When it comes to holding Crucial Conversations in healthcare, all parties have a common mutual purpose possible: what’s best for the patient. And yet this doesn’t make the conversations any less crucial, according to Matt Pfleger, the manager of learning and development at UMass Memorial Health, the largest healthcare system in central Massachusetts.
“It’s both much harder in healthcare because of the seriousness of patient care, and it’s easier because of that mutual purpose,” he said. “If we step out of content and focus on that mutual purpose, we don’t have to look very far to find that strong mutual purpose that should make everything easier. So both things are true.”
As the sole Crucial Learning certified trainer on UMass Memorial Health’s team, Pfleger facilitates Crucial Conversations® for Mastering Dialogue Healthcare as well as Crucial Conversations® for Accountability for everyone from housekeeping to high-level executives—often in the same open-enrollment classes, whether virtually or in person.
Pfleger said having videos and scenarios in which his learners can see themselves really helps the content hit home.
“It is very challenging to get a frontline caregiver in particular—someone who’s caring directly for a patient—away from the floor to engage in learning,” Pfleger said. “And when you’re able to do that, which is a big ask by itself, it sometimes is a harder ask for them to be fully engaged in the content that you’re putting in front of them. To come out of the gate with healthcare examples and scenarios immediately grabs that person’s attention, and it’s like, ‘Oh, actually, not only is there content for me, but this was made for me.’”
Among these learners are nurses and patient care staff who work in the hospital as well as caregivers with UMass Memorial Health’s Hospital at Home program, which brings hospital-level care to patients’ homes. With workplace violence on the rise in healthcare, it’s important to equip caregivers with tools for talking with patients and their families to keep situations from escalating, Pfleger said.
“We emphasize intention—what do I actually want for me, for my team, for the organization?” he said.
Being able to share their meaning and inviting others to do the same in a way that avoids the fool’s choice is critical when decisions are often a matter of life or death.
“You’re not coming to the hospital because you want to—something is wrong,” Pfleger said. “You might be having your worst day. So there’s a mindset of how we interact with people, but there are also tools and skills of how we are going to talk to you knowing that that’s the case.”
Exploring others’ paths and avoiding the victim/villain/helpless stories applies for both the caregivers and the patients, Pfleger said.
“Why would a reasonable rational decent person do this?” he asked. “She doesn’t feel well, and so maybe we should explore that and try to treat this person.”
Pfleger also cited the contrasting example video in the healthcare version of Crucial Conversations for Mastering Dialogue, where a patient’s wife gets upset that no one has responded to her husband’s call bell.
“Being able to watch that in an example that speaks to the audience helps them feel like, ‘Oh yeah, I can do that,’” Pfleger said. “Some of the videos aren’t perfect on purpose. The language isn’t always exactly what you would say in ideal circumstances. They still feel real. And so I think that helps people think, ‘Oh yes, I can lean into this more and make this a part of how I show up.’”
Speaking of showing up, Pfleger said his favorite slide from the course comes in State My Path, which reads: “Be confident. Your meaning belongs in the pool. Be humble. Your meaning is not all the meaning.”
The same concept applies in balancing personal examples and teaching from the course design.
“As a facilitator, you have a lot to offer that is unique to you for your learners—but also, just trust the material and teach what’s laid out for you,” he said. “I think the best part comes when you find the right spots to do each of those things—put your own flavor on it, but trust in what the master trainers have put together for you and the content that you have, and know that there’s more to look through… It’s okay to say, let me get back to you on that, or we’re going to get to that section later.”
