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Leadership Practices for Eliminating Patient Harm: Appreciation

In the previous part of this series, Marilyn, the nurse who is mobilizing leadership to address prescription error issues, asked nine staff members from her listening tour group to conduct their own listening tours regarding the effect of fatigue on prescription errors. Having collected responses to a compelling open-ended question, the group gathers with Marilyn to discuss their experiences and propose themes.

Before addressing the data, Marilyn asks the group about their experiences in general as well as their fears regarding being viewed as management pawns. A number of individuals found that their colleagues were a bit dismissive of what they were doing for this reason. However, this opinion seemed to dissolve once those spoken with experienced the deep listening Marilyn had coached the group on as part of the inquiry practice.

In fact, the group uniformly reports that the listening tour participants’ experience of being heard was at least as important as collecting the data. One member of the group stated that learning to listen in this way was a radical departure from their usual style and far outweighed the initial fear of doing the listening tour.

In analyzing the data, Marilyn coaches the group on allowing themes to emerge as well as challenging each other on its interpretation. As a group they test the themes for whether there may be technical fixes available for addressing what each theme exposes. For example, the group found most people are reluctant to actually say whether or not they are distracted from the task at hand due to fatigue or other circumstances.

The group proposes to experiment with a pre-task check-in as a way to promote focusing and exposing fatigue among their colleagues. While this practice may seem “technical,” its acceptance into the current culture would demand a certain amount of vulnerability, an attribute not highly valued currently.

As the meeting progresses, Marilyn and the group design their one-on-one feedback for the listening tour participants. The feedback consists of four parts. First, they will communicate the themes from the data and listen for the participant’s views on those themes. Second, they will describe their pre-task check-in experiment and listen for the participant’s reaction. Third, they will express appreciation for participation in the listening tour. Finally, they will close the conversation with whether or not there is anything else the participant wishes to say or do as part of the process.

The thought of expressing appreciation, a seldom-practiced conversation, causes some concern among the group. In response, Marilyn offers to introduce and model a way for her colleagues to express appreciation to their listening tour participants.

Over the last month, she has journaled about her experience with the staff in this group. From her journaling, Marilyn speaks to each person directly regarding what she specifically admires and appreciates about that person. She also states how what they did contributed to her and her development as a leader.

The staff engages with each other in practicing this form of appreciation. As the last person finishes speaking, the room is silent and there is a tangible sense of gratitude.

After the meeting, Marilyn intentionally pauses in her day by visiting the hospital rooftop garden. Once more she adopts a systemic perspective of her, and now their, work on eliminating prescription error. In this moment, Marilyn wonders if each of the staff would be willing to formulate and publicly declare a personal stand.

She says to herself that the mobilization of leadership from everyone has begun – new behaviors are being considered, loyalties are being tested and a new way of thinking about leadership is emerging. However difficult the journey becomes, she remains committed to a future free of patient harm.


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