EP 33: Innovating Health Systems and Combating Toxic Leadership

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Intro/Outro:
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, Dr. Renee Thompson.

Renee Thompson:
Hi everyone! Welcome back to the Coffee Break podcast. Wherever you are, I hope you're having a great week. Okay, you all know bullying and incivility happen because they can and it really takes dedicated leaders like all of you to do your part, to take action, and stop it. And today we're going to take a different approach to looking at addressing workplace bullying and incivility by looking at, dare I say, toxic leadership. Today, we're talking about you, and we're going to discuss this under the umbrella of innovation and change. And when I think of innovation, there's no one I think of more than Dr. Dan Weberg. Dan, welcome to the show.

Dan Weberg:
Thanks for having me. I'm excited to chat with you today.

Renee Thompson:
Oh my gosh, Dan and I were talking before we pressed record. The first time Dan and I met each other, I think, was in 2020, when Dan was on the editorial board for the Nursing Administration Quarterly, and they were looking for authors to write things that happened during the pandemic. Dan reached out and said, we'd love an article from you looking at teens and disruptive behaviors, and did they get better, did they get worse, and what does that look like? Since then, Dan and I have become colleagues and friends, and we have been chatting and laughing about this. I see Dan everywhere, and Dan sees me everywhere. It's just really fun. You know someone, or you meet them virtually, and then you see them in person again, everywhere. But to tell you a little bit more about Dan, he's worked in many large health systems and start-up companies to help build the future of healthcare. Dan is a fellow in the American Academy of Nursing, so proud of his work, and that organization is just amazing. He's also the author of two textbooks focused on leading change and innovation in healthcare. And so, Dan, as we started this conversation, we turned the mirror back on leadership. You've been working at a lot of large health systems. You had to have encountered some leaders who were like, oh, baby, you're part of the problem. So, can you tell us about your work and tell us a little bit about this whole idea of this toxic leadership?

Dan Weberg:
It's such an interesting topic, and it stems from a personal experience. We ended up writing a whole book chapter on it, and we put it in chapter 13 of our leadership book just to double down on the fact that toxic leadership is not great. Still, I had a leader in one of my organizations who was this erratic behavior, inconsistent, made these sort of awkward off statements. I'm so glad I don't have to come to this meeting anymore, and it was our team meeting. And because they had hired a VP to come in and do that instead, it just always challenged my values, and what I learned and valued in my leadership. And so I was trying to put language around it. I'm like, am I missing something, or is this normal? Like, where am I at? And I'm growing my leadership development. I was in this middle career, middle management, and senior middle management role, and I just couldn't put my finger on it. But I felt myself getting physically upset. I noticed I had changed my behavior at home. I changed my behavior at work. I would avoid that person at all costs. Every time an email came in, I was frustrated. I would already assume that it was going to be a bad thing in that email, and I just couldn't put words around it. So, I started looking at the literature with a colleague who's in a different organization and is experiencing similar things. We found this whole body of literature around toxic behavior, toxic leadership, and toxic teams. We ended up diving into it because we wanted to know what those behaviors were. For me, I was seeing it impact innovation. So it was impacting the needed change in the organization was needed to do with and it was stopping. It was causing people to focus so much on the day's drama rather than getting the work that needed to happen done. And I just mixed the innovation and the leadership piece together, and I was like, I got to figure this out. So, we ended up doing a lot of research on the impacts, and it turns out it's really bad to have toxic leadership in your organization.

Renee Thompson:
Yes, it's interesting because most of the work that we do here at the Healthy Workforce Institute focuses on equipping leaders with the skills and tools that they need to address bad behavior with their employees. However, Dan, you and I both know that sometimes, as I mentioned, the leader is the problem, and it bothers me so much because I'm this advocate for leaders, and these poor leaders are getting beaten up by their employees. But then I never forget that the people, the employees who have reached out to me to say my leader is the problem, my leader is the bully, and you're so right. When people tiptoe around their leader to the point where, oh my gosh, when you get an email, I'll get like a knot in your stomach because you expect it to be bad, there's no way you can create a space for innovation. So tell us a little bit about what you've discovered in really looking at leadership like toxic leadership and innovation versus, I don't necessarily want to use the word authentic leadership, still, somebody's a leader who people trust in their own thing.

Dan Weberg:
Yeah, even in my doctoral work, I studied the beginnings of this, and I looked at the literature on leadership behavior and its impact on creativity and change. And I wrote an article for Nursing Administration Quarterly about staff burnout related to transactional leadership versus transformational leadership. Transactional leadership is carrot and stick. You do something good, high five. You do something bad, we reprimand you. Transformational leadership elevates people, builds the team up, takes work together, and that kind of stuff. What I ended up finding in that literature review was that not only did transactional leadership impact staff burnout negatively, but it also impacted patient outcomes. And so, in organizations where you had a transactional leader on a unit, the mortality and morbidity of those patients went up. And so that now I'm like, all right, we're into the nurse-sensitive indicator piece here. We have to figure out if, like what resumed when you talk, you hear these things about nurse-sensitive indicators. If there's a fall, if there's an infection, if there's a central line issue, as we rally around that, and we fix it, and we go to zero. But when we have this sort of awkward, toxic leadership behavior, like, oh, that's just how Dan is, You just got to get to know Dan, and we dismiss it off. There's evidence to show that not only does it increase all the bad stuff with our team turnover, avoiding the person leaving the organization, but it's also hurting our patients. And so, my sort of burning platform now is that we have to identify what these behaviors are and hold leaders accountable for them. Otherwise, we're going to be hurting our organization. So, some of those behaviors are leaders that completely avoid conflict. So they let those rumors and those things fester. They create in-group and outgroup rivalries. This is all that you do at the Healthy Workforce Institute. It's all the same stuff. It's just that the leader is creating these divisions now. What we ended up doing when we looked at this was we looked at it from a complex systems point of view, and in complex systems, it's all about where attention and energy are focused with a team that's working on something. And what we found is that energy and focus moved away from the work and got sucked in what they called an attractor or a magnet. It magnetizes people's energy to that toxic leader, and so they spend all of their time trying to figure out what's going on. They never know where they stand. They can't make decisions because they fear they're in this fear fight or flight fight mode all the time. And so we started giving language to that and really kind of tie it to patient outcomes, organizational outcomes, and then holding leaders accountable for that behavior.

Renee Thompson:
You know, I've written down several things I want to go back to transactional versus transformational. Our mutual friend Rose Sherman, she wrote a blog article about this not too long ago. Actually, I'll find it and put it in the show notes. It was thoughtful, and it helped me to understand, too, that there are times when a leader does need to be transactional, and usually when it's a crisis situation. But we find that some leaders act that way if they're in crisis 24/7. You've heard the example. If all you have is a hammer, everything looks like a nail, and they're like pounding it, and they're creating this culture where people are afraid, and they will tiptoe again around that leader. And we talk a lot about how a leader approaches their day. When they first walk in, their team is watching them to see their mood, especially if they have felt that in the past. They've walked on eggshells. You talked about attention and energy. If your boss is in your department and is a toxic leader, do you think you're focused on patient care?

Dan Weberg:
Administration or anything else? Honestly, I wasn't in patient care when I had my toxic boss, and I couldn't even answer the emails without being frustrated. So it impacts all work.

Renee Thompson:
It does, and it takes so much energy away from you. And because many people don't feel comfortable or willing to have an honest conversation with them because of retaliation and everything else, they have to get it out of them. So they talk with their coworkers about it, and then you have the gossip, the triangulation, and the drama, and all of the things that always remind me. These are all distractions to the work, taking the energy away from what we're supposed to be doing. And so all the research that you've done, what would you say if somebody's listening to this and if they're like, oh my God, that's, my boss. Everything you're talking about, that's my boss. I don't know, Dan. What would you recommend? What are some strategies to maybe you can't fix them, but how would you at least be mindful of the fact that I'm not willing to allow this person to affect me to the point where I can't concentrate on my work?

Dan Weberg:
I think that's the big question. We came up with a couple of approaches. Actually, in our next book that comes out in September, we've updated it with a whole section around empathy. We're just trying to understand where that leader is coming from because they're in a dark place as well. If they're acting like this and having that sort of human-to-human relationship, but I think the first thing is boundaries. So you hinted at it. You have to have boundaries, and you have to realize that work is work. And if you have these sorts of behaviors impacting you in that time frame of work, trying to just and nurses are really good at this, and it's not the healthiest thing, but just try to compartmentalize it. Because what I found is it bled over into my personal life as well. And I'd be unable to sleep or be short with my family because I was so frustrated with something and just trying to say, like, they're not the problem. This is happening here, and I'm just trying to at least separate that just for your short-term sort of mental health and relationship health. Then, we came up with three approaches that you can take in an escalating fashion. The first one is you have to have a conversation about it. If you don't have that conversation, even if it's just, hey, I feel uncomfortable around you, or whatever that crucial conversation is, you got to address it. Because if the leader doesn't know it's impacting you, maybe they'll change. Maybe they're not even aware of it, maybe they are, but you won't know that unless you at least have that initial conversation. The second piece is if that doesn't work or that's unsafe in some way, then you can go with a group. Ask your colleagues, are they experiencing similar feelings, similar behaviors, similar sort of stress around that piece, not to triangulate or bully or sort of, you know, push people out, but to just check and make sure that this is a behavior that's happening all over the place, and then you can go with that team, maybe, and say, hey, we're just really not feeling this. These behaviors are impacting us in some way or you can go to like the HR team or somebody else that's trusted that you can have that conversation with. And then the last one is you have to decide if it is worth it. The data shows it will impact you personally, your health, your mental health, your physical health, and your work. And so at some point, if you've tried to address it and it's just not being fixed, you've tried to go up and use all the channels that you have, and it just isn't going to change. You have to make the decision to either stay and deal with it and fully compartmentalize it and just grit through, which I don't recommend, or find something else, either in that organization or somewhere else. And if it's a nurse that you have 30,000 open jobs in the country right now for nursing, you can find another role likely. It's not the easiest thing, and there are lots of factors to consider, but at some point, you're going to have to cut it off because it will impact the rest of your life.

Renee Thompson:
100% true. I want to talk a little bit about that initial conversation. We say this all the time. You can't expect anyone to adapt their behavior if they're unaware that their behavior needs to be adapted. And we make all sorts of assumptions that, of course, they have to know. They come across as abusive, aggressive, and condescending. And maybe not, maybe no one has actually sat down and had an honest conversation with them. And I so agree that's where it starts. Hey, I want to talk to you about something and even say, I'm uncomfortable bringing this up, and it might make you uncomfortable, but it's important that we have this conversation. Sometimes, you come across, this is how I feel. But then I'm so glad to hear you say sometimes it's not worth it. And I have recommended to some people who have reached out for help that they leave their organization, and if they've done their due diligence, they've had the conversation, they've reported it, and they've done all of that, or maybe they can't even do that because they're in such an unhealthy state. Then you've earned your right to leave. And then people say, then you let the bullies win. You know what? Sometimes, you just have to let them win because it's not worth your mental, physical, emotional, or spiritual health.

Dan Weberg:
Yeah, and it's not winning against the bully. Honestly, what are you going to win? You get him fired. Is that winning? I think it is about getting the work and aligning your values. And if your values are challenged every single day, it will create grit for you. And that's why we see a lot of this burnout is because people's values are being challenged every single day with the interactions they have with their team members. You can't live in that environment very long.

Renee Thompson:
You can't. And when you have a leader who doesn't recognize that and doesn't honor the values, you have your organizational values but then your own personal values. And when you think about it, all of the organizations that are out there and they have their values, integrity, respect, and all of that, those are human values too. They're not just a value for this healthcare organization because they're all pretty similar. And if you have a leader who isn't demonstrating those just key human values, then it stops everything. It does. And for you to check what you're like, I always say, what are my values? Who do I aspire to be as a nurse? And am I going to let anyone else affect who I aspire to be? But I think that helps ground you, too. And kind of being like on the reactive end or the passive end of someone toxic, you can reinforce these are my values. And as you said, Dan, set boundaries. This is what I'm willing to put up with this. And this is what I'm not willing to put up with because we want to be able to go home to our families and our friends and function, at least semi-function, as a human being.

Dan Weberg:
It's way more important than what happens at work.

Renee Thompson:
So, like, they're the ones that come home from work, and I'd be twitching for the next couple of hours.

Dan Weberg:
Totally. My wife should be on the podcast. She could describe all the things that went wrong when this was happening.

Renee Thompson:
Yes, because there's no way you can completely separate. You can set boundaries and healthy boundaries or smart to do anyway, even if you don't have a toxic person that you're dealing with, just setting some boundaries with the world, with society, I think in general is pretty healthy. Dan, can we talk a little bit about your work with innovation? I am fascinated by your work because it's not my strength. Innovation is not my strength. I always admire people who are different than me or their gifts that are different than my gifts. So, tell us a little bit about your work with innovation, especially when we look at healthcare and the nursing profession.

Dan Weberg:
Yeah, my whole career has been about how we use new care models and technology and just really rethink the healthcare system to build it into where it needs to go for the future. Healthcare started in the Industrial Revolution model, and it still is very much set up that way with service lines and hierarchy and all this stuff that comes from our history. We need to move it into more of this complex system where there's not that much of a hierarchy anymore. Because healthcare is so complex, everyone has a role to play in it. And so, really trying to look at how do we change that paradigm. And it's been fascinating, everything from what kind of emerging technology is coming out that can support nursing work and give us superpowers, things like AI and Google Glass, and all of those things that we see in the media, but how do we translate that into disruptive change within the healthcare industry? And lately, I've been speaking a lot about this idea of our blockbuster moment and not a Top Gun Maverick blockbuster, but like Blockbuster Video. Healthcare is at this precipice, right? Blockbuster Video had 9000 stores. They were opening a store every seven hours. And then they have one, and it's in Bend, Oregon. And it's also an Airbnb because they did not adapt to the changing conditions of the environment around them, and healthcare is right there. We have all of these new entrants coming into healthcare: Amazon, Google, Walmart, for a little while now. Walmart's out, but all these other places are coming in saying you can't fix yourself; we're going to blow it up for you. And what I see from legacy healthcare systems or traditional systems is they can't do what we do, so we're just going to keep doing what we do, and that's what Blockbuster said. I keep seeing these towers built with new inpatient beds and all this stuff. As I see the trend of care moving to the home and remote monitoring and virtual care, I feel like we need to have a different approach to how we build our systems of the future. And so I've been really fascinated about how do you lead that type of change, what are the leadership behaviors of that sort of transformational change? What can we learn from outside of healthcare? And some sort of, it's a weird term but futuristic stuff. What are these trends telling us that in 5 to 7 years, we need to be ready to do? So that's been what I've been focused on and all the aspects of leadership that allow for those conditions of novel change to occur.

Renee Thompson:
Yeah, and you're facing a current that wants to go the other way because how many times have we heard that's just the way it is here? This is the way we've always done it. So, Dan, you're asking people to think very differently and to go into a future that's really unknown. And there's a lot of uncertainty with that. People go to their fear response, oh my God, what does this mean for me? So you're asking people to change their mindset and what they're doing. And we all know that change is very difficult. It's a little bit about how you're working with; I'm not even going to say teams. This is the entire nursing profession, the physicians, the entire healthcare system, to help them to see that we don't want to become a blockbuster. We want to be Netflix. We want to be proactive and not reactive.

Dan Weberg:
The first thing I start with is when I do my keynotes and stuff, I ask the audience, what was the burnout rate 2017 for nursing? Just as an example, there is, I don't know, 30%. I'm like, no, it's 56%. And then I hear people through after COVID, oh, we need to get back to pre-COVID. We need to go back. So I try to start off with the data on where we're at. We have 50% of our nurses with worsening health. We have 29%, in a study we did with Doctor Burn Melnick, have clinically relevant depression symptoms, increased alcohol intake, significant stress, and clinically significant anxiety symptoms, like we're not in a good place. And so, why would we want to keep doing the things that we're doing? It makes zero sense. It's, let's just keep taking the poison. And so I think starting with just opening people's perception to what's actually happening with some of the data related to it and then trying to translate it into when I think people hear innovation, they're like, oh, that's some big new technology. The new MRI machine, the new robot, and all that. That's beyond what I can do as a nurse. But when you look at the literature and innovation, novel change happens in the micro-interactions we have with people every single day. It's the conversation you have at the water cooler that sparks an idea for a practice change that then gets implemented. Those are the things that you can do. And so I try and really relate it back down to all levels of an organization to say simply by the way you talk to each other, how you have conversations around change, around initiatives around where you think things should be that can catalyze amazing things to happen. There are really three rules to innovation. They're really simple. The first one is you don't have to be an innovator to lead innovation. So you need you don't have to have creative ideas to help people and facilitate teams to have novel solutions. But you do need to know what innovation is—subscribing only to performance improvement Lean Six Sigma or only to design thinking. Those are two religions that we have in the changing world, but you need to know both because they're used in different ways. So, you need to understand what innovation is. But you don't have to have a creative idea. The second rule is you have to have capacity and create capacity for innovation so that is time. That's resources, that's language. That's even just saying what innovation happened this month at a staff meeting. Like, what change did we make? So, just bring that language in regularly so people understand that we're changing all the time, and innovation is just another type of change. And sometimes it's a little bit bigger or gets more press or something, but we're changing our practice all the time. That's what our professional obligation is and so it's part of our professional practice to do it. Let's teach our teams what change is like and how they can lead it themselves. And then the third one, which is my favorite is leaders are deviation amplifiers. And so when we see this, it is my favorite one. When you see a nurse on a floor, for example, who's got all her patients tucked in, they've got all their meds delivered. The charting is done. She's like reading Time magazine or whatever at the nurse's station while everyone else is running around crazy. That nurse has figured something out differently. And so let's learn what they're doing and how they've gotten everything handled while the rest of the team hasn't, and start amplifying that deviation behavior. It's a positive deviation from what everyone else is doing. And so leaders need to be constantly looking for what are those different practices. Sometimes, they're good workarounds. Sometimes, they're just someone who has a different approach and starts amplifying that practice rather than trying to address the poor practices over here. And if we can amplify the good stuff, then people can see, and they learn from their peers. There's literature to say that we will adopt that change more effectively if it's grown within the same environment that we're working in. So if we can follow those three rules, change becomes not this magical technology thing. It becomes just the way we interact with each other, looking for those best practices and amplifying those over time.

Renee Thompson:
You brought up a really good point. Even myself, I think I have fallen into this trap of when somebody says innovation. I think it has to be technology. I think it has to be some AI to facilitate it. There has to be something that's major. But what you're saying, Dan, is it doesn't. It can just you can pick up innovation in just the conversations that you're having with your peers. And that's what I love about professional governance, too. You're in your group of people together to say, how do we make it better here? And you're pulling in people who are very different, and I love this on my team; there were about soon to be 13 of us, and there's someone on my team. Her name is Celeste. She's our client care coordinator. She is very innovative. If we're having an issue with our contact list distribution list or how we do things, So I'll figure it out. And she found an app that allows her to schedule my meetings for me without going back and forth with the client, like this app. It's like magic. It helps her. It cut her time in half because she's managing my calendar. It's like a full-time job, but it's having people on your team who think differently and are willing not to just say, well, I know scheduling meetings is tough. Yeah, you just got to hunker down and get her done.

Dan Weberg:
Just make the phone calls.

Renee Thompson:
No, there's got to be a better way. And I think everything that you're talking about for innovation, novel-looking solutions, giving them the capacity, and this deviation amplification, it really all starts with asking the questions like asking good questions instead of that's just the way we do it. What if we could make it better? What could it look like? And the work you're doing right now, especially right now, is so incredibly important to the future of healthcare. And if we don't step up and become part of this change, yeah, the Amazons and the Walmarts and all that, they're going to do it for us. Why don't we do it? As we wrap up, and let's say you've got somebody listening right now who is dealing, we talked a little about toxic leadership. And so you got to take care of that because it is impacting everything. But if someone wants to go back to their organization and say, let's take a look at how we could be more innovative, would you recommend maybe a first step for them?

Dan Weberg:
I think that the first step is what you are trying to achieve here. What is your end innovation? Because I see a lot of people want to do innovation for the cool shiny thing or the hackathon or the whatever the process, the post-it note day or whatever, what outcomes are you trying to move? And that really should drive your innovation initiative. So when I work with an organization, the first thing I ask is, what are your strategic pillars, and what's not working? And then that's the space where innovation needs to happen because, for the most part, innovation needs to be aligned with where your organization, your team, or your group is moving to, and then about 10% or 15% can be this, let's see what happens. Let's play around in what they call the blue sky space. But it really should be aligned because then your organization is more willing to resource it. That's where people fall down in the resources. So try to align the problem with the strategic pillars and then figure out where you're trying to go with it. And then I would say you got to learn about innovation. And it's not the Post-it note party where you vote on things. And then the most voted-on post-it note wins the day; that's like step one. And so our understanding of the entire life cycle, from ideation to testing to trialing and piloting to implementation, and what we call productizing, the innovation, like, that's a whole life cycle that you need to understand in order to be able to do it. And people get caught up in the idea generation as like what innovation is. And that's the very early first step. So I think just looking at stuff out there, there are great resources at the American Nurses Association that have an innovation resource kit on their website. You can go to my website. There are books out there. And so, I am just starting to get a little bit of dabbling in what innovation is and then thinking of it as a process, not a day. And you wouldn't do performance improvement in one day and just do a fishbone diagram. Be like, we're done, and we fixed it. You have to plan out that process. And just being willing to make sure this is a long process. It could be months and even years sometimes to get to the end state, but approaching those problems and problems identified. Then, really, just creating your co-conspirator network is the last piece. So get on LinkedIn, get on TikTok, find the people who are doing the work that you're interested in, and reach out and start sharing notes, and that sort of conversation creates novelty over time and gives you a bunch of resources. So that would be my approach to it.

Renee Thompson:
Wow, very powerful. I love how you started with what outcomes are you trying to achieve. You have to know what direction you're going, what are you trying to accomplish here? And then really taking a look at and love that you said that whole alignment because a lot of innovation requires resources. And if you can align what you want to do with the strategic goals of the organization, looking at outcomes, it'll be easier for you to do that. And you're right. Just like myself, I'm not as equipped to understand what innovation really means as I could be. And so, just to learn and you mentioned your website, how can people connect with you? I know you're on LinkedIn.

Dan Weberg:
LinkedIn is my spot. I used to be on all the other things, and I think I have accounts there, but I spend most of my time on LinkedIn. That's where my crew lives. That's where my audience is. And so you can follow me there. I speak a lot, and I teach at Ohio State, so you can find me in those places as well, but LinkedIn is where I caused the most problems.

Renee Thompson:
In the show notes, we'll have a link to Dan's LinkedIn profile and also his website. Dr. Nurse Dan and I were actually on there a little while ago checking it out, and there's some really great information there, so I highly recommend it. And if you're looking for someone to come in and speak to your organization about innovation and change, Dan's the guy. And it was funny, I was thinking about this and even telling my husband, oh yeah, I'm interviewing Dan today. Dan, I said, Dan Weberg, you know, I said, he's just a cool guy. He's a cool guy. Dan, I just want to thank you so much for being willing to be a guest on my show, and just for all the work that you're doing out there to truly make healthcare a better place.

Dan Weberg:
I appreciate that, and the same goes for your work. I think stopping this toxic culture that we see bubbling up within nursing is the first step for us to come together and change the world. And so, I think it's needed work, and I just appreciate the opportunity to to chat again with you.

Renee Thompson:
Yeah, yeah, I'm looking forward to our next conversation. So, thank you again for being here. And I want to thank all of you who are listening right now and for doing your part to stop the cycle of bullying and incivility in healthcare. And if you like this episode or you like my podcast, you could please give it a review, rate it, and then share it with others who really might need help to address workplace bullying and incivility. We appreciate you. We're glad you're here. We'll see you next time. Bye, everyone!

Intro/Outro:
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 HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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