Dear Crucial Skills,

After more than 20 years in clinical practice, I’ve noticed increasing role confusion in the operating room, particularly around peripheral IV placement by non-anesthesia staff. Although this task may seem routine, I am accountable for the IV’s function and safety during procedures. I’m concerned that some team members underestimate its importance or resist guidance. High staff turnover further complicates education and consistency. How can I improve my communication and educational approach to strengthen collaboration and patient safety?

Sincerely,
Concerned Clinician

Dear Concerned Clinician,

First off, shoutout again to all our healthcare workers who do so much for us. I was reminded of your great work again this last week when I went to visit my eighty-eight-year-old grandma in the hospital and watched the nurses and personnel ensure she was taken care of. Thank you!

Yet, just like the rest of us, clinicians and healthcare workers make mistakes for a variety of reasons. Your question highlights a challenge healthcare professionals have faced for decades: How do you address concerns about patient safety when the people involved don’t share those concerns or refuse to take responsibility for them?

Some people will listen to you because of your experience. But from what you wrote, many do not. But rather than focusing on how to get colleagues to listen, I’d suggest you begin to create an environment where everyone feels safe to speak up, learn, and hold each another accountable.

Here are four suggestions.

Start with Heart, Not with Expertise

In Crucial Conversations for Mastering Dialogue, we teach a skill called Start with Heart. Before entering a difficult conversation, ask yourself: What do I really want for myself, for others, and for the relationship?

Your answer seems clear: safe patients, competent colleagues, and a team that works well together.

But do your colleagues know your intentions, or have they drawn different conclusions? For instance, a colleague might interpret your guidance as criticism of their competence or an attempt to show your authority. You mention that others sometimes underestimate the importance of IV placement or resist guidance. Perhaps some do. But other times they may have other reasons for their actions, such as time constraints, alternative instructions, and so on.

So, instead of immediately going to corrective action, get curios. Ask, “How were you trained to approach this? What challenges are you running into?”

You’ll have a better chance of influencing behavior when colleagues believe you respect their experience and want to understand their perspective.

Make the Risk Visible

You can’t expect people to appreciate a risk they don’t understand. But telling them something is important isn’t always enough.

Begin with the facts. Explain what you’ve observed without assigning the “why” you’re guessing is the reason behind your observations. Then share your concern and ask for their point of view.

For example: “I’ve noticed that we don’t always have the same understanding of what needs to be confirmed when an IV is handed off to anesthesia. Because we depend on that access during procedures, I worry that inconsistencies could create problems for the patient. I’d like us to establish a consistent process. What suggestions do you have?”

You’re not saying, “I’ve been doing this for 20 years, so listen to me.” You’re explaining the risk and inviting others to help solve the problem.

Make Speaking Up Part of the Team’s Routine

This year, Crucial Learning and the American Association of Critical-Care Nurses (AACN) published Silence Kills 2.0, a follow-up to landmark research conducted 20 years earlier.

Among 3,500 healthcare professionals surveyed, only 32% reported speaking up directly about crucial concerns. However, those who consistently addressed problems reported 12% higher patient safety ratings and 11% better clinical outcomes than those who did not.

The research also identified four communication behaviors associated with a team’s ability to adopt better clinical practices:

• Speak up. Raise concerns when you recognize them, especially when patient safety may be compromised.
• Remind. When colleagues revert to old habits, respectfully remind them of agreed-upon standards.
• Hold accountable. When someone disregards an expectation, describe the gap between what was agreed upon and what happened, then discuss what got in the way.
• Challenge assumptions. Be willing to reconsider your own practices and invite colleagues to suggest improvements.

Start with one of these best practices and implement it as best you can. Then implement another. The goal is to create a culture where everyone feels responsible for raising concerns and improving care.

Of course, immediate safety concerns require prompt action according to your organization’s clinical protocols.

Turn Education into Shared Expectations

Finally, consider whether you’re dealing with an individual knowledge problem or a systems problem.

With frequent staff turnover, expectations can become inconsistent. New employees may receive conflicting instructions or may have learned so much in so little time they’ve forgotten every protocol.

Rather than repeatedly correcting individuals, work with your clinical leaders and educators to establish clear, shared expectations.

Bring the appropriate team members together to clarify responsibilities, procedures, and handoffs consistent with clinical policy and each professional’s area. Then incorporate these expectations into training, demonstrations, and regular feedback. Explain why each standard matters, not just what people should do.

You can’t personally ensure that every IV is placed perfectly or that every colleague has your level of experience. But you can help build a culture where concerns are raised, expectations are clear, and people learn from one another.

The lesson from Silence Kills 2.0 is that patient safety depends not only on clinical expertise, but also on what people do when they see something that needs to change.

Make it your goal to build a team where speaking up is expected, learning is continuous, and accountability belongs to everyone.

All the best,
Jordan