Dear Crucial Skills,

Working as a respiratory therapist, I frequently notice common, yet avoidable, mistakes that can cause major issues if not resolved.

One of our daily tasks as a Respiratory Team is to check the oxygen of all patients in our areas of the hospital. Frequently, I find problems.

There are two specific instances that come to mind. Both times I entered the room to find the patient’s oxygen saturation low. I immediately turned up the oxygen only to find that the poor saturation was due to employee error. One patient’s tubing was sitting on the floor, left there from when he had gotten up to walk laps. The other patient’s tubing was plugged into the air outlet in the wall, so the patient was getting only room air, not oxygen. The outlets are clearly marked—oxygen is green and air is yellow.

Both instances could have been prevented had the nurses paid better attention. I didn’t confront the nurse taking care of either patient because I felt like my emotions would have caused me to say something I would have regretted later. Had I not done oxygen rounds at that time, I wonder how long it would have taken someone else to notice that there was a problem.

How can I appropriately confront people I work with without causing an uncomfortable situation? I believe my patients deserve better care.

Signed,
Unplugged

Dear Unplugged,

First of all, let me acknowledge you for even asking this question. OurSilence Kills study of healthcare organizations across the U.S. found that 84 percent of healthcare workers regularly see things like you’ve described. And yet fewer than one in ten speak up about it.

And here’s the first point I’d like to make: the biggest reason people don’t speak up is that they believe it is not their job to do so. This belief is a critical problem we must solve in healthcare if we are ever to make significant improvements in patient safety and quality of care. Why? Because our research shows that the best healthcare is delivered in organizations where anyone can speak up to anyone who would benefit from feedback. So, thank you for recognizing that you have a responsibility to speak up about the problems in your hospital.

Let me share with you four pieces of advice that might make speaking to your colleague easier:

First, master your story. You were self-aware enough to realize that speaking up when you were angry or offended may not have been productive. Now it’s important you realize that your upset emotions were something you produced. You were not angry because coworkers made obvious mistakes. You were angry because of the story you told yourself about why they made those mistakes. You may have quickly judged, for example, that they did it because they were stupid, or lazy, or thoughtless, or all three. This is a common thing we do when others let us down—we leap to judgments and conclusions that escalate our emotions and make us less effective at confronting problems.

The first thing you need to do before speaking up is try to see how areasonable, rational, and decent person could have made such a mistake. You may, for example, consider that the nurse may have been distracted or called away while trying to reconnect the tube, or he or she may not have been trained sufficiently, etc. Does this kind of mental redirection mean you’ll tolerate the mistake? No! It just means you’ll approach the others involved as reasonable people who deserve understanding and civility. If you approach them as anything less than this, they are likely to respond defensively and you’ll be ineffective.

Second, create safety. Contrary to popular belief, the person you are about to approach is not destined to become defensive. Most people believe thatanyone who is confronted about a mistake will become defensive. This is largely incorrect. People don’t become defensive because of what you’re saying to them; they become defensive because of why they think you are saying it. The problem is not the feedback. The problem is the lack of safety. Help others feel safe by assuring them of your positive intentions and of your respect for them—in a truthful and appropriate way.

For example, you might start with a show of respect by asking permission before offering feedback: “I know I’m not a boss here or anything, but I noticed something with one of your patients that I think you might want to know about. May I tell you about it?” Then reassure them of your intentions and respect, “I’m sure I miss things now and again and I hope you’d return the favor if you ever notice. I also don’t want to be presumptuous or act like I’m perfect at everything. But I noticed that . . .”

Next, share the facts. Many people make mistakes in giving feedback by mixing their judgments or conclusions with facts. This is because they may, without even realizing it, have mixed motives. They want to give helpful feedback. But they also want to express irritation and punish the other person for creating the problem to begin with. Strip away that motive entirely and focus on the facts.

Here’s what not to say: “You were a bit careless in reattaching the patient’s oxygen tube. You should know that the green is oxygen and the yellow is regular air.” Instead, try, “When I was making oxygen rounds I noticed two of your patients whose oxygen levels were low. I became concerned and found that one of them had detached oxygen tubing and the other’s tubing was connected to the yellow air outlet rather than the green oxygen outlet.”

Finally, invite dialogue. If you’ve gotten your emotions in check by checking your story, started with safety, and then shared the facts, odds are the other person will be listening reasonably well at this point. The final thing I’ll advise you to do is end with a question that encourages open dialogue. For example, “Can we talk about what might have happened?”

Obviously a great deal might go right or wrong from this point forward, but if you continue to approach things in a safe and respectful way, while being honest in sharing your opinions, you are likely to have a positive impact. And if you encourage more people to do the same, you’ll be well on your way to having a positive impact on quality of care in your hospital.

Best of Luck,
Joseph