EP 60: Building a Culture of Change: Practical Strategies for Leaders

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Dr. 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, Dr. Renee Thompson.

Dr. Renee Thompson:
Hi everyone! Welcome back to another episode of the Coffee Break podcast. Wherever you're listening to this, or maybe you're watching this, whenever that is. I just hope you're having a great week and all right. Have you ever tried to change something at work? Maybe change a process, change the way you do things, and then you meet the gang of resisters, the naysayers. Wow. If that has ever happened to you, today's going to be a great day for you because that's exactly what we're going to talk about today on the podcast. We're going to be having a chit-chat with Dominic Petrovia, who's going to tell us how to actually mitigate those issues. So Dominic, welcome to the show.

Dominic Petrovia:
Great. Thank you so much, Renee. I'm very happy to be here.

Dr. Renee Thompson:
Yeah. Dom and I met each other at the Synova NICU Leadership Forum conference of gosh, I don't know, was it April? I think it was March or April, and he and I were in line waiting for them to give out prizes. And we were just talking, and he was telling me about all this really great work that he's done in change management, and as a nurse, he has seen his share of bullies, and naysayers, and resisters. So I said, all right, Dom, we need to have a chat about this. So let me tell you a little bit more about Dom. He has over 15 years of clinical practice and leadership experience in the NICU pediatric space. He has a lot of consulting experience in team building and transition planning, and he currently serves as a senior leader at Keriton, a platform that supports feeding, safety, and nutrition analytics in the NICU pediatric space. So, Dom, I want to know a little bit about the work that you're doing at Keriton. And then, we'll shift into change management and how to tackle these naysayers. But tell me a little bit more about what you do at Keriton.

Dominic Petrovia:
Sure, absolutely. Thanks, Renee. So at Keriton, I serve as the chief subject matter expert, a key opinion leader for our company. In healthcare technology, it's always important nurse to nurse that we have a nurse at the table making those decisions with the rest of the senior leadership team. So, part of what I do in my role is not only just business development and outreach, but also assuring that our platform is performing to its utmost to support nursing leaders, clinical nutrition leaders, as well as the end users. Because as we know, as we get into, change is hard, especially when it's new technology. So, we want to ensure that our workflows are efficient as well as safe. So what we really do is, again, provide quality analytics data for our leaders, as well as workflow efficiency for those on the ground performing direct patient care.

Dr. Renee Thompson:
Excellent. Oh my gosh. So needed. And we were just talking before we hit record that we're both going to be at the next Synova event in November at the Perinatal Leadership Forum. So if you need some help, make sure you register for the conference and stop by and see Dom. Okay. Let's talk about let's talk about change. Okay. What are the challenges that you've seen out there, especially when you're introducing change as a leader?

Dominic Petrovia:
Okay. And I'd love to share anecdotal, Renee. I think it's just a great way to do so. I always like to joke and say I take off my carrots and hat and put on my nurse leader hat for a moment. I've worked as a leader overseeing NICU and pediatric areas for years, and I was actually given the privilege of opening a new NICU, which in one of my roles as a leader, and I will say that is new technology, new space, new workflows. For that example, we went from a 1200-square-foot rather NICU to a 14,000-square-foot NICU.

Dr. Renee Thompson:
Oh my gosh.

Dominic Petrovia:
16 beds to 40 and included for our NICU friends at home. Centralized prep, which we know is a lot different than bedside prep for our neonatal and pediatric nursing colleagues. All of that was new. We had a lot of change, new equipment, new monitors, you name it, technology, all of those things. We know healthcare is ever-changing and we try to be as adaptable as we can, but again, that's a lot of change at a very quick pace. So, as leaders, we really have to strategize on how we manage that change. And of course, you are going to have your change agents that you have a feel for as a leader, those folks that you have that report with, etc., and all of that kind of goes back to practicing what I like to call practicing your presence, rounding with your teams, knowing your teams, and knowing who your change agents are going to be when we have to incite that change. Now, of course, again, something that you and your wonderful organization do is talk about those folks who are not so apt to that change. They take that ball, so to speak, and run with it. I used to call it spinning it up in the unit, if you will, that negativity that this is never going to work. This is going to be a failure. This is, this just isn't going to happen. We can't do this or my favorites are I'm going to retire and I won't make it when I go through this change, this is going to put me into retirement. All of those things, I think a lot of folks have heard when we've gone through change in the healthcare area, the ways you really mitigate that, I think some starts with strategy are really, again, finding out who those naysayers are and trying to, if you will, kill them with kindness. A part of that really is trying to engage them as part of the change process. And again, if you're feeling that resistance and really trying to peel back the layers with those folks, what I've always taken an approach of, it's a little analytical, which kind of takes away part of the softer side that we have as nurses, but almost looking at it like a root cause analysis. What is the why? What is your why? Why are you here? What brings you here every day? Tell me. And in our case for NICU Pediatrics. Is it the babies? Is it your colleagues? Is it the convenience of the schedule? Tell me, what's your why? Give me your why. And sometimes you can peel back through those layers and see that maybe they just didn't feel engaged in the process from the start. And then you have some folks that, unfortunately, you do engage, and they still want to resist the process.

Dr. Renee Thompson:
So I actually want to unpack that a little bit more because in the culture change work that we do, it's culture change. And so this speaks exactly to what you're experiencing or/and what you're sharing, where we'll go into an organization, we do our consulting, and there's a whole group of nurses and techs and physicians and providers like, oh my God, we need this. Yes, we need your help. And then you have those resisters. They don't think they need our help. It's not us, it's management. It's the physicians. It's all these other people, okay? And I've given this a lot of thought, and I'm really interested in your thoughts on this. Why do people resist change? And one of the reasons that I've seen. I actually use an example when you're a brand new nurse, when you're a brand new nurse, and you have to put your first Foley catheter into a human being. Okay, not a mannequin, but a human being. You are so focused. You open up the bag and peel back the packaging paper, and then you put your gloves on, and it might take you three minutes to get the sterile gloves on. And meanwhile, you might have somebody, an experienced nurse, next to you, saying, oh, for the love of God, just give it to me. I can throw it into seconds because they have mastered it. There's no uncertainty. There's no energy that their brain has to use to be able to put that catheter in. You've done it so many times. Just like seat belts. Automatic. Now, back in the day when we didn't have to wear seat belts, we had to be reminded the alarm or kids. But it's become so automatic that we don't even think about it. I almost look at asking somebody to change in that way where I'm so used to this workflow, this process being this way, that I don't have to spend any brainpower thinking about it. Now you're asking me to think differently or to do something different. I'm back to the day when I had to put my first Foley catheter in. So, I think that might be one of the reasons that they resist without realizing it, but I'm really interested in what your thoughts are.

Dominic Petrovia:
Yeah, I absolutely agree. And a large part of the strategy, Renee, is easing into change. Again, we said earlier, it's a lot of change at once. So what I actually did in the story I was sharing about the new NICU is as we were transitioning again, these builds take time, but we do. It's not all dropped at once. We progressively make decisions on different pieces of technology, etc. we start bringing them in. So as the unit was even being built, I was actually doing videos and putting them in as emails to staff, sort of a sneak preview for huddles, etc. Here's our nurse call system for codes and things like that. Here's what this is going to be about. Here's what our new monitors are going to look like. Let's get a pilot monitor and sit it in a unit so you can play. Now again, this is no substitution for the formal education that we developed, etc. And competency validation rather. But this is again slowly easing into the change, and this is actually part of what I do at Keriton. When I talk to my folks about deployment, our clinical partners, we bring them job aids, things of that sort and tell them the transition between training and going live. Start edging those in, communicate in your daily huddles or your shift huddles, whichever methodology you utilize in your unit practices. We love our huddles. Everyone's a fan of the huddles. We can talk safety. We can knock that out in hopefully 2 to 3 minutes. But get that started just as I like to call it a little sports analogy the highlight reel. Give them the highlight reel. And say, oh, we've got some new things happening. Here's the new spotlight. Here's what we're going to be getting in the new unit. Take a peek. And it starts to ease that change. Again, we want to try to just smooth these things in and reduce, as you had said that sort of PTSD, if you will, of that I remember you gave a great example with the sterile gloves because I remember being that shaky guy making sure that I'm not going to break that technique using that. And then I remember precepting nurses and saying, this will be you soon. Trust me, you'll be doing this in about five seconds flat, not even thinking of it. Yeah, it'll come with time.

Dr. Renee Thompson:
It takes time. And you bring up a really good point because I've seen leaders do this well, and I've seen leaders not do this well, where there's a change in something that they do, whether it's something major, like completely renovating their department or it's just a simple process, but they wait too long to communicate it. It's like they're told that this is going to happen, but, you know, they don't say anything until the week before or the day of. But what you're saying is important is, start to communicate that this is coming early, and so I think that's a key takeaway. You need to, if something's going to happen, even if it's six months from now, talk about it now. Hey, six months from now, this is going to happen. And every single week and as you get closer every day, you bring it up. But the other thing, and this is going back to the resisters, is getting people's input. Okay, this is the goal. This is what we're trying to accomplish. This is our plan. But I really want your input so that we make sure we're not. I always say, what am I forgetting? What, they know what you're forgetting, but you're not going to know unless you ask.

Dominic Petrovia:
100% agree. Even part of transition planning. I love to give examples in practice for any new unit builds. Again, we'll talk about that from our transition planning perspective. Having your staff go in, which I've done with post-its. Where should things go in the room? I know it from being a clinician, but I don't know what I don't know sometimes, and having that cognizance is there. This is your unit, and another, sometimes, I could be full of cliches, so I apologize for that. But I like to have folks have what I call a piece of the place. And truly when they feel they have a piece of the place, and that could be in policy development, that could be in education design, that could be in anything that we talk about from a shared governance perspective. Or again, just this transition planning, giving them that piece and feeling as if their voice is heard, can really help support that buy-in. And again, we can't say that's the ultimate panacea, because we do know that sometimes that's not always the case, and we have to set expectations. This is the road that we're heading on. We want you to be on board. What can we do to get you there? But there's only so much we can do. This is where we're heading as a team. We want you to be here with us, but we understand if it's just not a place you want to be. And sometimes, those expectations can be challenging, and they can be really tough conversations to have. And as a leader, I never wanted to have those conversations. I wanted to fully exhaust every possible way to be supportive and be a true servant leader, but sometimes, you could hit that point. And as leaders, we need to understand that it's okay that sometimes we have to have that crucial conversation with some of those folks that really have put that full stop on the change. Again, we want to give them everything they can, or we can rather to support.

Dr. Renee Thompson:
So what happens when you've done that? You even said you got to kill them with kindness. Those naysayers. Okay. You got to invite them in, ask for their input. What do you do if there's a difference between passive resistance? I'm just not going to get involved. I'm not going to participate. And active resistance where they're deliberately. I hate to say this, but I've seen it sabotaging process change. Okay. And I'll give you an example that I saw firsthand. I went back into clinical practice, I don't know, maybe 9 or 10 years ago, and I just worked a couple of days a month at a local hospital just to keep my toe dipped in the water. I don't do that anymore. But they were rolling out this whole bedside shift report and during the week when the manager was there. Let's go. Bedside shift report. And they'd go into the room, and they would do what they were supposed to. But on the weekend especially, I worked mostly the weekend. I remember this one nurse; there was a newer nurse who said, okay, let's bedside shift report. And she basically made her feel like an idiot for wanting to do that and gave her a hard time about it. And this was the same nurse that during the week. All right, let's go. Shift report. So, that was someone who was actively resisting, and, yeah. What strategies, what strategies do you have for them?

Dominic Petrovia:
I am picking up what you're putting down, and I have lived it. I have lived it. I will say it goes back to again practicing that presence as a leader. Remember, the patients don't all jokingly when I say this: go to sleep at night, and the work doesn't get done. You still have your teams at night on your and your weekends, and I still recall another small anecdote I had overseen again, an ICU and pediatric area in one of my roles, and I came in at night just to round, and I shell shocked these folks for a day. They thought, well, wait, why are you here? And of course, the first by the look on the face is number one: you're not in trouble. Number one, no one's in trouble. I'm here to meet you and to learn what's working and what's not. And in the case of what you're talking about with bedside rounding again, that's practicing your presence and seeing the process in action on all shifts and having those crucial conversations if you need to. And really, again, when we talked about change agents and fostering those change agents, making sure those change agents are covering all the shifts. You really need that, even if it's not a formal leadership title for folks. I always like to call them your frontline leaders. Leadership does not need a title. It does not need a Roman numeral next to it or any of those things. You see your informal leadership leaders out there in your teams, and you cultivate that. You find those folks, and when you see those folks again, you cultivate them. You promote them. You become their hype man, if you will, which I love to say, even with our own industry nurses, I love to be the hype man for our industry nurses out there. That's what we should be doing. And again, when you have those folks that are those that nurse that kind of shut down, that newer nurse, you do pull them aside and you have the conversation that this is the expectation and here's why. And if you have to be transparent and again, we have to be mindful with policy, etc., especially with say, bedside report. We need to talk about things like safety issues. So, there's a prime example. We need to transparently say here's what happened. Because of bedside check wasn't done. This patient got the wrong fluid for six hours. We're not going to say who did it because it could be anyone, but here is why we have the systems in place. Nurses and other clinicians, we are academics, no matter what level of degree they have. We are academics. We are critical thinkers. We always should, as leaders give a why. There should always be a why. And again, with those folks that may be sort of pushing or resistant. Give them that why and tell them this is the reason why we're doing what we're doing. And sometimes, again, you can be transparent as a leader and say this is required if we have credentialing agencies, things of that sort. Yes, this is why it is required by this. And it is something that we have to do together as a team. What are the barriers? I can help eradicate as many as I can as your leader. Some, unfortunately, are innately built, and we're going to have to roll with it. But what else can we do to make this more comfortable? Are there issues that, for example, for your bedside report example, are there distractions? Are there some things that are occurring? Can we do some kind of quiet time? Do we need a specific space? Do we need to be able to have a crucial conversation with families to say, wow, we're doing a bedside report unless it's an emergency? We need to have this time from a safety perspective. Again, chats I've had with parents when I've done my clinical work as well, is we want to ensure we're doing safe things. We want to provide safe care and safe communication. We promise we will get to your needs as soon as our report is complete. And just teaching and scripting that conversation with your staff as well. All of those strategies can play in.

Dr. Renee Thompson:
Well, and you brought up something that I think is incredibly powerful. It's you cannot ask people to change anything if you're not going to tell them why. And I don't know if you've ever read Robert Cialdini's work. He wrote that book, Influence. I have this, the most recent edition. It's pretty thick, but I've shared this example where, let's just say you go into Starbucks and there's a long line, and you, like, what are the chances that if you ask the person in front of you, hey, can I cut in front of you? What are the chances they're going to say yes, pretty much none. But if you just say, hey, can I cut in front of you? Even just the word because, without anything increases your chance. But if you say, can I cut in front of you because I'm really late for a doctor's appointment, or don't lie, okay, but there's, like, a 60% chance that they're going to let you cut in front of them. And if you explain the why, that might help address some of those resisters. Because if you don't tell them why, they don't understand the importance of this and are more likely to sabotage. And I always like to look at the whole left and right brain approach where you give them the stats.

Dr. Renee Thompson:
Studies show, give them some evidence. This is why we're doing this because studies show blah blah blah. But then, just like I used to get, people would complain about getting their stroke hours in every single year. We had to have. I think at first, it was eight hours of stroke continuous education to be stroke certified, and I'm a neuro nurse, so I had to do that, and nurses would complain about it. And then we would say, if your mom was a patient in a department, your mom had a stroke, wouldn't you want the people taking care of her to have eight hours of continued education every year? Actually, I'd want them to have 100 hours of my mom. But you give them the left brain, studies show. But then you relate it back to the emotions. You relate it back to the purpose. Why we're here. I think about in your world, these babies. If this was your baby, wouldn't you want whatever the change is? But you got to tell them the why. And even then, sometimes, some of them won't get it. But you're going to capture more if you tell them the why.

Dominic Petrovia:
Absolutely. It's that openness, and transparency, and truly giving rationalization. No one ever wants to hear because I said so. That works psychologically. I don't have the literature to support this, but we know at those early developmental stages we hold a little bit of that boundary, but that's the working world.

Dr. Renee Thompson:
So I love it.

Dominic Petrovia:
Yeah. In the working world, no. We've got folks that are confident, strong caregivers that are giving so much of themselves every day. The least we can do as leaders is be as transparent as possible and support them.

Dr. Renee Thompson:
Yes, and you mentioned earlier about getting their input, especially when it comes to collaborative problem-solving. And I've been talking a lot about this lately where, okay, let's say you have something that you're changing, and we can use any example. But before you even start the process, think in terms of, who are my key stakeholders? Whose input do I need? And sometimes that's different, you know, roles, maybe a physician or provider could be respiratory. I think of those little babies and respiratory and maybe a newer nurse, maybe a more experienced nurse, maybe somebody in a supportive role. But get those people together and say, here's what we're planning to do. Here's why we're doing this. We really want your input because we want this to go as smoothly as possible. And going back to what you talked about, it can really and getting one of the resisters. So I love, you said earlier, and I didn't pick up on it until now, I remembered. But you need to know your people who are the early adopters, who are the people who are going to like, yes, okay, let's do this. And who are your sisters? And make sure that they're sitting at the table when you're correct about this.

Dominic Petrovia:
I believe controversy breeds innovation, truly. So again, that's not obstructive thought, but that's challenging the ideals, and that's something I wanted to share as well as we get close to wrapping up, is that leaders also have to have that cognizance that said change if it is not mandated and maybe they're leading the charge with that may be their desired outcome or the change that they instilled wasn't effective and that there's an alternative route. And having that sort of self-awareness to know, okay, we're going to try this. It may not work, but let's get some feedback on how. And that was another thing when I was doing the transition planning new unit work, etc., Renee. Was that when we got started, I actually put up I am a big fan and I'm sure you are too. We all love our big Post-its, those easels that you can stick on the walls. Such a fan. Besides that, and my educator hat loves the laminator. But that's another topic. Love the laminators. So I would put up a Post-it in the lounge again, private, anonymous, etc. What's working, what's not, in the new space? Because, again, there are some things we can change. I can't take a bulldozer to the walls. But if there are some arrangements in other ways, maybe supplies, maybe this maybe workflow is not ideal. We could change it. Let's talk. What can we do? This is your area. Really empower your folks. This is your space. You're here for 12 hours a day. Most of them. What can we do to make it better? Again, some things. Unfortunately, we don't have a lot of budget, but there's a lot of gray, so let's work through that.

Dr. Renee Thompson:
It reminds me of an activity that we do a lot with our clients. It's called the One Thing Activity. And actually I'm heading this afternoon to spend the day tomorrow with one of my clients, and we're doing this activity. It's one thing. So you get people together, and you say, what's one thing? If we fix this one thing, it would make everything else easier, and you have them make a list. So easel, paper, you have them. It can be stickies, or they can write whatever you want to do, and then you go through each one, and you say, do we have control over this? Yes or no? Do we have control over this? Yes or no? And if it's no, cross it off your list. But if it's yes. And sometimes it's a, well, maybe okay, so leave it there. But it's exactly what you're talking about. Yes, how do we make this better? What are the issues? And you make your list. And then, do we have control over this? Like. Yeah. I'm not going to get a bulldozer to knock down the walls unless you're doing reconstruction, but it's getting really clear on controllable factors. And if you don't have control over it especially I'm thinking about when you're implementing an electronic health system, you don't have control over that. So stop complaining about it. Okay. There's kind of nothing you can do about it. How do we integrate this? How do we make this work for us? But you don't have control over which system you're using. So it's similar to what you're talking about and getting really clear on those variables that you do have input you do have control over, I think is just brilliant, Dom. Just brilliant. All right, so we have mostly leaders listen to this podcast. If you have a leader saying, oh my gosh, nobody ever taught me any of this. We get into battles all the time when we're asking our team to change anything. What is a practical strategy for them to start getting their team prepared for change and dealing with those resisters? So, I actually asked you one question, but it has two parts.

Dominic Petrovia:
No problem. I think it's when you really have to put on your detective hat all of the key to this, and you've heard me go back to this route, Renee. And it's always been my cornerstone with leadership is, again, practice your presence. Be there, round. We know that rounding, again, I have to go do a little PubMed search. But I know from firsthand experience that rounding has such efficacy when it comes to your staff engagement and truly having your finger on the pulse of what's happening in the areas that you're overseeing as a leader and starting and asking the questions, what are you worried about? What do you think is going to be great about it? And even when you're new to an area, like I said, when I've been the new kid on the block saying, what's working, guys? What's not? You actually want to hear what I have to say? Of course I do. This again, you're here, you're supporting, and in my case, you're taking wonderful care of these children. What? What can I do to make it better? I am here to support you. That is the leader's role: to support you and assure that everything that we can do in our sphere of influence can improve your day-to-day. And that's the start. Is that discovery? Have that discovery with your staff. Again, it is tough when you go into a situation where, again, you may be candid, not the best hand, if you will. So you go in, but stay resilient and learn to discover. Establish that rapport with your team. You're going to be able to see, as we stated earlier, your change agents, folks, that may not be so apt to that change, but give it some time and a little bit of TLC and you'll see some results.

Dr. Renee Thompson:
Yeah, I think it's so wise. And it goes back to, I consider a fundamental skill that a leader needs to develop, and that is their ability to listen and observe, and it sounds so simple, but I know, especially when I was a frontline leader, I had a thousand things on my to-do list. I almost felt that I had no space to listen and observe. However, in retrospect, if I would have given myself that space to do that. I wouldn't have had a thousand things to do, because a lot of them were dealing with badness and things that went wrong. But putting that effort in upfront can save you a lot of time and energy spent later on. This has been wonderful. Thank you so much for your willingness to be a guest on my show. It's funny because you never know if I meet you out there. If we start having a conversation, next thing you know, you're going to be on my podcast because I'm always looking for really interesting people who bring a different perspective or who have expertise in areas that I don't, or who we share similar experiences, just to be able to provide our leaders with some additional strategies and considerations when they're trying to cultivate a healthy work culture. So, Dom, thank you so much.

Dominic Petrovia:
Absolutely. It's been my pleasure, Renee. Thank you for having me.

Dr. Renee Thompson:
All right. So, if people want to connect with you, what would be the best way for them to do that?

Dominic Petrovia:
I think what's best is that, message me on LinkedIn. Dominic Petrovia. I'm sure there'll be some information later. Our website is www.Keriton, k E R I T O N, .com. There is a contact us link again that you can, it will go directly to me if, one, you're looking at a NICU and pediatric space any feeding management solutions or support, happy to help you, or if you just need to grab me for a little bit of tete-a-tete for leadership conversations, I'm here to support all of our fellow clinical leaders. We are in this together, folks.

Dr. Renee Thompson:
Oh my gosh, that's very generous of you. We will have Dom's LinkedIn link in the show notes along with Keriton's link. We'll also, I'm going to drop in Synova's link to their website because they do if you're in the NICU or perinatal leadership space. If you've not heard of Synova, I'm telling you, you need to know Synova. And again, Dom and I will be there in November. I'll be speaking, and actually, I'll be in the exhibit hall, too. So, if you're there, make sure you stop by and say hello. But we'll put all of that in the show notes. And I'll also put the book by Robert Cialdini, Influence. I'll put a link to that in the show notes, too. So again, Dom, thank you so much.

Dominic Petrovia:
Absolutely. Take care.

Dr. Renee Thompson:
Those of you who are listening or watching right now, thank you for being here. We know that you have busy lives, but the fact that you carved out some time to spend with us tells us that you get it. Being a leader is not easy, but it's a skill that you can learn, especially a skill in helping you cultivate and sustain a healthy work culture. So, if you like this podcast, if you could please rate it, review it, and share this with another leader who might need to hear this. This is how we get known. The Apple Podcast algorithms, it's all about how many ratings and reviews that we get, and then they can kick it out there, especially to the people who need it. So if you would do that, I'd be so grateful. So thank you for being here. Take care everyone. Bye!

Dr. Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found this podcast helpful, we invite you to click the Subscribe button and tune in every 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 us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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