone complaining of chest and upper abdominal pain: “It’s just gas.”

Tell someone feeling short of breath: “It’s just anxiety.”

Dismiss workplace conflict with: “It’s just a personality conflict.”

Carl Jung first wrote about personalities and conflicting opposite types.  The famous Myers-Brigg’s personality test uses pairs of opposites:

Extroversion/Introversion,

Sensing/Intuition,

Thinking/Feeling,

Perceiving/Judging.

But the concept of conflict gets twisted to explain all persistent conflict between two people.  Why do we think personality conflict can explain so much?

Did Churchill and Hitler have a personality conflict?

Are personality conflicts holding back world peace?

Dr. Russel Watson says personality conflicts are not the true source of conflict in the work place.  He describes personality:

“The word itself is complex…unique constellation of one’s consistent behavioural tendencies…Terms used instead of ‘personality’ include: type; behavioural style; preferences; traits; and temperament, among others…closely describe work behaviours…how one does their job, or goes about their normal day-to-day activities.”

Instead of personality conflicts, Watson suggests that we fight over value conflicts:  differences in ideology.

“While behavioural style describes how one does their job, Values illuminate why one does their job, ie, their wins, drives, and rushes as they perform their duties.”

Lencioni tells us to ‘mine for ideological conflict‘ in his book, “Death by Meeting”.  He says we need to debate how our ideas differ or meetings are a waste of time.

Wrestling with conflicting ideas and values seems odd to a post-modern leader.  Post-moderns put weight on opinion, context and environment; everyone’s opinions are equally valid; you just have to be tolerant and get along.  We’ll dig into this in another post.

Do you find yourself relying on ‘personality conflict’ to explain difference of opinion?  Are you avoiding the hard work of digging into the real issues? I’d love to hear what you think by clicking Leave a Reply or # of Replies below.  Thanks!

Patient Flow into Buckets or Patient Flow into a Funnel?

bucketsNurses and doctors think patients belong in buckets.

Not literal buckets; buckets of care: primary care bucket, emergency medicine bucket, inpatient bucket…

How do we know providers believe in a bucket concept of care?

They tell patients they’re in the wrong bucket!

They tell patients to get out of the bucket!

They tell patients to go to a different bucket next time they need care.

Hilton hotels suggests staff should be empowered to handle ANY issue that arises for guests during their stay.

What happens in healthcare?

Sorry, ma’am.  You’ll have to go somewhere else for that.

Sorry, sir.  I don’t have time to discuss that with you.  The ED isn’t the place for that kind of problem.

Subtitle:  And don’t come back next time!

Funnel of Care

Patients should seek care where THEY choose.  How they choose and how we can help them make a great choice will be discussed in another post.  For now, once patients present with a concern – no matter where they present – we should be prepared to help to whatever extent we can.  Sending them away with a dismissive, “This isn’t an emergency” is unacceptable.

The funnel starts where patients choose to access care.  The funnel continues to more and more specialized care until patients get what they need.

With bucket-thinking, we expect patients to make their own clinical judgment.  Then, we berate them for poor clinical judgment:

“Why didn’t you go see the family-doc/walk-in-clinic/anywhere-else?”

But without clear, available access, patients are forced to attend the ED.  EDs refer patients to their family docs for follow-up far more than family doctors refer to the ED.  Referral patterns have reversed.  We could make the ED a referral only facility like an ICU – no entry without a referral letter.  Family Docs and clinics would need advanced access, longer office hours, basic resuscitation equipment…

System issues force patients to seek care wherever they can get it.  It’s our job to help them when they get there; not send them away.

What do you think?  Would you want your family to be sent away from the ED?  Is that safe?  Is it good customer service?  Click Leave a Reply or # of Replies below.

87 Ways to Block Patient Flow Improvements

Blond Boy CryingChange stretches us.

Even good change – getting married, having a baby, retiring – is tough.

In our department, we’ve had a ton of change to improve patient flow, and we’ve heard a ton of complaints.

Here’s a few:

  1. You’re moving too fast.
  2. You’re moving too slow.
  3. What’s taking you so long to get moving?
  4. I wasn’t at the meeting.
  5. I wasn’t invited to the meeting.
  6. You had the meeting without me!
  7. You have too many meetings.
  8. I’m tired of going to so many meetings.
  9. No one asked for my opinion.
  10. You already asked for my opinion.
  11. You should talk with those of us who do the real work.
  12. You shouldn’t listen to whiners from the front line.
  13. You should consult outside experts.
  14. We don’t need experts telling us how to do our job.
  15. You’re too idealistic.
  16. You’ve lost your ideals.
  17. You can’t see the big issues.
  18. You can’t see the details.
  19. Why improve what’s  already better than most?
  20. This place has gone to hell.
  21. But look what we stand to lose!
  22. You have too many details unanswered.
  23. Your proposal is too detailed.
  24. It’s too complicated.
  25. It’s too simple.
  26. It will never work here.
  27. It’s never worked anywhere else.
  28. It takes too much time.
  29. I have nothing to do now.
  30. I’m underutilized.
  31. It takes too much energy.
  32. What are you not telling us?
  33. Your emails are too long; you tell us too much.
  34. You don’t expect us to believe that’s why you’re doing this, do you?
  35. Your data is biased/skewed.
  36. You collect the wrong data.
  37. Your data is anecdotal.
  38. Let me tell you a story I heard…
  39. You should work more clinically; you spend all your time in the office.
  40. You work too much clinically; you should spend more time in the office.
  41. This seems to be all about special treatment for XX providers.
  42. What’s wrong with special treatment for YY providers?
  43. Why should we treat patients as family?
  44. Just because I get special treatment for my family doesn’t mean other patients should get it too.
  45. We might miss one sick patient.
  46. These patients aren’t sick; they should wait.
  47. These patients could all be seen in a walk-in clinic.
  48. These patients need a nurse, a full set of vitals, an ECG, and an acute bed STAT.
  49. One bad outcome is enough to stay the way we were.
  50. It costs too much.
  51. This would work if we spent more.
  52. You are asking us to do someone else’s work.
  53. Someone else is stealing my work; I’m going to submit a union grievance.
  54. There’s no infection control.
  55. We don’t need to see infectious patients so quickly; they can wait.
  56. It’s too stuffy.
  57. It’s too breezy.
  58. There’s too much paperwork.
  59. There’s no paper for notes.
  60. There’s no privacy.
  61. I need more people around to feel safe.
  62. There are too many people.
  63. We need more nurses/doctors/patients/support in the same space.
  64. I feel disconnected from other staff.
  65. I don’t like working shoulder to shoulder with other staff.
  66. It feels like you aren’t supporting the team.
  67. It seems like you only support the X team.
  68. You’re dividing the X team.
  69. I’ve done this for decades.  I don’t need to change a thing.
  70. Those new guys are out of date.
  71. It’s the wrong focus.
  72. You just want to be famous.
  73. Why don’t you spend time on what really matters?
  74. You are out of touch.
  75. You sound like a corporate pawn.
  76. All you care about is X metric.
  77. You just want to undermine Y group of workers.
  78. This sounds like what failed last time.
  79. Are you saying we aren’t working hard enough?
  80. You don’t know what you’re talking about.
  81. If you just changed X, you wouldn’t  need to do this.
  82. You know, this will never work.
  83. We need to give more power to the people actually doing the work.
  84. This is embarrassing.
  85. I used to be proud of working here.
  86. I wouldn’t send my family here; I’d send them to the terrible hospital down the road.
  87. Why can’t you admit this is a stupid idea?

Kotter discussed many of these in  “Buy In”.  He suggests that there are 4 main attacks:

  1. Fear Mongering
  2. Death by Delay
  3. Confusion
  4. Ridicule/Character Assassination

Kotter proposes the following response:

  1. Invite attacks
  2. Respond with clear, simple common sense
  3. Respect always; never fight
  4. Focus on the audience
  5. Prepare for attacks

Change cannot be blocked.  Leadership is change.  Time changes things even if leadership will not.  Patients have benefited from disruptive innovations in our ED, and our whole team proudly wears the scars we earned through it.

How have you responded to change?  Does this list sound familiar?  Click Leave a Reply or # of Replies below.