Healthcare is an endeavor driven, sustained, and reliant on humans. That inevitably means we work in complex, imperfect systems with imperfect colleagues and our imperfect selves. In the course of a day, it’s possible to notice a myriad of imperfections and think of hypothetical strategies to do things better. When we identify these challenges, we have an opportunity to share our ideas with leadership to bring about solutions.
However, we need to be thoughtful in our approach.
Fostering change and overcoming issues that we face every single day requires understanding an environment that thrives on human connection and productive dialogue. In order to make our work “work” for us, we need to learn how to have conversations with our leaders that not only identify problems without accusation but lead to collaborative support and execute sustainable change.
Here are four steps I take to have productive conversations with leaders:
1. Identify and understand the true problem. This is a step that a lot of people miss: We can see the frustrating things, but we don’t necessarily know what the actual problem is or why it is happening. Sometimes, doing a root cause analysis of a recurring problem can help to identify why something is happening repeatedly. In root cause analysis, continue to ask “why” until the underlying cause is evident. For example:
- Problem: Boarding times in the emergency department are increasing length of stay.
In this example, it is fair to Ask Why: “Why is that happening?”
Your care team’s response: “the admitting hospitalist is not coming down to admit.”
Ask Why: “Well, why is the hospitalist not coming down?”
Response: “Because the admitting hospitalist is covering the floor and admitting patients and can’t get down.”
Ask Why: “And why is that?”
Response: “Because two hospitalists left unexpectedly, and we didn’t have enough hospitalists to cover a night admitter and another to manage the floor.”
- Problem Source: Staffing shortages are leading to increased length of stay.
We have now found the cause for our problem and can better frame it to leadership.
2. Talk with trusted teammates. Take what you learned from step one and run it by a couple of teammates. Crowdsource what is really going on and find out from others about their perceptions and understanding of the problem you are trying to solve. Your request is more powerful when you can say, “I’ve spoken to four or five colleagues and they all agree and we have some solutions in mind.” It will also help refine your pitch to leadership, ensuring your evaluation of the problem and proposed solutions are airtight.
3. Request time with your local leader. Frame the meeting as an open-ended discussion to address local issues. For the conversation, focus directly on laying out the problem and your thorough, crowdsourced assessment of the problem. Create shared interest and position your and your teammates’ voice as advocates for patients, the organization, and the care team. Suggest a solution based on your understanding of the problem and the feedback you received from the team, in a manner such as this: “We have an idea that we think can work and benefit patients, the care team, and our group…”
4. Ask for their sponsorship of your solution. If this is something that requires resources, state what you think is necessary and be prepared to assure leadership that the solution will not compete with other priorities and instead offer compelling benefits. Request a follow-up as the next step. If this has to be presented to other leaders, offer to be a voice and advocate for your team in the decision room.
Having productive conversations with our leaders is a skill we need to develop so that we can effectively become active participants in solutions to challenges. How we frame the conversation with leaders often predicts the probability of action toward a solution. Understanding problems with deliberate thought to root causes, gathering perspective from teammates, and framing solutions with an ask for sponsorship is far more likely to get the responsiveness we seek. Have experience and/or tips to have productive conversations with leadership? Let us know in the comments below, or reach out to us on LinkedIn and Twitter!
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Stefanie Simmons, MD, FACEP is the VP of patient and clinician engagement at Envision Physician Services. She served as University of Michigan/St. Joseph Mercy core faculty and coordinated collaborative care between APPs and physicians. Currently Dr. Simmons contributes to emergency medicine, high performing teams, and clinician self-care curriculum.
