Monthly Archives: July 2015

Leadership

Communicating: some wise advice from Lao Tzu

For a leader one of the toughest challenges is communicating. Getting right the what and the how, the who and the when and even the where isn’t easy.  In certain situations, there is no perfect way.  Sometimes it’s not just what is said or how it’s said, but who is saying it that matters the most.   Effective communication starts with the speaker, the leader: their credibility and the level of trust the team or organization has in the leader.

Over the years I’ve worked hard at improving the effectiveness of my communication. With patients and families I’m effective most of the time, but there is always room to improve – the approach to communicating needs to be tailored to the individual, as well as the situation and circumstances – and that’s hard to get right every time.   Even within one episode of communication, the approach needs to be fluid.  This takes emotional intelligence and practice.

Lao Tau has some advice for communicators.  Lao Tau said, “He who knows does not speak.” He also said, “Practice doing ‘not doing’.” These two tenets of Daoism need to be front of mind when a leader is communicating.  He is telling us to listen – do more listening than speaking.

One can gain many lessons about communicating from Daoism. Daoism encourages one to consider that the whole is real and the divisive is perceptual.  A single idea or opinion cannot be good or bad, because that would place judgment, which is a comparative and perceptual approach not a synergistic or uniting one. To throw out an idea would threaten the balance of the whole.  Lao Tzu said, “Long and short complement each other.” Meaning you can’t have long unless you have short.  In communicating, one would do well to remember that nothing is really new, or better, or old or bad, it simply is, and whatever it is complements and colors the conversation, making it more whole, more real.  To do this takes listening.

Nevertheless speaking must be done. It’s what people expect from leaders. My first goal when I speak is to drive common values and principles, to align thinking and actions, and to motivate effort towards a shared vision.  In other words: be inspiring.  My second goal is to be a sensemaker.

It is the job of the leader to bring order to the whole in order to influence the group to reach their shared vision. This is called sensemaking. A leader must do it well and communicate it well to be a good leader. Lao Tzu said, “What is a wise man’s job, but to make another wise.” A leader’s job is to create wisdom for all. Great communicating requires a humanistic approach, which results in an increase in collective wisdom.

Quality & Safety

Tackling Task Saturation

Task saturation is the phenomenon whereby one’s brain becomes overloaded with significant information or stimuli and begins to fail itself. Task saturation often happens to a person when there is a crisis or when they are multitasking or when there is more to do in a given amount of time than is possible. Sounds like healthcare to me.

Pilots and nuclear reactor operators have developed methods and tools for overcoming task saturation. The most prominent are: 1) checklists, 2) mutual support, 3) crosschecks, and 4) huddles. Over the years, I’ve seen these things work in healthcare, but I’ve not seen them used as often as they could.  Crosschecks include double checks with colleagues, and making sure that all key indicators that will allow for effective sensemaking and situational awareness are being monitored.

Checklists exist in healthcare, but not often for crises or when the system is overwhelmed. Mutual support exists, but it’s often not there at times when it’s needed the most. Crosschecks are also used, such as in structured code situations, but they aren’t used enough. Huddles are increasingly being used, but often the time when they aren’t is when task saturation or a crisis is occurring. No one wants to take the time out to do it.

EMRs can be used to provide checklists, reminders and crosschecks. Working in teams and having huddles can provide mutual support. Having the collective discipline to stick to these principles when they are most needed is critical. Having “practiced” as a team with “learning” (debriefing) as part of the process is helpful.

The best medicine for task saturation, of course, is to avoid it from happening in the first place. Nevertheless, it happens enough in healthcare that it would be best to be prepared. How does one avoid task saturation? There have been examples where variability has been reduced despite the notion that variability in demand and volumes can’t be controlled in health care. Surge plans, flexible staffing, flexible roles, and early warning systems are all examples of preventing task saturation.