Shifting Conversations

One great conversation can shift the direction of change forever.

– Linda Lambert

Alisha Patel, a senior administrator at a thriving medical center in New England, was surprised at the less-than-stellar patient satisfaction report that was sitting on her desk. Her surprise turned to understanding when she saw which hospital unit this was from. The director of that unit had recently quit because she felt frustrated with the new leadership model and refused to change. Alisha was filling in until a new director was hired.

She sent a copy of the patient satisfaction report to the nurse managers in the unit. She also emailed them an assignment for their next management meeting, which was a week away: Pay attention. Look for what staff members are doing that contributes to patient satisfaction. Come prepared to share a story of a best practice you've seen during the week.

The nurse managers were confused when they got the email; one even wrote back, asking if Alisha had made a mistake. "No," she replied, "please look for what's working well and bring your best story next week." This was a dramatic shift from what these nurse managers were used to, and it created quite a buzz. The former director usually read them the riot act, tried to find who was at fault, and demanded they do better, or else. They were glad to see her go!

When the nurse managers met, Alisha acknowledged the team for their quality of care and service to patients. Then she asked about their stories. They each shared a story of best patient care and then together analyzed the stories for strengths and replicable practices. They discovered several unique actions, but mostly there were consistent themes for what created high patient satisfaction. The nurses seemed excited about the ideas. "This was an amazing way to handle our problem, Alisha," one of them exclaimed. "I can't tell you how many meetings we've had that focused on this problem, and nothing ever changed. This was so effective. I know things are going to improve after just one meeting with you!" They left the meeting committed to sharing and implementing the best ideas. They were alive with possibilities!

Alisha smiled confidently as the staff left. She was thinking about the changes that had occurred over the last year. She remembered what it had been like working at the medical center before introducing their new leadership model. They had experienced steady growth in patient services over a three-year period, and, based on that growth, the demands on the staff were having a negative impact on performance, which was evident in their quarterly reports. Patient satisfaction had been steadily declining. Decreasing employee engagement was reflected in unplanned absenteeism and lower retention rates, which made matters worse for everyone. On top of that, patient "throughput" was not optimal, which meant the center lacked the beds they needed to serve the people who needed them most.

All of this negatively affected both the bottom line and employee morale. Everyone felt overworked and stressed. She knew the staff were always striving to provide a high quality of care, but the medical center's growth had become stressful, triggering short tempers, a lack of compassion, limited time for patients, and tension among staff and administration.

Alisha had not always been such an affirming leader. She was responsible for quality, and she lived by the quarterly performance reports. When performance stats were up, she didn't worry; it gave her a chance to focus on other responsibilities. She would send the reports to directors, but she never went out of her way to acknowledge them. She took good reports for granted. When performance stats started declining, it was a different story. She gave the reports all her attention. She spoke face-to-face with directors, and her tone was critical: "These reports are not satisfactory. Every quarter it's the same or worse. You've clearly done nothing to improve!"

The managers would defend the results, saying, "We have made changes, but we can't do anything when we are understaffed and people don't show up for work. Some of our staff are already working double shifts to cover for other folks!" "I don't want excuses, I want results," she snapped. "We are doing the best we can," a manager snapped back. "Well, you'll have to do better!" Alisha ended the conversation.

The managers always left demoralized and with no ideas about how to resolve the issue. Alisha's levels of stress and dissatisfaction grew over this period, and it became next to impossible to hide her frustration from her colleagues. Her stress rolled over into her family and nonprofessional life as well. She became short-tempered, negative, and quick to criticize both her kids and her husband. She had fast developed a reputation for being the kind of person she never wanted to be, as a manager, partner, or parent. She realized she was going to have to do something if she wanted things to change. So she began an online search. She was intrigued by the headline of an upcoming workshop she found, about something called Appreciative Inquiry (AI), which promised tools and strategies for strengths-based change at any level — personal, organizational, and community.1 What caught her attention was this headline:

The Best Healthcare Clinics in the World Are Strengths-Based; Their Performance Outpaces All Others!

She read further: "When we're unable to act with agility, speed, and unity, opportunities are missed and revenue is lost." It was as if these words were written just for her. In hospitals, she knew, agility and speed can mean the difference between life and death, and lost revenue seemed to lead to financial decisions that negatively affected quality. What convinced her that this was the workshop she needed was a quote from David Cooperrider: "We change best when we are strongest and most positive, not when we feel the weakest, most negative, or helpless." She realized she had become negative, focusing on everyone's weaknesses, including her own. Everyone was feeling helpless to turn things around. So she clicked on the registration tab.

During her online training, she learned about the practices and principles of AI. Somewhere in the midst of the week she realized she herself had actually been contributing to the problem at her own medical center. She had dug in her heels and had badgered the staff, without asking any questions or helping to find solutions. She vowed to be part of the solution when she returned.

The first thing she did was to create a positive framework for her next conversation: More and more, our patients feel...