I write all the time about the need to have difficult conversations more effectively and what makes it hard. Hard in this context may involve telling something that’s difficult to say. But it also means listening to things that are hard to hear. And doing all of this in a way that improves relationships, instead of eroding them further.
When this doesn’t happen research shows a serious negative impact on morale, productivity and the bottom line. And in some cases it’s even more important than that: it can kill.
We heard recently about a London hospital unit that was consumed by a ‘toxic’ work environment among surgeons. According to the leaked report by former NHS England deputy medical director Mike Bewick, the south London facility had a cardiac surgery death rate of 3.7% - well above the national 2% average.
What went wrong? The report points to internal politics with inadequate scrutiny, to a department riven between ‘two camps’ exhibiting ‘tribal-like activity’. Staff members said they ‘felt that there was a persistent toxic atmosphere and stated that there was a "dark force" in the unit’.
And yet nobody did anything? It’s not good enough - we have rights and responsibilities and we need to exercise both. Doctors (and indeed leaders in all walks of life) say ‘Show us the data and we’ll take it seriously’. Well the data is there: according to a study in the journal Pediatrics, a rude comment from a third-party doctor decreased performance among doctors and nurses by more than 50% in an exercise involving a hypothetical life-or-death situation.
‘We found that rudeness damages your ability to think, manage information, and make decisions,’ said Amir Erez, an author on the study and the Huber Hurst professor of management at the University of Florida. ’You can be highly motivated to work, but if rudeness damages your cognitive system then you can’t function appropriately in a complex situation. And that hurts patients.’
So we know that how people communicate with each other has an impact on results and we also know, in the case of doctors, that if they can communicate effectively with patients they are less likely to be sued. This seems like something we should really get better at.
So why isn’t it happening? The same reason it doesn’t happen in other organisations. It’s hard. It involves lots of work, over time, and often dealing with egos that don’t think they have anything to learn. Or, if they do, it can’t possibly be that important.
It’s not a good enough excuse. Those who ‘get it’ need to be more vocal and organisations need to put their money where their mouths (or slogans) are. Don’t send your people on a one-day training programme and expect that to fix things. It’s important - work at it. Teach the behaviours explicitly, hire for them, train for them, get rid of people who won’t show them and create a culture where what’s being said is more important than who’s saying it.
Hierarchy is necessary. And I understand it’s necessary in healthcare. But following the chain of command doesn’t mean those at the top can bully those below them and it doesn’t absolve those at the bottom of responsibility for their behaviours either. Hierarchy tells us our roles and responsibilities and one of these, no matter where you sit, is to put the organisation’s desired results at the heart of what you’re doing: in the case of healthcare that result should be patient outcomes.
And don’t think that if you’re not in healthcare this doesn’t apply to you. The lessons here are relevant outside of medical settings - of course your situation may not involve life and death but the impact on cognition of rudeness is everywhere and why sap away mental resources when you don’t have to?
The science is clear: how we communicate matters. It can improve but that takes work. If you don’t work at it the tendency is for people to create factions and develop a culture of fear. And yet the report had to be leaked so clearly there’s some way to go before there is a real commitment in the NHS to dealing with this problem. And I’m worried that the same is true elsewhere.
Dawn Metcalfe is an executive coach and author of Managing the Matrix.
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