EP 62: Fostering Accountability and Inclusion in Nursing Leadership

CB_62 – Dr. Maureen Chadwick: Audio automatically transcribed by Sonix

CB_62 – Dr. Maureen Chadwick: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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. Today is an extra special day for me because I get to chat with Dr. Maureen Chadwick, otherwise known as Mo, who is the senior vice president and CNO for Ascension Health. Mo, welcome to the show.

Dr. Maureen Chadwick:
Thank you so much, Renee. Super excited to be here and just truly honored that our paths have crossed.

Dr. Renee Thompson:
Okay, so we have to talk about this, Mo. Okay. This is the funniest thing, and it's serendipity. It's I don't know what you call it, but I want to share how Mo and I actually came to kind of meet, and then I said, oh my gosh, you have to be a guest on my show. Well, a couple of months ago, somebody from Ascension, I think it was Karen Diaz, reached out to me, and she was asking for some help. And we were talking, and she said, oh, by the way, I know a lot about your work because of our CNO, Mo. She loves your book enough, and she's always like quoting things from the book. And so I was like, oh my God, that's so nice. So I went into LinkedIn and I saw that we were already a first connection and already had some LinkedIn messaging dialogue. So I just said, hey, thanks so much. I talked to Karen, and then you said, hey, why don't we meet? You're a Pittsburgh girl. I'm a Pittsburgh girl. I'm like, oh my God, I didn't know you're from Pittsburgh. So then we hopped on the call, and Mo, why don't you take it from there?

Dr. Maureen Chadwick:
So, first, I just want to say to everybody, I have been a lifelong fan of Dr. Renee Thompson. So we're on this call, and I can't remember which one of us said, maybe. I said, you know, before we jump into the potatoes, like, where did you grow up in Pittsburgh? Because, you know, Steeler Nation is pretty big. And Renee says … And I'm like, well, that's interesting because I grew up in Crafton. And then I think you might have asked where I went to high school, or maybe I asked in, and you said, Carlynton. For anyone listening, no one's ever heard of Carlynton High School, even in Pittsburgh. So I'm like, I went to Carlyton High School, too. And I think you asked, what year did you graduate? And I said, 1982. And you said, so did I. So then we were like, okay, what's your maiden name? And as soon as Renee said Rossi and I said, No, yeah. I was like, oh my gosh, you were in the band. You were in the high school band. I was on the swim team. I played tennis, so it just, it still gives me chills. Such a fan of yours. And I love, also, and what really resonates is we both have been on this journey of really working with, had our personal experiences with respect to incivility and bullying and nursing, and how can we, because this truly is under our control as nurse leaders, how can we disrupt the incivility? So that's how our paths crossed. Again, truly honored to be here, Renee.

Dr. Renee Thompson:
Oh my gosh. It was like one of those moments I will never forget. As soon as you said, what's your maiden name? And I said, Rossi. You're like, oh my God, you're Renee Rossi. I said, what's your maiden name? I'm like, oh my God, you're Maureen … Of course I know you. Because I did some, I tried to dive on the swim team and then hit my head, and I said, that's enough of that. But then I think I did some stats, and I went to all the swim meets and then, yeah, the band and all of that. And then it's funny because I text my best friend Kimmy Gannon, who, you know, like, oh my gosh, guess who I just talked to? She's like, oh my gosh. It was just hysterical. So that was a, definitely, a magical moment. It was. And as you said, Mo, how do we disrupt this whole problem that we have right now in healthcare, this incivility and bullying? And so we're going to talk about that today. But I want to tell you a little bit more about Mo. So she has her PhD in organizational learning and leadership. Her dissertation focused on the lack of diversity in nursing and understanding the lived experiences of racial and ethnic minority nurses and the nursing leadership's role in those experiences, which I think is fascinating. And then, since April 2022, Mo's provided leadership and set strategies for nursing professional development, nursing quality, and research and system-wide regulations. Her key focus areas are driving nurse retention, thank you; nurse leader development, thank you; change management, thank you. Okay. Implementation of evidence-based practice to drive nursing-sensitive indicators. Thank you, thank you, thank you. And regulatory bodies. So amazing work that you've done. But I really want us to get started really talking big picture here. So we know that nurse leaders are the stewards of precious few and getting fewer resources. Human capital. Okay. Goods and services. Like pretty much everything. Financial. It's all of that. What is the role of the CNO in being that steward of the environment in, you know, the environment that people work in? Because we have a lot of CNOs who listen to this podcast. And from your perspective, how can they actually be the stewards of the environment for their people?

Dr. Maureen Chadwick:
So I think one of the big opportunities as CNOs and when we talk about disrupting incivility, we also have to talk about like we are enabled to do this, but we've also enabled the bullying. You know, what you permit, you promote. So nurses are, if we look in the mirror, we're enablers. So it's really the opportunity for us to pause, to really look in the mirror and say, you know what, I can create an environment where everybody feels included and working in faith based healthcare. What's really important when we look at the value of reverence and human dignity and treating everybody with kindness and respect, and as the CNO, really taking the bull by the horns to say to your entire executive team, to all your teammates, whether it's the CMO, the president, this is not going to be tolerated, but I need your help. I partner very closely with our chief medical officer because I can't do this alone. I can set the expectations with respect to how people can expect to be treated when they come into our organization, but how we disrupt that cycle is going to take a partnership, because we all have worked not only with nurses or physicians or patients who have disrespected nurses. So, how do you do that in partnership? So it's but what's exciting is we own this, we can own this and run with this. And that's what I've said to frontline nurse managers who are most vulnerable in this space because they've never had to deal with this. But I tell them, I'm like, you're the CNO of your department. You can set the tone for what will and won't be tolerated. And what I've learned is it's really been empowering. And what I love is, and you and I have talked about this before, there has been so much in the literature about the need for leaders to disrupt incivility and to disrupt bullying, but no one's told them how. And that's what I really love about your book, Enough! That's like the cookbook for me to go out and actually do it. So I'll pause there and see how that lands.

Dr. Renee Thompson:
Yes. Okay. A couple of things. I love that you don't see this as just a nursing problem. It's actually an interprofessional team problem and partnering with your CMO. So anytime we go into an organization now and we start doing especially the consulting work that we do. No, we won't do this unless there is an executive position partner who's part of it. Because, you know, we get into this us versus them mentality. The nurses are like, it's not us, it's the physicians. The physicians are like, we have issues with nurses. Like, whoa, whoa, whoa, wait a minute. We're not demonizing any one role, but how do we, at that executive level, set the precedence that we are going to work on this together? So I'm curious if you could talk a little bit about that dyad relationship. And is it, would you say, especially if, you know, there's a chief nurse listening right now, is it an easy sell or is it difficult because again, it's trying to get buy-in to be part of resolving an issue like this, that it's not a clinical issue. So people tend to say, oh, well, you know, these are the soft skills, but as you and I know, they're not soft, they're essential. So, can you tell us a little bit about how you were able to sell this to your CMO?

Dr. Maureen Chadwick:
Absolutely. So simultaneous when we look at creating high-reliability organizations, so simultaneous to my work on disrupting incivility and bullying, our chief clinical officer, Rich Fogel, who's a great friend, in addition to Tom Malloy, who's the CMO, probably about 18 months ago. And we were part of that. And I and this is really about culture. This is about organizational culture, to your point. This is not about us versus them. It's the what is the culture of your organization. But they created this we Got your Back campaign where anybody, whether you're a physician, a nurse, a support staff, but stop the line when something didn't feel right. And as long as it was done in good faith. But let me tell you, the first 6 to 8 months, people were like, oh, this is just the latest and greatest, you know flavor of the month. 18 months later we are now going to we've got your back 2.0. And it is completely aligned and tied in with the work we're doing on disrupting incivility and bullying, because the other thing again back to human dignity. And I'm a firm believer no one gets up in the morning and says I'm going to go to work and see how many people I can disparage today. It just doesn't happen.

Dr. Renee Thompson:
Well, maybe.

Dr. Maureen Chadwick:
Okay, there might be 1 or 2 that we have a special plan for them.

Dr. Renee Thompson:
Yes.

Dr. Maureen Chadwick:
But truly, I think when you couch the conversation, and part of my job, Renee, is to protect your nursing license. Part of my job, you know, Dr. Fogel, is to protect your medical license when you start a conversation. That way, even with the most challenging individuals, it's about protecting their dignity. Even when you might be saying to yourself, man, this is not going to be an easy conversation. And it's about protecting patients. So the We Got Your Back campaign and the work we're doing on incivility. It really goes hand in hand, and it truly is. And we've had some amazing stories. And it's really about elevating those stories as well. When someone does stop bullying, particularly having been a cath lab director and an or director, those are intimidating spaces in facilities, but they don't have to be. They do not have to be with the right environment. So I'll pause there to see if that.

Dr. Renee Thompson:
Yeah. So, I think you bring up a lot of really good points. First of all, I love your We Got Your Back campaign, and it almost gives you permission to speak up even if you're uncomfortable. Because we say this frequently, it's okay if you're uncomfortable, have the conversation anyway. You know, it's not a matter of comfort. It's a matter of willingness. And having it as a campaign makes it, in a way, easy for that person who may be reluctant to speak up and stop the line. But hey, we have a campaign now, so it's giving me permission. So I think that's a smart strategy because there's a difference in just telling people, hey, just speak up. If you see something that's not right versus a this is important to our organization, to the point where we have this as a campaign and this is what it looks like, and also what's really important. Mo, and I'd like your input on this teaching people how to speak up. There's a difference in, hey, you need to speak up versus say these words to this person when this is happening and giving them some of those strategies. So can you tell us a little bit more about the campaign and how you're equipping everybody to be able to have those conversations in the moment, even if they're uncomfortable?

Dr. Maureen Chadwick:
Absolutely. So I love the how, it goes back to the how and really what we've encouraged everybody, and I think I've heard it on some of your podcasts. Everyone needs to have an accountability buddy. Yeah. Somebody that they can role play with, somebody that they can role, you know, role model from. But it's really is what is my go-to line when I need to pause a situation. And we actually have it on the nursing side. We have a pause campaign. So it's really knowing, and I can share that with you because it's really been powerful. It's really about pausing the situation. But what is your line? So what you just said, this is going to be really difficult for me. And I said to people, it's okay to talk about your feelings like this is a really uncomfortable conversation. However, I need to stop the line because here's what I'm worried about. So it's about pausing. It's about asking questions, curious questions, not judging questions. Curious questions, really understanding the entire situation, and then sharing your observation, And then, what is the path forward? You know, what does that path forward look like? And we wanted to give people so that anybody can use pause anybody to stop the line. But it's really what is my go to when I need to stop the line. And also we've encouraged people. What is your go-to line when you have to stop incivility? Because that's really hard to and I've coached the nurse managers. So we had we do a quarterly nurse leader development series, of which I'm faculty. You know, I do parts two hours every quarter. All our leaders attend the nursing leaders. And in July we did one in Rome. Really, it's actually my Old Nurse Left Behind campaign.

Dr. Renee Thompson:
Okay.

Dr. Maureen Chadwick:
And it was about how do we disrupt civility but really for nurse managers. So we've had these follow up office hours where we've had 362 nurse leaders, majority nurse managers. We've had seven sessions since July. And they're just so hungry. Hungry for this? For the how-to. But I use the example because we've all dealt with it. You're walking down the hall in your department. You're the nurse manager. But I say aka CNO of your department. You hear loud voices, I'll just say screaming and yelling in the nurse's station. Somebody struggling with self-regulation today, and part of you wants to walk the other way. But you know, you have I'm like, guys, you're the CNO of your department. You have an obligation. And I said figure out your go-to line. Because if you can hear it halfway down the hall, so can all the patients, and that is frightening. Patients are already extremely vulnerable. So if I hear, I mean, we've had patients, and I know any system has, you know, quote what they've heard outside their door, and believe me, it's humbling. A lot of humility in these jobs. So when you go to the nurse's station, it's okay to say you know what. Renee and Mo, I need to pause you, and they might not want to pause. And I'm the leader in this department. I need to pause you, because I heard this altercation going on halfway down the hall. And it is frightening to our patients. So we're going to take this whether it's a closet, whether it's a bedroom, whether it's an empty patient room. I'm going to facilitate. I don't know what's going on here, but I am going to personally facilitate this issue between the two of you. And then you just sometimes just have to guide them like we're going to we're going into, you know, a clean utility room to it's not one of those we're going to schedule a meeting. It's, as the leader, I have to intervene right now. That strategy has really helped our nurse leaders just to figure out what is their go to line to disrupt and coach a situation.

Dr. Renee Thompson:
Okay, two things. First of all, I love this whole mindset of you are the CNO of your department because what I find is that a lot of those, and we'll just call them frontline leaders. Could be a manager, unit director, you know, whatever, you know, terminology that you use. They don't always believe that. They don't always take ownership as if they were the CNO, and Mo. I was one of them when I was a frontline manager. I'll never forget this. I was in a graduate program, and our systems chief nursing officer at the time taught a class that I was in, and I was sharing my frustrations with my staff and HR, and HR was giving me a hard time, you know, putting them on corrective action and all of that. And I'll never forget this, Mo. She stopped, she leaned forward, she looked at me, and she said, you are accountable and responsible for your department. And basically was, stop blaming HR for the fact that, you know, you've got these issues. You're responsible; they need to support you, but you need to show up that way. And to your point, it's easy for us as human beings when we hear something like that to, oh, turn, turn around and go the other way because it's easy to identify, okay, who's responsible for this? Is it me? And I think to your point, if every person in a leadership role, even an assistant nurse manager, sees themselves as the CNO of their department, it changes the game. But you have to give them the, here's what you can say, and I really like the whole, I need to pause you, because it's non-threatening. It's raising awareness. It's stopping that behavior in the moment because it's a distraction to everybody else. And to your point, earlier patients and families can hear this. And then removing them to, you know, either have the conversation or to make sure that the conversation ends so that they can get back to doing what they need to do. And that's caring for patients. So love the whole CNO of your department. It's just a mindset shift that anyone who's listening right now who is in a leadership role, I want you to see yourself as the CNO of whatever department or whatever work that you're doing. You are the CNO.

Dr. Maureen Chadwick:
Well, and part of our jobs as the hospital CNO, assistant CNO. So we created a nurse leader structure, evidence based, because, again, if a nurse leader has 150 direct reports, that makes it extremely difficult. So we've just implemented in the last well, it's taken a year. Evidence-based nurse leader structure ties out to the AONL compendium, where our nurse managers have a headcount of approximately 60 headcount, not FTEs, because we all know 60 FTEs could be 100 headcount depending on the type of department. And then, after that, they get the support of an assistant nurse manager. So, really giving them. What is that? I know we use the word span of control. And I just heard recently, I forget where I heard it, span of responsibility and accountability. I love that. I was like, so I told my team, I'm like, guys, we've got to iterate our language forward. It's span of accountability and responsibility. So, really, providing the managers with they do have the bandwidth. But then to your point, equipping them with the tools. So, once I pause the situation. So we got Mo, and Renee is teaching them how do I facilitate. Okay. Now I've got them in the clean utility room. Now, what do I do? You know. So, I got them that far. And it's really about facilitating the dialogue, and all along, protecting human dignity. And sometimes you may have to say, listen, Mo and Renee, I realize you're never going to have dinner together. However, part of my job is to protect both of your professional licenses. So it could be nurse-physician who, you know, doesn't matter what the combination. And I need to, I'm going to be Switzerland. I'm going to help you sort this out. And then I need to understand from the two of you that you're committed to make sure we're delivering safe patient care. So what I love so probably it's probably been 18 months now we have three service commitments extending kindness. So we have this whole period before I love we have three now extending kindness, listening to understand, and serving together. So the listening to understand, and I like being able to tie these strategies into our service commitments. So, really setting the stage in the clean utility room with Mo and Renee to say, okay, Renee, you're going to listen to understand to what Mo has to say. And likewise, Mo, you're going to listen to understand what Renee has to say. And I tell them, prepare because immediately when Renee starts telling her side of the story, Mo's going to interrupt and be like, no, that's not, no. And that's where you have to channel your inner calmness to say no. If you're responding, you're not engaging and listening to understand. So I really need you to commit to listen and then vice versa. And what's really powerful when the two individuals actually hear one another, they actually, most of the time, solve the issue, or you can provide your observations. Now, in some extreme cases where I'd be like, okay, we're going to agree to disagree. However, you're both taking care of patients this shift. What I need to know is that if a fire breaks out in this department, that you both are going to work together not only to assure patient safety, but one another's safety, because sometimes people need that kind of mental jolt, if you will, because it really puts it in perspective. When people look at, oh boy, what we were arguing about, really.

Dr. Renee Thompson:
Right. They realize it's sometimes it's just unimportant. Minor. You know, they're really just distractions. And it reminds me of a couple of things that we say we share a lot. When two people are having some conflict and they're brought together, it's both of them coming into that conversation with the perspective of, I want to build a relationship. And I love the whole listen to understand versus winning an argument, because a lot of people, they want to win that argument, okay. Like, and it's not about who is right; it's about what is right. And you being able to say, if there's a fire, I need to have the confidence that you two are going to be able to put your differences aside and work together for the sake of the patients and for the team. It's very similar. And the fact that you're infusing the kindness, the listen to understand, serving together, you're using that language in the conversations. Because Mo, you've done such a great job really focusing on addressing workplace bullying and incivility. You know, absolutely holding people accountable and having your leaders take ownership. And I love the whole span of responsibility. I'm changing my language to that, too. So, can you share a couple of other really great strategies that you believe have been very effective? So we talked about Got Your Back. We talked about what do you call them again, the kindness, the listening. Are they your values or?

Dr. Maureen Chadwick:
Your service commitments. Service to serve how we're, how we will serve together.

Dr. Renee Thompson:
I love that. So how, in addition to those really powerful strategies, can you share any other strategies you have to really stop the cycle of bullying and incivility at Ascension?

Dr. Maureen Chadwick:
Yes. And what I'm excited about, because in talking to our nurse managers and stressing that they're the CNO of their department, oftentimes, they're you're like, I didn't know that I could do that or that I could say that. And that's where it is really important to have your AR partners part of the conversation. Because even when I was doing these office hours, they were there. I'm like, I just want to check what they are. Am I still in bounds? They're like 100% because what I and I lovingly, if anyone from any associate relations departments are out there is I opened these office hours with my goal is let's put AR out of business so that we manage things in our own department. And they're like, you're. And I said, I'm only joking because there's always you're always going to need them. But it doesn't have to go first to AR, there's so much we can do. And I have a strategy that I really like to use to disrupt gossiping, which I believe falls in the incivility bucket. And I say to people, you know, if we're human, everybody likes to be in the know. So a couple of things that I stress with my team. You may have information, but if it is not your message, you know, check yourself. If it is not my message to share, I have no business sharing. Number one, but really the trying. I call it the triangulation station, and aka gossiping, because people when you approach someone and say, you know, are we gossiping here? That no, I would never gossip, you know, but it's okay to say. And how I teach the managers is we all get triangulate. As parents, it's come to mom. They don't like mom's answer. They're going to dad rather than having the conversation together. So I keep it, like, really simple that way. But oftentimes, a nurse will say, Renee comes to me as the nurse manager and wants to talk about, well, like, oh my gosh, working with Mo this last shift, it's been terrible. Here's all the things that she, you know, can't do anything right, blah, blah, blah. So then, and I share with them, when I was a novice nurse manager then I would, oh thank you so much Renee for that information. Really appreciate it. Wrote it all down. I'm going to go meet with Mo. Can I go meet with Mo? Give all that information to her. She's like, Renee doesn't know what she's talking about. Then I come back and then I go back to Renee. And by then, how much time have I invested when the issue is really between Mo and Renee? So what I said to them, and this is just fascinating, once I figured it out, I was like, God, this is so brilliant. And I'll tell you what, it sets the tone in your department is that when Renee comes to me about Mo, I'm going to say, Renee, sit tight. I'm going to go get Mo. We're going to get this solved quick, fast, and in a hurry. And generally when that happens, you see the color drain out of the person's face.

Dr. Renee Thompson:
I can imagine.

Dr. Maureen Chadwick:
Because they're like, oh, I didn't really, they're like, no, no, no, it's not. I'm like, no, no, no. If it was important enough for you to come to me as your leader from patient safety, from a protecting your license, we're going to have this conversation again. I'm going to be Switzerland. I'm going to ask that you all listen to understand. So then I go get Mo, and then I facilitate the conversation, which occasionally is challenging. Well, it's not challenging for the person facilitating because again, you're facilitating. Like there's clearly a conflict because what happens otherwise is the individual goes and talks to 20 other people in the department and doesn't talk to the person. They should be talking. And then you've got this whole swirl and drama, which, oftentimes, when you peel back the facts, the facts say one thing, but the drama is already escalated.

Dr. Renee Thompson:
Oh, my gosh, yes.

Dr. Maureen Chadwick:
And what I said to the nurse managers and coaching them, I'm like, just try it. It's going to feel really awkward and get your accountability buddy to practice it, because I said, I guarantee, you do this for a month, the gossiping in your department is going to just go way down.

Dr. Renee Thompson:
They'll stop.

Dr. Maureen Chadwick:
So that's one thing, then another. I have two more quick strategies. Well, not they're not quick. But with respect to having the conversation with the bully is and what I tell the managers. This is not easy. And this is where the hospital CNO and the directors, because I said to them, really, as a nurse manager, you know, you're feeling really vulnerable. So, I think it probably wasn't until I was a director in the cath lab. I had been a director in acute care and critical care, and then I really got comfortable in the cath lab just interrupting or disrupting. I don't want to say interrupting. It's really about disrupting. But words matter. Incivility. So this is where for frontline managers, that director, and that CMO are critically important. Because oftentimes, when I have done these sessions, when you ask nurse managers if they know who the bully in their department is, every hand goes up. When you ask how many of them have had the conversation? 95% of the hands go down because they're just not equipped. And everybody plays the video in their head of what this conversation is going to look like. And that just creates personal anxiety when if you just stick to the facts. So it's really about working with AR, your CNO or director to say, I really, I've tried. I need to have a really direct conversation with this person. Have the facts ready. Also, be ready for I coach them. Be ready for a variety of reactions. I tell them, have your box of Kleenex ready because in my experience, sometimes the most aggressive personalities will just break down in tears and then think this conversation isn't going to happen. So again, practice. Be ready to say, listen, I know that I'm going to give you a moment to compose yourself, but we are going to have this conversation. So here's some Kleenex, and I tell them, just have a bottle of water handy in your office because they're going to need that. Give them, just be comfortable sitting in silence for a few minutes and say, now, this is going to be as uncomfortable for you to hear as it is for me to share with you. And again, it's about protecting human dignity because this individual has a family they have. So, really, we're going to go through this. But what I'm going to ask you is you're going to write the action. I had a really good mentor years ago that said, as nurse leader, sometimes we promote big mommas like we're writing people's actions. These are adults, right? They have a nursing license. They have checking accounts. They have. So really setting the expectation that I need you to write this action plan on how you're going to show up differently. That's in alignment with our values. The action plan needs to include two evidence-based articles on the impact of instability in the healthcare environment. And then part of the action plan is if you've got a journal club in your organization, they're going to do a journal club on one of the articles which that just and I reinforce this is completely confidential. So unless you share with people that you're on this action plan, and what's really, really powerful is oftentimes the action plans they write are ten times harder. I mean, it's got to be measurable. And usually between the six and 12-week mark is when you see, you know, people are either going to turn it around in 70% of the time. People did turn it around because no one ever sat down and had the conversation with them. Yes, it is truly an act of reverence for human dignity to sit down and tell people how they're showing up. So, a funny story. One, I had one nurse. This was when I was a hospital CNO. She came to my office. She's like, hey. And I probably had 600 or 700 nurses. So, you know, I felt pretty good about knowing everyone. She said, hey, I just want to thank you. And I'm like, oh, what's going on? She said, you saved my marriage. And I said, what? I know because I have my own adventures in the marriage department, so that was kind of funny. I'm like, well, I don't know if I saved your marriage. She said, no. She said I was the bully in my department. And this was like a year later, I said, well, obviously, it worked out because you wouldn't still be here because I was pretty clear, you know, people of the environment, as you know, that we were going to work in. She said, what I didn't know is I was also the bully at home, and that still gives me chills when I. So I think that's the thing. When we extend kindness to have these difficult conversations, do not underestimate the impact of extending kindness and speaking the truth in love, because you really, it can be a game changer for people's lives. And the other thing, and Dr. Fogel just shared this quote with me, and I love it. This was in Tennessee when we were together because, as a leader, we can be very fun. But he said his quote was, do not mistake my kindness for weakness because I can extend, I know. Isn't that something? Because I can extend kindness and have difficult conversations. And I was really so I use that all the I told him, I said I'm stealing that one shamelessly. Do not mistake my kindness for weakness. And then I have one more strategy.

Dr. Renee Thompson:
Okay.

Dr. Maureen Chadwick:
This is for departments. So you take over a department and you immediately recognize that there's normalized deviance going on. So, not that that's ever happened, but in my experience, I had this happen in a cardiology area. But what was really cool I know within three weeks I was like, oh, we got to do something. But again, how do we create psychological safety? So what I did in the staff meeting, physicians and staff, everybody got a pack of yellow stickies, put a big roll of paper on the wall, and we would have the staff meetings in the holding area line down the middle. What's appropriate behavior on one side, and then what's crossing the line? So I had everybody put their, do their yellow stickies, put them up on whichever side you think this should go on. So 95% of the stickies were on the appropriate behavior side. And I would pull them off and read them and be like, okay, well, no, this goes on the other side. I won't use some of the examples, but, you know, disparaging comments. No, this goes on. So what we were able to do though from there, and what I love about your work, Renee, is creating what are our department cultural norms, right? And what I would add to that is you have to get down to the foundation. And this exercise allowed them to get to the foundation of what their old cultural norms were, so that then, from there, we created here's how we're going to show up in this department. But had we not done this exercise because in their head, there was a lot of inappropriate behavior that they thought was, that's okay, and no one ever told them it wasn't. And it wasn't. You know, you're bad people because I believe this is never about a person. It's about the behavior. So that was like the department-wide strategy.

Dr. Renee Thompson:
Oh my gosh. Okay, I need another hour with you. Okay. To unpack all of this, I do want to reinforce something that you said that I hope everybody else caught this too because this is one of those things that I see leaders do repeatedly over and over again, that's repeatedly that actually prevents that person to take ownership of their behavior. It's that whole action plan. But what you're doing is you're telling them you're going to write an action plan on what you're going to do to step up to meet these expectations. I love the fact that you're telling them, I want two evidence-based articles and to participate in the Journal Club. Okay, for some, it might feel like punishment initially, but what you're doing is you're not telling them what to do from a this is what you're going to do to step up. But you're asking them how will they step up. What do they need to do? And it takes the responsibility off of the manager's shoulders and puts it back on the person who is the I don't want to say the problem person, but the one who's behaving in an inappropriate, unprofessional manner. They need to take responsibility for it. And I think as leaders, we tend to be fixers, problem solvers. We're like, okay, you're going to do these things, but instead, we need to take a step back and say, all right, what do you need to do to make sure that you're meeting these expectations? And I think that's brilliant. And if you're in a leadership role and you're listening to this, this is my big takeaway, stop telling people how they can meet the expectations. Tell them what the expectations are, and then ask them how they're going to meet those expectations. And I think that's so wise because then, instead of enabling them, you're empowering them, right?

Dr. Maureen Chadwick:
100%. And like I said, generally, 70% of the time people turn it around, 25% of the time, we had to help them arrange their talents to the competition. And then 5% of the time, right in that meeting, if they walked out, then it was over. You know, you got to go out there and, you know, that was probably the easiest one. But to see 70% of people, because that's the other thing, too. With the nursing shortage, we cannot just say, just fire everybody who's having a bad day. We just can't. And if we lead with kindness and really seek to understand, because generally, there isn't one of us listening to this podcast right now who doesn't have stressors going on outside of work. So, things are pretty complicated in society right now. So I think that leading with kindness can really have a powerful.

Dr. Renee Thompson:
Yeah, and you and I have talked about Radical Candor. You know, Kim Scott's work. And we'll make sure that we have a link to her book in the show notes. But Radical Candor is all about caring enough about somebody to tell them the truth. And when you take a look at that whole concept and you couple it with human dignity. I think it's very powerful that you can be a leader who can have difficult conversations with people, but it come from a place of, I'm going to say, love. Maybe that's a strong word, but at least kindness and caring about other human beings, even the human beings who are not behaving in a way that's kind or caring or professional. And, you know, I'm going to reinforce this, that you said a lot of times nobody's actually sat down and had an honest conversation with that person. And we talk about that person sometimes for 20 years. But we actually sat down and had an honest and respectful conversation with them about their behavior. And I think that's where it really begins. And so, Mo, as we're wrapping up, if somebody is listening right now, I know we've talked about a lot of strategies. We talked about mindset. If somebody is recognizing that, wow, they really need to step up and start disrupting incivility, what would be like one practical action that you would recommend them take?

Dr. Maureen Chadwick:
Well, I think, first of all, if they don't have your book.

Dr. Renee Thompson:
Aw.

Dr. Maureen Chadwick:
This isn't a promotion, but this is truly this is amazing work that helps ground them. And what I say to people, you know, this isn't Mo Chadwick's strategy. This is how do we disrupt incivility. But I think the most practical thing is getting comfortable with yourself. What is my relationship with myself? You've got to be in right relationship with yourself before you can have difficult conversations with other human beings. So, really, being in a good headspace that way. And secondly, it's okay getting comfortable with being uncomfortable, if that makes sense, because these are in getting comfortable. And I think oftentimes depending on the generation, we're not really great at expressing our feelings, but getting comfortable saying, I need to pause you and I need to have this difficult conversation, which is going to be a difficult for me as it is for you. And I think the other thing, and I just had to coach some managers on this because do you really strong point. If no one's ever had the conversation with someone for 20 years, I guarantee you they probably have 20 years' worth of excellent performance …

Dr. Renee Thompson:
Oh, boy. Yep.

Dr. Maureen Chadwick:
And again, that doesn't stop you from having the conversation because you can say these are our cultural norms. This is how we're this is the environment again back to where we started. The environment that I want to create as the nurse manager, as the hospital CNO, I am a steward of precious few resources and I need to have this difficult conversation. So I think that's where I would start.

Dr. Renee Thompson:
So wise, just very, very wise. Thank you, Mo, for, not only for being willing to hop on this coffee chat with me, but also for your amazing leadership and willingness to have those uncomfortable conversations because they're not easy. And I teach this, but when I have to have one of those conversations, I still get butterflies in my stomach, and I kind of lose my peripheral vision for a moment. You know, I have to, and you mentioned this. You have to prepare for these conversations. And it just goes to show you that it's not about being comfortable. It's about your willingness and knowing that when you first start having these conversations, you might not be great at it. You might mess them up. But that's okay. You'll get better. And I think you mentioned earlier, having an accountability partner that you can do some role modeling. Hey, can I test this out? You know, I want to see what it sounds like. I think is also really helpful. So again, thank you. And if people who are listening or watching right now want to connect with you, what's the best way for them to do that?

Dr. Maureen Chadwick:
100%. Well, first, Renee, I just want to say thank you.

Dr. Renee Thompson:
You're welcome.

Dr. Maureen Chadwick:
Because I think as nurse leaders, we can create a movement. We can truly disrupt what has been going on in nursing homes for generations. Yeah. If people want to get ahold of me, I'm on LinkedIn. I'm working on my social media. And then also probably the easiest way is [email protected]. Okay. If they want to get ahold of me.

Dr. Renee Thompson:
We'll make sure that we have your LinkedIn profile linked in the show notes, your email. I'll also include a link to my book. Thank you for that. And we'll have the link to Radical Candor. Mo and I were talking before we hit record that we both are planning to read Radical Respect. That's Kim Scott's newer book, and I'm going on vacation. Probably when this airs, I'll be on vacation. So I'm bringing it on vacation, and I think most of it's going to be your holiday.

Dr. Maureen Chadwick:
Yes, yes, I try to at least read one book a month. I'm a little short on that, but there's so much good work out there. And I definitely want because I believe. And I haven't read it yet, but the Radical Respect ties into leading with kindness.

Dr. Renee Thompson:
That's what I'm thinking too. So I'm really excited to read this. And even though I'm on vacation, that's where I get my reading fix. I read every single day. But this gives me permission to read, like, all day long. Well, maybe not all day, but yeah, so we'll have to get together after. You can compare notes on that.

Dr. Maureen Chadwick:
Yeah. You have a book club. We can have a Renee Thompson book club.

Dr. Renee Thompson:
We could. You know what? That's actually not a bad idea. Let me think about that. I think it would be great. So, well, thank you again for being here, Mo. And thank you, if you're watching or you're listening, for carving out time out of your busy day to spend a little bit of time with us. And if you really like this podcast, can you please give us a rating, post a review, and share it with others who may need to hear this message today? So again, thank you all for being here. Thanks, Mo. Take care everyone.

Dr. Maureen Chadwick:
Thank you again, Renee.

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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