EP 15: Strategies for Retention and Respect in Healthcare

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Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break, breaking the cycle of bullying in healthcare one cup at a time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare, bullying, and incivility. I am your host, Doctor Renee Thompson.

Renee Thompson:
Hi everyone. Welcome back to the Coffee Break podcast as bullying and incivility exist because they can, and especially right now, we are in the middle of National Bullying Prevention Month. So it is our opportunity right now as leaders to learn the skills and strategies we need to stop it. And that's really what this podcast is all about, giving you the practical skills, the knowledge, the tools, the resources that you really need to stop the cycle of bullying in your organization. Today is an extra great day because we get to spend some time with Stacey Schaab, someone who I actually have only recently spent time with, gotten to know over the last not quite a year. Stacey is one of the ambassadors in our Certification Culture Change program, and she has just impressed me so much with her ability and commitment to truly establishing a healthy work culture. So, Stacey, welcome to the show.

Stacey Schaab:
Oh, Renee, I am just so excited to be here. Thank you for the invite.

Renee Thompson:
When I was thinking about who has really influenced me and who have I learned from, you're one of those people that a lot of the work that I do is really teaching and influencing and sharing and mentoring and coaching and all of those things. But equally, I learned from others. And again, that's really one of the benefits of me having this podcast, too, because not only do I get to learn from people, but I know the listeners get to learn as well. So, thank you again for being here. I'd like to officially introduce Stacey to let you know a little bit more about her background. In 2016, Stacey joined Inova Health System as Director of Quality for the Inova Mount Vernon campus. Stacey oversaw regulatory compliance, OPPE and FPPE, patient safety, quality, and performance improvement, and in 2019, Stacey became a Senior Director of Nursing at Inova Mount Vernon Hospital. Stacey's varied career includes nursing faculty administrator, social work consultant, television reporter, radio talk show host, and college instructor. Stacey is a certified professional in healthcare quality and a Certified Joint Commission Professional. Stacey earned her Nurse Executive Board certification as well as her Gerontological Nurse Board certification. She is a licensed nursing home administrator and a Six Sigma Black Belt in healthcare. Stacey was also invited to speak at Capitol Hill regarding rural healthcare in the United States. Just what an amazing journey that you have had. But before we talk, I have you have to tell me a little bit about being this television reporter and radio talk show host. Would you mind sharing with us all about that?

Stacey Schaab:
Not at all. I love to chit-chat can you tell? My undergraduate degree is in television, radio, film. And my goal was to be a television reporter with a focus in medicine. So now you know how everybody has all these combined degrees back then Purdue, which is where my undergrad is from. You had to take one path or the other. So it was television, radio, film, or nursing. So I went down the path of television, radio, film, and I just, I had the best opportunities ever. Honest to goodness. I worked at NBC for a while. Then I had a national syndicated talk show that was on Whoa, Whoa radio, huh? And. Well, yeah. Wow. Yeah. Somebody actually heard me. I think they were in Puerto Rico. They're like, I heard your podcast. Really? Did, you know? Cool. And what happened to me is I wasn't feeling like I was making a difference. So back then, there wasn't just medical reporting; it was reporting. And if you happen to catch something medical. Wonderful. I was doing a lot of general reporting, and I didn't feel like I was making a difference. I went back to what I knew, which was nursing homes. That's where I had started, 15 years old as a certified nursing assistant, way back when.

Stacey Schaab:
And that's where my path led me at that point in time. And I went back. I wanted to be a director of admissions because when I was on the floor, all those people did, they just went out to lunch every day, and it was just great fun. And then I got the job, and I found out, yeah, you really don't get to eat because you're busy talking and making the sale, right? Yes, I was doing that. And director of social work. I had so much fun; I truly did. And then I went down the pathway to get my administrator's license, which I did do, and I'm really proud. It was hard. It was really hard. And I had so, so much fun. So I think my career's a little bit backwards because I was over the director of nursing and, say, 200 nurses, and now I'm a senior director of nursing, just in a different area. But the fun thing was for that it made me very well-rounded because you have to know everything. You've got to be able to take care of the patient experience side but also deal with surveys. And I do love myself a survey like, do you? Oh, I'm telling you, I just, I love to memorize regulations and then.

Renee Thompson:
That's all you, Stacey.

Oh no no no no no no no no. That's, um, you know, and then put it all together. But, you know, when we talk about that, the one thing that I noticed was often when people want nurses to make sure you're following this 18in from the ceiling, but nobody ever says why. The reason is right. If something is blocking that 18in and there's a fire, the sprinkler is not going to reach everything.

Renee Thompson:
Wow.

Stacey Schaab:
I really like putting the why behind it.

Renee Thompson:
There is a lot of work done by somebody. His name is Robert Cialdini, and he wrote the book Influence, which I've read 2 or 3 times now, especially when I started this company. I knew my strategies worked, and I had a strong message, but if nobody heard it, if I couldn't get that message out to people, what good was it? So I read a lot on how to get your message out there, and I read a lot of his research that he's done. And to your point, this is something I think leaders could do that would make things easier for them and their team, especially when they'll say, it's hard to hold people accountable. People aren't holding themselves accountable for compliance things and competencies and all those things. Exactly what you said if, and he did this research, if you tell someone what to do and explain why they are like ten times more likely to actually comply. And even if you just use the word because, hey, I'd like you to do this because you can just the word because increases their chance. But it's so incredibly important to explain the reason behind why we're asking our teams to do the things we're asking them to do. So yeah. Spot on.

Stacey Schaab:
It leads me to my three E's. Are you ready?

Renee Thompson:
Three E's? Yeah.

Stacey Schaab:
Well, my three E's to live by. The first one is evaluate.

Renee Thompson:
Okay, so explain that.

Stacey Schaab:
Evaluate what the situation is before making any type of movement. So when you go into a new environment, just do an evaluation. Then my next one is educate.

Renee Thompson:
So, you evaluate the situation first. And you know what? It's so funny I just had a conversation today with a chief nursing officer. There's a challenging situation. Let me just say that. And I have a good relationship with her, that I could actually say this to her. I said, we hopped on a call and I said, okay, I'm trying really hard not to be reactive here. However, this is how I see this unfolding. Tell me what? And you know what, Stacey? I think if taking that step back and evaluating, assessing the situation before you act, before you intervene, is so incredibly important because there probably a lot of people out there like me who tend to be reactive, and it's something that I've had to work on over the years. So you evaluate the situation and then talk a little bit more about what it means to then educate.

Stacey Schaab:
Yep. Let me go back to evaluate a little bit more because just as you love to talk about animals when you speak, so do I. And I know I just love animals. So, the one thing I like to do is evaluating the culture. And I don't know if everyone has heard about the Seagull methodology. Have you heard about the Seagull methodology? But I bet as I tell you, you're going to go, wait a minute, this has happened. So the seagulls methodology is every day is going along well at the hospital, life is good, blah blah blah. All of a sudden, something terrible happens, and zoom, zoom, zoom, it's all these bosses that come in, and they don't evaluate the situation. All they do is say do, and then they leave. And sadly, I think we've all been in that situation before.

Renee Thompson:
Yes, we've experienced it on the receiving end. I know myself when I was a staff nurse, I had experienced it in my leadership team swooping in. And again, I think this is where I think it's so important that a leader knows themselves even taking a look where there's a challenging situation. I know my tendencies is to be a seagull and just swoo, but that's probably not the wisest choice. And to take a step back, I always say do that. Compensatory pause. Like with PVC, I'm an old cardiac nurse, so the compensatory pause and evaluate the situation first. I think that's so wise.

Stacey Schaab:
And then I think about educate and for educate I like to talk about fleas. Oh, you're in Florida, right? So you probably do have those little sand fleas.

Renee Thompson:
We have those they call them noseeums. And I don't know if I'm pronouncing it right, but these are tiny, teeny weeny little flies that will bite you. And what happens is you don't notice it until the next day. I'll never forget I was standing outside. It was during dusk, and that's when they're out there. And I kept feeling like I may be getting bit up, but didn't see anything. But the next day, when I woke up, my legs were covered in welts because that's what happens. They are brutal. So we have noseeums in and it's they're called that for a reason. Noseeums you can't see them. They're so tiny. But let me tell you, they pack a wallop.

Stacey Schaab:
The next day. Right?

Renee Thompson:
Oh yes. But yes. So fleas.

Stacey Schaab:
Fleas. What's amazing? If you put fleas into a glass jar, they can hop out. So please are known for hopping. Jump, jump, jump. Right? However, if you put a lid on top of the glass jar and it doesn't have to be a glass lid, it can be one of those mason jar-type lids. They'll hit their heads enough. And then what do you have? You could actually have a lot of fleas with headaches, which is true. Yeah, but then you also have fleas that will no longer jump out when you take the top off.

Renee Thompson:
Oh, because they've learned.

Stacey Schaab:
They have learned not to go above. And so that's one thing. When you're educating, and you want people to start thinking outside of the box, if they've come up with ideas before and they were pushed down, it's going to take them a little while to become comfortable and be willing to talk. Right?

Renee Thompson:
Yeah. This is so true. I hear this a lot when it comes to reporting disruptive behaviors to your boss. So we hear this all the time. We've told our boss all about this person and their behavior, but nothing has ever been done about it. Now they stop telling. They stop letting their leader know that these situations are happening because they've become complacent. Nothing's ever going to change, just like the fleas. But I never really thought of it from that perspective. But it's so true because if I come to you ten times and you either dismiss me ten times or I don't see any change happening because of it, I'm going to stop coming to you and stop beating my head up against the top of the jar.

Stacey Schaab:
It happens. It does. And finally, empowerment.

Renee Thompson:
Empowerment. And is this Stacey would you say everyone or are you talking primarily leaders or the team or both?

Stacey Schaab:
Well, you know what? I'm so glad you brought that up because so many people think if you walk around and you have a name tag or a title or large and in charge, and I think that's a mistake that a lot of us make, but we need to look for the informal leaders. So I'll tell you a story. The fabulous farewells we do here. And I sent you a couple of them. I know they are just wonderful. Since then, we've actually added a red carpet. Don't ask. We're over the top.

Renee Thompson:
Oh my gosh.

Stacey Schaab:
It all started. So I've been talking about we're going to do fabulous farewells and what's it going to look like? I didn't know, I just wanted to do awesome arrivals. Fabulous farewells. A clintech started going out with her own money and having a card made with the patient's name on it and how proud she was of them. And then everybody would sign the card. That's empowerment.

Renee Thompson:
It is. You're right.

Stacey Schaab:
And now we do that all over the acute inpatient rehab here at Inova. And it's that's where the magic happens. It doesn't happen in some executive suite. It happens when you're out with the patients.

Renee Thompson:
What you just said was so incredibly powerful because it's a part of our framework, our healthy workforce framework. We strengthen the organization. We equip the leaders, we empower the employees. Because when you can include those employees in anything that you're doing, culture change or trying to improve your collapse rate or Codi or you include them. When I think of shared governance and I think of and they're the common ones, but if you empower them the way you have empowered them to get involved in doing something unique, something that's not the standard that everybody does. Like your fabulous farewells. And what's the arrivals called?

Stacey Schaab:
Awesome arrivals.

Renee Thompson:
Awesome arrivals. So Stacey. So this is one of the things that I was so impressed with Stacey. She would share with me these videos of when they would have patients who were, you know, leaving the department and they would dance, and everybody would have fun, and there was food, and she would send them to me. I'm like, oh my God, this just made my day. Especially if I was having a rough day just to see so much joy from the people in that department. Can you talk a little bit about how you really infuse fun? And I love that it's attached to this empowerment.

Stacey Schaab:
I like that you brought that up because, like, it's all about having fun. We only live one life, right? And if you think about it, you spend more time at work than what you probably do at home. So why not have fun? The patient will get to choose a song that they like for their graduation. So we have had everything. We've had New York, we've had celebration. We've recently had somebody who was into heavy metal, not my seat, but it's okay, I can dance. Being so close to DC, we're very diverse, so now I can do the little Ethiopian dance. They do all their shoulder stuff and it's just it is the most fun. And when you talk about empowerment. So after that, so one of the nurses she bought pom poms for her unit. So that's okay I like having the pom poms. That's good. So then they started going into the rooms and singing Happy Birthday to the patients. If it was their birthday I'm like, oh anybody can do that. Any hospital can do that. Or even for me who's toned up, I still sing not well, but I do sing. When I was off last week, I got a little video, and we had a patient here that played the violin.

Renee Thompson:
Wow.

Stacey Schaab:
And he was taking his violin and to other patients to play their songs for them and to lift their spirits. That's what empowerment is. It's making that connection, and it's building the relationships.

Renee Thompson:
And I think this isn't something that, oh, just do these three things and your people will feel empowered. It's a culture thing. It's, I think, a combination of a few things. You have to have a leader who recognizes the importance of engaging their employees and truly designing a culture where people feel that they belong, they feel valued, they have fun. Because we all know this. Working in healthcare is probably more challenging now than it really ever was before. That doesn't mean you can't have fun or you can't make it a place where you can enjoy it, and you've done such a great job with that. Can you tell us a little bit more about the departments that actually do these fabulous farewells and awesome arrivals? These are rehab?

Stacey Schaab:
This is acute inpatient rehab. And so it's a short-term stay usually 1 to 2 weeks. And I would say everyone's looking on retention recruitment nurses. So, two of my units for this year you know what their turnover rate has been? Zero.

Renee Thompson:
Wow.

Stacey Schaab:
And the other unit is 7.69 for the year. And I can't fault him because we're in this area where we have a lot of military folks and a couple, the wives wanted to move with their husbands.

Renee Thompson:
There are some turnover that is understandable there. So you can't just look at the numbers when you agree. I know you're a numbers girl, but you can't just look at the numbers when it comes to turnover or retention, because this Stacey with the work that we do to address disruptive behaviors. Sometimes turnover is good. Turnover it is.

Stacey Schaab:
You know. It makes me think about Jim Collins. Good to Great. And I often think, do you have everybody in the right seat on the bus? And then sometimes you may have to get someone off the bus, and it's okay. It's not like decisions to terminate someone. They're always very difficult, always very difficult. But when the time is correct for them to move on, they're usually happy, almost relieved. Any person that I've had to terminate has always given me a hug, and we keep in contact still to this day because it just wasn't the right fit for them. And that's what it's really all about.

Renee Thompson:
And we had a guest. It was Randy Kern. It was the last episode that we aired. He talked about conflict, and he said something similar where you give your people an opportunity to become the best versions of themselves. You set those clear expectations. And I'm talking more so behavior here, but it's same with performance. You coach them, you help develop them, but at some point, they need to own their piece of it. And if they're not capable or not willing to meet those expectations, then it's time for them to go. And he also said that you give them a chance and you work with them, but in the end, they end up recognizing, yes, it is time for me to go. And they're grateful almost because you did show that you wanted to support them, that you were there to help develop them. It's almost like they terminate themselves.

Stacey Schaab:
They always terminate themselves.

Renee Thompson:
Yes. And I love the fact that you said they end up hugging you and you stay in contact with them.

Stacey Schaab:
Of course. Of course, if someone's not the right seat on your bus or they need to get off your bus, it doesn't mean that they're not worthy of being somewhere else. It just means that this was not the right place for them during that time. But I loved how you talked about setting expectations. I would say that is one of the biggest mistakes that managers make in today's world is somehow they think that everybody can read their mind. So you know exactly what I want. So I'm very clear with my nurses and clintechs, and that is I have two numbers that I like. I like zero, and I like 100. Nothing in between. So zero is zero falls zero hospital-acquired infections, and zero hospital-acquired pressure injuries and injuries. Yep. And 100 are for likelihood to recommend. Are you going to go out and tell your friends how wonderful your stay was here at Inova Mount Vernon Hospital?

Renee Thompson:
That's, uh, Net Promoter Score, right? Something like that.

Stacey Schaab:
Where is what they call it? Same thing.

Renee Thompson:
What people recommend you. You said something that you're so right. I think if you're listening to this and you're in a leadership role, it's don't make assumptions that your people know what your expectations are. Because as you said, Stacey, they're not mind readers. And it's being really clear to the point where we had another guest on the show and she said, if anyone in her department and I'll just say misbehaves, they all know they're going to be meeting with Kristen. They all know this because they know about her expectations for behavior. Somebody on our team, Diane Salter, Diane, she actually said the same thing recently where every day almost she's reminding her team about her expectations for certain things so that it is crystal clear and people aren't left wondering. And sometimes I think I've heard this from employees that sometimes they walk on eggshells around their leaders, or they're never quite sure what they're going to get, depending on the day. And that goes. That's the same for expectations that they have, too, 'cause they change their mind all the time and wait, I think today's we're recording this. I think it's boss's day today, boss.

Stacey Schaab:
Yes it is, I think this, and here we are. I talk about accountability as well and making sure that it's equal for everyone, but also putting it all into the context of just culture. Three parts to just culture. Number one is a human error. Number two is an at-risk behavior. And number three is reckless. So you've heard all this before, right? So human error just means I made a mistake. I think nobody comes to work. Nobody comes to work not wanting to do a good job. But it is possible to have a mistake. That's human error. And the hard one that people really struggle with is that at-risk behavior. So the two examples. Was I use is when you came to work today. How fast did you drive? Oh, I went 67. But what was the speed limit? Oh, 65. So you knew you were doing an at-risk behavior. In the hospital settings we have all the scanning now of the name band with the medication. So you opt to do a workaround, which, any time you hear the word workaround, just stop. That means something not good is happening.

Renee Thompson:
Right. This is an at-risk behavior.

Stacey Schaab:
Exactly. And then finally, when I talk about reckless, I always think of like a serial killer type. Something like this is something they're really. Or the angel of death. Remember those stories?

Renee Thompson:
Yes. Yeah, yeah, yeah.

Stacey Schaab:
It's on purpose. So with all those put together, then I always think about the second victim. So Doctor Elbert was the gentleman that came up and coined the terms internationally actually for second victim. Wow. And the best way to describe that is if a nurse gives a medication and it's a wrong medication to the patient, the patient is the first victim, the nurse is the second victim. And when I used to speak on this, it I'll never forget. I had a gentleman in the front row. He had been a nurse for 38 years, and he had made a mistake, and he never shared that with anyone until that point in time. And it just really makes you step back and say, healthcare. It's we're dealing with drips and IVs and giving blood. There's a lot of potential for errors. And even though we certainly want to set our staff up for success, we're all still humans.

Renee Thompson:
We are, and we talk a lot about psychological safety and creating a safe place for people to admit that they've made a mistake without fear of punishment or retaliation. And that's not easy, especially when you have people who are, as you said, at-risk behavior. They're not scanning, they're doing work around. They don't see that as potential farm until a mistake is made. And if we can catch them and have them stop doing those at-risk behaviors to prevent the mistake from happening to begin with. But still, what happens when you do make a mistake and there has to be a willingness of everyone to admit that they've made the mistake. And then as an organization, as a leadership team, being able to sit down with that employee. And you're right, they are the second victim and help them through that process so they don't end up like the gentleman in your front row who for 36 years or so made a mistake and didn't tell anyone. Could you imagine the burden, the heavy burden on them all these years?

Stacey Schaab:
I can't. I remember my medication error. I actually remember the date. And you don't forget those things.

Renee Thompson:
Well, I remember mine.

Stacey Schaab:
And it didn't hurt the patient, but it was the wrong medicine. And just knowing that I made that mistake, it sticks with you.

Renee Thompson:
Oh, I cried, and I gave somebody a medication that was supposed to be IM. I gave it IV, um, and called the pharmacy right away and they said, ah, check the vital signs. I'm like, already dead. They used to probably fine, but I cried and I was probably ten years, 15 years into being a nurse, I wasn't brand new. It happens. It can happen. And I was in a hurry. Didn't check, but it people who I worked with made it okay. They supported me. So I was able to process it and let it go as I made that mistake. I won't ever make it again.

Stacey Schaab:
And you weren't a good place for it. So that's good that you did have the support. So wow.

Renee Thompson:
We've really talked about a lot of different things. So just to do a little bit of a recap, we've talked about your three E's and I wrote them down so I wouldn't forget. It's evaluate it's educate and it's empower.

Stacey Schaab:
Correct.

Renee Thompson:
And I think when we look at what creates a healthy work culture, absolutely those are a part of it. We also talked about how not to be and I think this is part of it though, how not to be a seagull or a fly or flea, right? Because in doing so, it creates a culture where I think people can be reactive and not good at problem solving problems, and people don't feel empowered. We also talked about how to just interject some fun into your department, and I think that also goes with that empowerment. How do you empower your team to inject some fun and humor into their workspace? Because to your point, Staci we spend more time at work, I think, than we do with our at home, with our family and friends. We do. And is there anything else, any other actions? We have leaders listening right now who are on their journey to cultivate and sustain a healthy work culture, free from bullying and incivility. Do you have any other recommendations for a leader who's trying to do that right now?

Stacey Schaab:
I would say always look deeper, look deeper. There was a nurse that was always late for work. You may have heard this always late, always late, and late again. And they were going to write her up and that was going to be her final written warning. But the leader took time to visit with the nurse. What he learned was she came in the back door and on the loading dock, one of the deliverymen was having a heart attack.

Renee Thompson:
Oh my.

Stacey Schaab:
And she saved his life. Wow. So I say always look deeper, build the relationships. Because that's truly kind of what our entire world is based on, right? Friendships and relationships.

Renee Thompson:
Yeah, you're right. Very similar to when we say everybody has a story. And I've said this before, too, we're all born with goodness in us. But sometimes life gets in the way and we don't know what somebody's life is like. However, Stacey, you and I both know there is a point where you say, okay, you have a story, but when you cross the threshold of this workspace, it's got to be game on. And if you're not able to do that, then this is not a good fit for you anymore. So there's a tolerance for that. But I love that. Go deeper. Find out. Is there something else happening in this person's life that is creating what we all see when they come into work? And I think that's a valuable perspective that I think if leaders would recognize that before they react, this is going back to don't be so reactive, don't be a seagull. Just find out. First, ask the question. So thank you for that.

Stacey Schaab:
Absolutely.

Renee Thompson:
So I usually like to ask our guests if they're either reading something really great right now, or if there's a book that they would recommend that every leader should read. Do you have one of those books?

Stacey Schaab:
I probably know a lot. I have a lot, but I will tell you my favorite. I've actually seen him speak twice. Um, it's by John Maxwell and the 21 Irrefutable Laws of Leadership. I think it's just one of the most powerful books, and it's what I would call a bathroom read. So it's not hard, right? Kind of short and sweet, but the examples are just so powerful.

Renee Thompson:
I read this book years ago, and you're right, it was not complicated because some books you read and you're like, I can only read like one chapter at a time because it's so complicated. It makes me think too hard. And I like some of those books. However, this was very powerful but simple language that I think it's a great book and I've read it, and I may have to reread it because when I ask these questions, what book are you reading? I'm like, oh, I've read that. I want to read it again or I haven't read that one. So my list is getting very long. Thank you so much, Stacey, for being a guest on our show, and for just all the great work that you're doing to cultivate and sustain a healthy work culture. We so value you in the program that you're in with us and keep sending those videos because they bring a little bit of joy to my day.

Stacey Schaab:
It's the best part of my day. It's the best part of my day.

Renee Thompson:
It is to see those patients dancing and to see and some of them in wheelchairs, dancing. Okay. Some of them are just not capable. But then to see your team standing next to them, celebrating with them, it just reminds us all that there is still some goodness out there in healthcare, and we just need to embrace it and expand it. So thank you for that. And also thank you for listening and for doing your part to stop the cycle of bullying and healthcare. And if you enjoyed this podcast, we'd encourage you to follow us, subscribe, and to leave a review because that helps other people get to know that this podcast exists. And so as we wrap up, I just want you to remember that the way we treat each other is just as important as the good care that we all provide. Thanks everyone, and take care.

Renee Thompson:
Thank you for listening to Coffee Break breaking the cycle of bullying in healthcare one cup at a time. If you found these practical strategies helpful, we invite you to click the subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility. Visit Healthy Workforce institute.com until our next cup of coffee. Be kind, take care and stay connected.

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