EP 63: Transforming Silence into Solutions: Tackling Workplace Bullying and Incivility

CB63_Laura Canfield: Audio automatically transcribed by Sonix

CB63_Laura Canfield: 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. I want to thank you for giving us some of your precious time, and I want to start by just letting you know that a lot of times managers, like an individual manager, will reach out for help. And when that happens, I'm not always as hopeful that we're going to be able to help them. But when a CNO reaches out, then I'm like, yes, okay, the CNO reached out. They get it. They want to help their leaders. And today is a treat because we get to talk to someone who did just that. So, I want to welcome to the show Dr. Laura Canfield, who is the VP and CNO of Cottage Health in Santa Barbara, who reached out to us for help. So, Laura, welcome to the show.

Dr. Laura Canfield:
Thanks so much, Dr. Thompson. It's great to be with you. Oh my.

Dr. Renee Thompson:
Gosh. I've been looking for, Laura and I have been working together now since January, I think, of 2024. And one of the things that I really love about Laura, first of all, she has 25 years in nursing leadership. Okay, so she's been a leader for quite a while, and this was the first time at Cottage Health that they actually created a strategic plan with healthy work environment as the focus, and I think that's what prompted you to reach out. I don't know, can you tell us a little bit about that? Like why healthy work environment? What prompted you to say this needs to be part of our strategic plan, and I'm going to reach out to Renee for help?

Dr. Laura Canfield:
Yeah, thanks so much for asking this question. As you mentioned, we did with the team of leaders and really engaged staff here, create nursing's first strategic plan. And there are four pillars to our nursing strategic plan, and healthy work environment is one of the foundational pillars. And when we were envisioning this as part of our magnet journey, we knew we had an opportunity to do better in this space to provide a culture and environment that really supported the work and our staff, and it was a natural step. It was the next step to our journey of creating the healthiest workforce that we can in our system. We have a three-hospital system on the central coast of Santa Barbara, and we are rooted in shared governance. We have a 20-year shared governance culture. Yet I was becoming aware of pockets of incivility reports that we could do better and a real awareness that our managers didn't know how to start to address it, and that's what led me to you, Renee. And I have to say, one of our leaders had heard you speak, and she brought your name forward to me.

Dr. Renee Thompson:
I want to hug her. Tell me who that is.

Dr. Laura Canfield:
She raised her hands. I was bringing this up. I was talking to our leadership team about, frankly, some anonymous letters I had received. And I received a series of letters; some were anonymous, some were not anonymous. And I shared this with transparency. We know post-pandemic how challenging things have been, and we've had some changes in leadership. And despite our shared governance culture, some staff was uncomfortable bringing this forward and just really didn't know how to address it. So when I started to receive this information, read these letters, they were actionable to me and starting with local leadership. And it really became clear that we had not provided enough support for our frontline leadership, both formally and informally, to really address disinformation. And there was a lot of fear around how to move forward. So we're just so grateful for our partnership and the body of evidence and work that helps us move forward in this space.

Dr. Renee Thompson:
Okay, you said a few things. First of all, you recognized that you had some pockets of incivility and you were getting feedback or you were getting letters. Laura, there are some people who would say, that's just the way it is here, or they wouldn't have taken it serious enough to actually say, okay, we're going to do something about this. And this was probably around maybe ten years ago when people still weren't willing to be transparent about the issues that they were having surrounding culture. But there were times I would go into an organization, and they would tell me, please don't use the word bullying. And I thought, wait a minute, okay. If it's bullying, we need to give it a name, okay? But what we find is mostly incivility. There's not actually a whole lot of bullying. It's mostly incivility. But what you did was say, okay, we have an issue, and we're not going to just ignore it.

Dr. Laura Canfield:
It's interesting you say that, Renee, because here at Cottage Health, we had the exact same experience. So I started to receive some letters. I talked to local leadership of those areas, and it wasn't just in one area. It was a few different diverse clinical settings with different issues incivility, maybe some allegations of bullying, lack of follow-up. And when I went to one of those local areas to inquire, I had the local leader say, please don't use the word bullying with my team. And I was so taken aback. First, I thanked her for letting me know, because I was about to address a staff meeting, and of her team, very large group, 142 people, and she was so uncomfortable with me using the word um, but it really was happening. And in this case, in this department, there was some bullying. And I thought, if we can't name it, how are we ever going to provide tools? But it showed me that this leader really didn't have resources, was very uncomfortable, and had this fear-based leadership in this area. And it led me to ask questions, bring up this scenario, get feedback. And that was the venue. It was a leadership meeting that one of our clinical managers over another area had seen a talk you had given we were able to reach out, and we put a team together, and knowing that this was a healthy work environment was a pillar of our nursing strategic plan, which we were just envisioning at the time it all came together well.

Dr. Renee Thompson:
And it's interesting you had a similar path. How people end up getting to us is you choose not to ignore it. You choose to take action. And like I was working with this one chief nurse who said, well, we've got a bullying and incivility problem. I'm not the expert. Does anybody know an expert? And somebody in the room said, oh my gosh, my friend Renee is the expert. And then we started working together. But one thing I'd like you to talk a little bit more about, Laura, is how you saw this as not a nursing issue, but an interprofessional team issue, because you initially said we put a team together, but even all the work that we've done, it's not just the nursing leaders, it's the physicians and pharmacy and respiratory, the CNO, the CIO. It's all everyone. So, can you tell us that approach to solving this problem?

Dr. Laura Canfield:
Yeah, of course, we look at formerly nurse-physician collaboration through our NDNQI surveys. This is something that we've assessed for many years. And we know that we've had opportunities in different clinical areas with an opportunity to collaborate more effectively. We know the situations that occur and bubble up with all sorts of providers and nursing and just lateral violence too. It's a term that we've used that we incorporated here about ten years ago, starting in our emergency department. There's really a lot of grabbing on to this and just really trying to socialize that concept of being ensuring that a handoff that with the stressful work, everyone is their best self. So, you know, this has been something that hasn't just been focused on nursing, that we've had an awareness that really could apply and the tools could apply to all our professionals. And while nursing did lead the development of the team, the strategy, the the reach out, it really has been embraced by all levels at our organization. And Renee, you came on-site for us in person in February of this year. You did a kickoff for us and it was attended by our chief of staff. It was attended by leadership in our physician space, and I got feedback after that introduction of the evidence-based topic that it was some of the best content they'd received. And this came from physician leaders that had been previously maybe not aware of how significant an opportunity that we had, and when it's only coming from me, or certain leaders wasn't able to move the needle like we want it to. And I'll just add to that, I was really educated that there's a whole body of knowledge on this topic. How pervasive, how widespread, especially in the post-pandemic environment that we're all managing now, that we're not alone, that it's not shameful that this is what happens in high-stress environments. And like any other problem that we face or complexity, we bring a set of evidence-based tools to it. We look at the opportunities we practice, and we get better. And that was new, it was new for me. It was new for many of our teams, including our ancillary team members and our physician partners. We've gone on to have Dr. Mitch …, and he's coming next week.

Dr. Renee Thompson:
He is. We're excited.

Dr. Laura Canfield:
… Next week for his second session, and we had 280 attendees, and this is procedure-less. We have four residences at Cottage Health here through GMEC. All of the residents were able to attend the session and it was standing room only back in October. And on December 11th, we have our second session about identifying behaviors. And we had wonderful feedback there. So, really, it is a interprofessional, all-hands-on-deck group effort to do better in this space.

Dr. Renee Thompson:
Okay. I want to reinforce something. A couple of things that you said. First of all, we find that there's sometimes a hesitation or reluctance to get involved because a lot of physicians and others see it as a nursing initiative. However, it's one of those things that I say this frequently. They won't listen to you, but they'll listen to me. You bring in an external person who basically is sharing common ways. These disruptive behaviors are showing up, and they're like, oh, wait a minute. Yes. It's so it's not just lip service in your organization. They're hearing, no, that there's evidence to support not only, as you said, Laura, how it shows up, the impact, all of that, but most importantly that what we can do about it and bringing the work towards not demonizing any one role like we all misbehave. We can all act in ways that are incredibly disrespectful and unprofessional, so we can all work on addressing these issues. And when equipped with the strategies on actually how to do that, that's when you really start to see improvements and you've done just a remarkable job with that. And yeah, Mitch is on our team, and we, Surgical Services really wanted to do something for them. And so we put this together and Mitch went out there. When you see that, when you see that there's standing room only, it tells me that they're hungry for this work, even though initially they may have been resistant when they when you give them a little taste of it, they're like, oh my gosh, this will make our lives so much better. And you've done such a great job with that. But I'm really interested to know if you had anyone when you were a little resistant.

Dr. Laura Canfield:
Let me just take a step back, if you don't mind me in just to say that our leadership team that is nurse leaders, but other leaders, as well, has really embraced this work, and I am simply have the privilege of being the facilitator and sometimes signatory on getting initiatives through, but really, this has been so embraced. And we started with the eradicating bullying and incivility cohorts in two separate areas, right? Interprofessional leaders. And as we transferred over to opportunities and content for surgical services. Perhaps there was a little bit of why do I need this? But we had that resounding endorsement from your very first presentation with us that included our chief of staff at the time. A few key leaders, some of our executives, some of my colleagues in that space that really endorsed this is important, and it really has been embraced. So Mitch's talk in October, as I mentioned, we had our main auditorium. We overflowed into two separate rooms that had to be zoomed in because the auditorium, which holds about 150, was standing room only and take evaluation of that work. We had over 180 positive feedback comments that were narrated in our evaluation, and we haven't received that much pushback. Now, I will say some of the content follow-up, especially in different providers who have very busy schedules with our champion-based model that we had and we get the most engaged champions. Oh my God, we could ask for sometimes that follow up on completing modules, assessing their knowledge base in the various areas for the skills for healthy communication. We've had to circle back with people a few times to say, hey, remember this is on your queue. This is your due date, and this is important work. But so those are a few examples of some of the challenges we've faced. But overall, it's been embraced. And despite a grumble like this, the sessions that we do with Mitch, we delay our start time right by about an hour, and there's a little bit of grumbling, oh, I can't start my case until 9:30, when I normally start at 8:00 or 8:30, but they know that it's invaluable. And we are really fortunate to have great partnership here with our medical staff leadership, and I would not be able to bring this forward without their willingness to listen and be challenged, and kind of face their opportunities as well. And you mentioned it, we all have them. We all have them. And that's what's so equalizing. I think with the content, everyone can see themselves in the scenarios, in the examples, and the tools which have to do with role-playing. Ding it's really tangible. People can take it, people can make it their own. And we're talking about it so much and it really is removing that stigma.

Dr. Renee Thompson:
It is. And to your point, it's giving them those tools, allowing them then to make it their own. That's going to be difficult because to really change culture and especially you're on the magnet journey and all those things. And NDNQI all of those we know culture impacts all of that. So, for you to really improve your culture and make it stick, it really requires a top-down, bottom-up, everything-in-between approach. Like you can't just say, oh, I'm going to because what you didn't do was say, oh, we're going to have Renee come out and do a workshop, and then check a checkbox because one workshop does not change behavior. And so we put together this whole year-long program. And we've learned this too over the, you know, 13 years I've been doing this. People need that in-person, face-to-face opportunity to get some content, but then also to engage in conversations, get questions asked because it's almost like you create that burn. We need this help. We can do better. Now I feel like we have the tools and you've been able to reinforce that along the way. And you're right, there are challenges. People are busy, but you're always keeping your finger on the pulse of where everyone is. Laura, how do you measure success? That's always been a tricky point. People are like, how do you measure outcomes? How do you know this has been successful? Because we're dealing with human behavior here.

Dr. Laura Canfield:
Yeah, thanks for asking. And it's important we're going to take this opportunity, this work, the effort, and the engagement that we've seen as some of our exemplars for Magnet. And we are able to resurvey our staff annually with the Gallup tool for engagement. There are questions that specifically ask about burnout. There are culture of safety questions that are embedded in this large survey. We also do a pulse survey about at midyear to assess how people are feeling about it. And at the unit level, I have to tell you, we have so much happening at the individual unit level. And from posters that are up in various work environments to a model like where are you on the line? So imagine a line, a horizontal line, are you above the line or are you below the line and asking those questions daily? Really just engaging. And we are going to put a Smart goal around talking to each other and civility. And we're considering doing this actually came from one of our champions who is our clinical manager of our ED. And he brought forward a Smart goal idea and how we're going to measure handoff. And when we look at handoff for example, we're at full capacity today at our large campus. And we have patients boarding in our emergency department. I just got a ping broken in. Can someone wants to cancel surgeries because we don't have it? We're at capacity, right? So throughput capacity management is really important to us. And this is a stressful time for people. And when we look to do our handoff, we need to do it quickly. And we understand the pressures on both sides for everybody involved. So, looking at a measurement and a goal between how quickly we can do handoff, how people feel about the handoff, we have a research institute here. So, we are looking at more formal ways to measure the content and the application of some of the things that we've learned so far.

Dr. Renee Thompson:
Wow. You're probably talking about Blake.

Dr. Laura Canfield:
Yes, yeah. Blake Henderson, really amazing leader. And before he's relatively newer to the clinical manager role in a formal way. But he's been on our career, our clinical ladder, for years. And he was one of the leaders of the lateral violence campaign that the ED spearheaded. I mentioned about ten years ago, and he brought that forward and has really been just a champion in every sense of the word with integrity. We also have an engaged leader and doctor, Karen Rose, who is our clinical manager and our neonatal ICU, and truly have just embraced this work, and I think, have felt empowered. And we start our meetings with a healthy workforce moment, just as you have suggested. And that is sometimes recognition for a job well done. It is sometimes sharing a good catch that one of us identifies that could help avert patient harm. And sometimes it's how are we implementing the tools? And there is a hunger here. I have to say, we started with the model, with the cohorts, and we're going on to cultivating healthy teams. It is rare that I meet with an individual staff member that they don't ask me what's next with healthy workforce? Have didactic content. People are hungry for it. And you mentioned the in-person and the rollout, and it is train-the-trainer model like we're providing this content. We're disseminating that. But people do like the benefit of either in-person or some kind of didactic content, so I know we're exploring those things, and people are just hungry for it here.

Dr. Renee Thompson:
Well, and I, this is our approach. We look at a hybrid model. We usually want to start with an in-person, and then we get people into some of our programs. And some of those programs are hybrid. So there's didactic. Yes, here's the course. Here's the content. We help then engage people in conversations about what they're learning. And then your leaders hop on our monthly calls. Every single month. We have your leaders from Cottage Health on these calls, learning and talking with other leaders from across the country about how to handle some of these disruptive behaviors, and how do you really cultivate the good behaviors and cultivating a healthy work culture. But then, it can't just be the leaders. It has to be the teams, too, and our cultivating healthy teams. It's all about, you know, these are the topics how to reduce gossip, give and receive feedback. We don't teach people how to do this. And when you do, when you teach them, and you give them the tools, then they can be addressing some of these behaviors in the moment when they're faced with them, with a colleague, instead of running to their boss. And then the boss is spending 40% of their time dealing with conflict, when then what you've done is you've equipped them and now they can handle not everything, not everything, but they can handle some of the maybe lesser intense issues, colleague to colleague. And we've seen that too, where people are like, okay, what's next? I got this. What's the next one? And I'm so grateful to hear that, Laura. But it goes back to you as the chief nurse, recognizing the need for this and then taking action, doing something about it.

Dr. Laura Canfield:
Yeah. And again, I'll say that I brought this to our CEO, our COO, my colleagues that I work very closely with, and we're really proud of our 20-year history of shared governance. It doesn't mean that things don't bubble up despite a wonderful foundation with a lot of integrity. And people were, and I want to just acknowledge, too, that I might have had a gut reaction of, oh no, this can't be true here. This can't be true at Cottage Health, and it was true. And that is any leader, anyone who works closely with amazing teams and knows the important work that we do. Just really taking the opportunity to identify how can we be better without internalizing it, without being defensive. When I clearly admit that it was difficult to say, hey, it seems this is the second letter that I've received bringing forward some information that's difficult to read. We need to take this seriously and be able to present it to colleagues and get the support to bring a formal curriculum and strategies forward. Because as we talked about at the opening, when you can't mention the word bullying for fear of what might happen, how can we move forward there? It's been a great experience.

Dr. Renee Thompson:
Well, again, just to reinforce exactly what you said, it's easy to get defensive. It's easy to stick your head in the sand and say, not here. This isn't happening here. You don't want to swing the pendulum so far the other way that oh my gosh, this place is toxic. Okay. Like it's not. There's somewhere in the middle where you can just say, okay, we have an issue. Let's address it now before it becomes a bigger issue. And when organizations reach out to us, and they say, you know, we've got some pockets here, we've got some opportunities, I'm so happy to them work with them. When someone reaches out and says it's toxic. It's so bad we can't keep people here. I'm like, oh, why did you wait until it got that bad? Don't wait until it gets that bad. And so as we're wrapping up here, Laura, if there's another CNO who's listening to this or watching this, and maybe they're in the same situation that you were in where they're getting some feedback, what would you recommend as a first step for them? Because I know you mentioned something about your COO, but can you give them advice on what to do?

Dr. Laura Canfield:
Sure, yeah. And thanks for asking. I think the very first step, I think, is to just keep your curiosity and an awareness that this could be a legitimate opportunity to do better. As I mentioned, I really was like, oh, no, that that can't be true here with our outcomes as such, our culture, I think, challenge yourself to really critically appraise what's in front of you and take the first step by connecting with those leaders in those areas, getting their feedback and also front line people. When the leaders can't define what incivility or bullying is themselves. When you ask them, do you have a bully culture in your unit? They might say no because they're unable to really identify it, and that was some of the most important content. What is bullying, and what it isn't? And that was really foundational for us. So I think starting with circling back with the people who bring forward the concerns, listening, doing your best, and gathering the information, and asking more than one person, and then you can bring forward a team. I was able to partner, like I said, with our senior executives to illustrate the need. And I'll say our CEO was cc'd on some of these letters. So our CEO had the opportunity to read some of this personally, and those that he wasn't CC'd on, I shared them to make the case. I started to talk about it at different leadership meetings. When one of our managers, who is at a different campus, I didn't know her well, said, hey, I heard Dr. Renee Thompson speak on this topic. I'd like to talk to her name, check out her podcast, and that's how it happened. Renee, I also want to offer myself as a touchpoint, or for anyone who might want more information on more details about how we brought this partnership forward, what we're still doing, what our future vision is, because there's a lot of work. And as we complete a few cohorts, more, more leaders are asking, more leaders are saying, hey, Laura, I saw what you did in Women's and Children's Services with your content here. I want to do that for my leadership team, too. So I think those are the first steps, and it's been a pleasure. Your organization was easy to work with. It made it easy for us to make our end. I think engaging your team, you also alluded to it isn't a top-down initiative. This comes from everyone, and buy-in has to be there in order for it to be successful. So those are a few of the things that I'd recommend.

Dr. Renee Thompson:
I think that's excellent advice and starting with get curious. Dig a little deeper. Do a little investigating. Start talking to people. How true is this? And at what level? Okay, because you get some feedback and then present that to your key stakeholders. And then it's like, okay, here's a solution. And get their buy-in with what you did. And yeah, you've been a great partner. And we're excited for continued partnership with you because, as you said, this can't be a one-and-done. Yeah, it has to be something that's part of your strategic plan and that you're always making sure that you're equipping your leaders and their teams and then engaging them in conversations about it ongoing. It's not another flavor of the month. This is now become habit and how we do business. So Laura, if people want to connect with you, what's the best way? I know you're on LinkedIn, but is that the best way?

Dr. Laura Canfield:
Yeah, I'm on LinkedIn. I'm happy to provide my email address as well and really would be happy to talk with anyone. And again, I humbly share that a lot of people are involved with this work in this work in Cottage Health, and we've inculturated it and we're talking about it in every opportunity that we have with a lot of different stakeholders. So we have many individuals that could speak to this in our initiatives here. And I'm available for for that as well.

Dr. Renee Thompson:
Well, thank you for that. And we'll make sure we have a link to Laura's email address and her LinkedIn profile in the show notes when this episode airs. And Laura, I just want to thank you for being here and again for being so committed to cultivating a healthy work culture at Cottage Health. I so appreciate you and your good work.

Dr. Laura Canfield:
Yeah, thanks. I feel the same way. It's always wonderful to see you out at conference, and we're looking forward to next week with Mitch. And this is the most important work that we're doing. It impacts our patient outcomes. There's resonance there. People know that. And we're really grateful to have a body of evidence that we can bring forward.

Dr. Renee Thompson:
I love it.

Dr. Laura Canfield:
To support the work.

Dr. Renee Thompson:
Well, thank you. I appreciate you so much. And again, all of your leaders and their teams, we've had such a great experience working with all of you, too. And I also want to thank those of you who are either listening or watching for carving out time during your day, evening, or night to hop on this podcast. We know you're super busy, but the fact that you protected some space to be able to hop on and listen is I'm very grateful for that. And if you like this podcast, if you can please post a review, rate it, and then share it with others. Maybe someone who needs to hear this today. So thanks, everyone. We'll see you next time. Take care.

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.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

Automatically convert your mp3 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you’d love including enterprise-grade admin tools, advanced search, world-class support, generate automated summaries powered by AI, and easily transcribe your Zoom meetings. Try Sonix for free today.