EP 6: The Power of Authentic Leadership in Healthcare Culture

Coffee Break_ Episode 6_Barry McElyea: Audio automatically transcribed by Sonix

Coffee Break_ Episode 6_Barry McElyea: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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.

Renee Thompson:
Well, hi, everyone! Welcome to another episode of Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. I am Dr. Renee Thompson, your host for this podcast. And, you know, this is really a podcast that gives us an opportunity to talk to amazing leaders from all over the country who are already successful in addressing bad behavior and cultivating a healthy work culture, and I am beyond excited to have Barry McElyea as our guest today. Barry is the VP of Nursing Perioperative Services at Inova Fairfax Hospital. So Barry, welcome to Coffee Break.

Barry McElyea:
Thank you so much, Renee. I'm so excited to be here today. This is fun for me; my first time being interviewed on a podcast, so I'm excited.

Renee Thompson:
Really?

Barry McElyea:
Yes!

Renee Thompson:
This is your first time.

Barry McElyea:
I've been bragging to everyone about it. I'm like, I'm going to be on a podcast, so I will distribute this far and wide.

Renee Thompson:
Wonderful. This is like your celebrity, when this comes out, people can be asking you for your autograph.

Barry McElyea:
Absolutely. This, you're, just you're just feeding my ego here. But that's okay. I just enjoy working with you so much, and it's fun to have the opportunity to talk about this work.

Renee Thompson:
Well, thank you, and I couldn't agree with you more. And so, to officially introduce Barry and let you know a little bit more about him, Barry has administrative and clinical leadership oversight in more than 60, okay, brace yourselves, 60 operating rooms and procedural spaces. He has over 28 years experience as a nurse. He has a master's degree in nursing executive leadership, where he developed this interest in bullying, lateral, and horizontal violence. This is why Barry and I get along so well. He has served as a keynote speaker at many conferences, and he really wants to share his passion for addressing workplace bullying and incivility. I love this, and in his downtime, Barry loves to travel, me too, immerse himself in local culture, and is a voracious reader of police procedural-style novels. That's super fascinating. You're going to have to tell me all about that.

Barry McElyea:
I will, so what that means is I know.

Renee Thompson:
What is that?

Barry McElyea:
I know where to hide a body if you ever need help. It's all the CSI-style stuff. I don't know why it fascinates me, but I think it's because I can just disconnect from my work. I just sort of read a good police thriller. So just joking about hiding the bodies.

Renee Thompson:
Okay, I was just going to say, be careful. This is being recorded. So if anybody disappears in your circle of friends and family, they're going to come after you. But the one thing that I also really appreciate about Barry, and this is how I met Barry, Barry and I did a lot of work together. We implemented our Department Culture Change Initiative, which is a system that we know works to transform cultures from dysfunctional, disrespectful, you know, bullying, incivility to more of that high-performing, respectful, professional team. And we started doing this work, and surgical services was one of the areas that we implemented this system. Barry and I had a chance to really work hip to hip together with not only Barry and some of the other leaders, but his entire team, including the physicians, the surgeons, the providers, this is a team approach to culture change. And then, we were so successful that we decided recently to launch our Culture Change initiative as a certification program, and Barry is one of our ambassadors really helping to scale this work across his organization, because why should just the CVOR benefit, right, Barry? It should be the entire organization, and really valued my time with Barry and learned a lot from him, and that's why I knew I had to have him as a guest. So, Barry, can you tell us a little bit more about yourself and how you really became, you know, an expert in addressing disruptive behaviors, especially in surgical operations?

Barry McElyea:
Yes, thank you for asking that question. So, as you mentioned, I've been a nurse for 28 years, and at the beginning of my career, I experienced a lot of bullying. And I'm also, and I share this when I do talks about it, I became a bully. Because when we live in that toxic environment, as human beings, we seek to fit in, right? So, as a young person out of college, I desperately wanted to fit in with my colleagues, and then I started to recognize that I was becoming part of that toxic behavior and, quite frankly, embarrassed about it. So whenever I do talks about this, I always bring that up and tell people, I actually do a talk about professionalism in the workplace. When we onboard new nurses and new techs, we set an expectation right from the get-go of what we expect here in Inova. And you know, it's funny, you think you shouldn't have to tell people that, but I've learned over the years that it's important because people have different frames of reference, and especially with intergenerational communication styles, there are differences as to what's okay for one person or another person, it's regional. So we do this talk, and I always share the story about how I found myself becoming a bully because I truly believe that people want to come to work and be successful, and they want to lift other people up, and sometimes, we have to remind them of what that looks like. So it became near and dear to my heart because I have seen so many people over my career who maybe left nursing, who were forced out. Going through COVID in the last three years, we just lost some of the civility that we had seen. So when I met you, I didn't think there were other people who had a passion for anti-bullying, right? It doesn't necessarily sound like the most glamorous, sexy work to do, but I will tell you, it's meaningful, it's fulfilling because you can really lift people up and help them be the best version of their selves. So that's, for me, was a personal journey. And now I've gotten a lot of fulfillment out of helping people, taking someone who may have been considered the problem child of the unit and having them become a rock star of the unit because we taught them tools on how to communicate. And so, for me, that's what's really exciting, and I really get a lot of joy in that.

Renee Thompson:
I can see that, absolutely. And I'm curious, Barry, was there a moment when all of a sudden you turned the mirror back on yourself and you saw yourself in that way, or was it somebody who brought it to your attention? What made you realize that, oh, my gosh, I'm part of the problem. I have joined the herd, like they say, and you know, if you can't beat them, join them. I totally get that. But what was it that helped you to see yourself?

Barry McElyea:
So, my first role in leadership. In my first role, I was a nurse manager in a unit, a small unit focused on breast cancer surgery. That's not important, but what was important was I was using some of the styles that I had learned to try and manage. So my boss came to me and said, We're going to do a 360. I'm like, What's a 360? She's like, You need to get some feedback from your peers and people who work around you to understand how they experience you. And I'm like, What do you mean how they experience me? I'm a delight. She's like, No, maybe you're not. Maybe you're not a delight. So I will tell you, that can be painful to have people give you, you know what I'm referring to when I talk about a 360? So you have people give you honest, unbiased, anonymous feedback, which allows them to be really brutally honest, and I will tell you, I was surprised at the feedback. I had not become aware of how I was being received by people, maybe having a tone that was derogatory, or snide remarks, or I was not seeing the way that I saw myself, and that was eye-opening for me. I really spent about 3 or 4 days first depressed and then thought, Well, wait, I've never been one to be beaten by anything. So this is a gift, this feedback is a gift. It was painful, quite frankly, a little embarrassing, but I think that's what turned it around for me because I said, you know, I want to be part of the solution. I want to be the leader that people really enjoy working with, I want to be the leader who demonstrates the positive behaviors, and so, for me, that was the turning point. Probably about 15 or 16 years, my first nursing leadership job, I got told unequivocally I was not a good leader, and I decided I was going to turn that around.

Renee Thompson:
You know, that could have gone a very different way. And we deal with this a lot where a leader finally has an honest conversation with their quote-unquote, bully or, as you said, you know, problem child, and there's a natural human tendency to get defensive and to then maybe even go on the attack. I've heard this so many times, but you did exactly what I try to give leaders hope that this could happen where you probably, as you said, you were depressed for, you know, embarrassed for a few days, but then you sort of got over yourself, and you looked at it through their eyes, and you had a decision to make. Am I going to just, Nope, not true, it's all them, blame them? Or am I going to look at this as, because I always say, when you get the same feedback over and over again, there's always a thread of truth that.

Barry McElyea:
Absolutely.

Renee Thompson:
The thread can be so thin, or it can be as thick as a rope, and what do you do with it? But then you're able to come back and say, You know what? All right, I have some things to work on. That's what I try to, when I'm talking to leaders about having those honest conversations, I try to encourage them, even if the person gets defensive at first, give them some time and then circle back with them because many times they realize, okay, there is a thread of truth to this. Now, what do I do? So, thank you for sharing that. That's not easy. You know, it takes courage to actually not only turn the mirror back on yourself and then take positive action, but then to admit it, but I think it gives you more credibility because you're walking the talk.

Barry McElyea:
You said something intriguing. You know, give people space. I think oftentimes, the first time we talk to someone, and I don't want to use the word confront because confront has a negative connotation, but when we make people aware of how they're being received, it may be the first time they've heard it because, especially in our profession, we're not good at saying the thing. We're not good at being, matter of fact, saying this is how we're experiencing you, this is what our expectation is. And so that's the leader I've become, is give the feedback in a very matter-of-fact way. It doesn't have to be mean or spiteful or an angry conversation. And I think sometimes we get ourselves so hyped up that I'm going to, you know, I have to talk to Renee and tell her that this behavior is not in alignment with our values, and it's, so then I can't authentically give her feedback that she can hear, right? So that's what I've learned over the years, as it's become very natural for me, and that's what I try to teach the leadership team that I work with, is that we owe it to our team members to give them the feedback. We steal their success if we don't tell them. And I've seen so many team members turn around and become those A players, because someone actually had the grace to give them space to hear the feedback.

Renee Thompson:
Right, you respect them enough to be honest with them. And I think, and tell me, Barry, if you agree, that as long as it comes from a place of, I want to help you to get better, I want to help you to be successful, not from a place of I'm right, you're wrong. Because I think that's where sometimes people, they approach it in a more emotional way instead of just from that objective. This is the behavior, has nothing to do with who you are as a person, this is the behavior, and we always say focus on the behavior, not the person. And having the respect to give them that honest feedback and to take your emotions out of it, which I know for a lot of us it's not easy, but it's something that you can work on, and it sounds like you've done a really good job with that.

Barry McElyea:
And the program that we did together through your company, that's one of the things we teach people, is how to have, let me back up for a second. The one thing that you say that I love is Name the behavior. I refer to it as Say the thing. I'll be in a meeting with my team, and you can always tell when someone's hedging a little bit, and I'll say, Say the thing.

Renee Thompson:
Just say it.

Barry McElyea:
Right? It doesn't have to be, I can't, I'm not a mind reader, right? So, say the thing. So, I still encourage feedback from my direct reports and say, I need you to tell me where I've gone wrong. And over time, you actually learn to crave that feedback, you actually learn to want to be better. And so you move it from that place of defensiveness to a place of I'm getting better and better at what I do, and that's why I think I have such trust with the team I work with is, because we have all gotten comfortable naming it and speaking it. So you taught me that. You know, I called it Say the thing, you call it Name the behavior, but it's a really great spot-on advice.

Renee Thompson:
Yeah, and I thank you for that, Barry. And I think the bottom line is you engage in honest conversations with people and everybody around the room or everybody in the department they know, but nobody's willing to say anything. And what we do is we teach people how to say it in a way that promotes positive change, not attack someone. Because I think that's the other issue, as people, they know they need to say something, say the thing, but they don't always know how to do that in a way that's productive, and that's something that we definitely work with our leaders and our teams with. And one of the things that I know you do, you do this probably better than most leaders who I work with, is really, as a leader, holding people accountable and setting those expectations for behavior. And first of all, why is that important for a leader or a leadership team to do? And can you give us some because, you know, this podcast is all about the practical strategies, giving us maybe 2 or 3 strategies that our listeners can immediately implement into practice?

Barry McElyea:
Absolutely. So thank you, it's interesting, I've worked in a number of places over my career. I've moved with opportunities. I get a phone call and say, Can you do this? And I'm like, Yeah, I can do that. Every time I've walked into a new organization, I've been handed a file, and they say, Mary Smith has been a problem for 20 years, so we want you to handle it, right? And so you're like, Well, wait a minute, hold on, I have some follow-up questions. Why has Mary Smith been a problem for 20 years? And why do I get to be the chucklehead who has to deal with it, right? But I learned quickly that this is, what you've described is a common occurrence. There is some real discomfort around holding people accountable. And so this is going to sound like a cliche, but what you permit, you promote. So when a team sees you allowing one person to misbehave or not behave in alignment with your mission, vision, and values, you lose credibility. One person, you know, one bad apple spoils the bunch. It's absolutely true. These colloquialisms exist for a reason, because one person can take a very high-performing unit and just destroy it. So I felt like, and feel like, it's more important, I'm responsible for all those members of that team, right? So you'll hear people say, Oh, well, that's just the way Mary is. That's just the way she is, and you know, 20 years ago, I'd be like, yeah, you know, Mary's worked here for 25 years, and that's just who she is, or Bob has worked here. I reject that now. We all have the capacity for change. We all have the opportunity to do better. When we know better, we do better. And quite frankly, some of it is just me maturing in my career, some of it is seeing that people actually crave accountability. When you give them clear direction for what is expected of them, most people will meet you there or even go higher. Now, I will tell you, in my career, there's probably been 3 or 4 people who did not want to go there, so we invite them to go work elsewhere.

Renee Thompson:
That's right. … Hiring down the road, yeah.

Barry McElyea:
Yeah, the first thing you need to do is lean into it, get uncomfortable. Just understand, I'm going to be uncomfortable having this conversation. It doesn't feel good the first few times. It never feels good to sit down and say, Renee, you're not meeting my expectation. I will even sometimes start the conversation just to get it going. I'll say, Renee, this is really tough for me. I'm going to tell you, I am a little bit uncomfortable, but I have to share this with you. And then the person sitting across from me knows that I'm a human being, too. I'm not there to roast you, but this is a tough conversation. It's awkward, and that sometimes breaks the ice. Number one, it allows you.

Renee Thompson:
I want to unpack this a little bit more. I've seen this, and I'm sure you have too, where sometimes people in a leadership role, especially an executive leadership role, they think they have to not show any emotion, they have to not show any vulnerability. So for someone, let's say, even a CNO, to say, I need to have a conversation with you, and I'm going to be really uncomfortable having it, a lot of them don't even think they should or could say something like that. And what we try to say is quite the opposite; it shows your human side, that you're not, Yeah, as you said, going to roast them, but I think it's very appropriate, especially if it's true, to say: I need to talk to you about something, I'm uncomfortable bringing this up, and it may make you uncomfortable, but because I value you, I respect you. The relationship I have with you is important to me. Just be careful you don't lie, okay? If the relationship isn't important to you, don't lie and say that it is, like you have to find something that you can be honest about, and then engage in that conversation. I think that's so powerful, and a lot of leaders don't realize that that's not only something they could do, but it's they should do if it's true.

Barry McElyea:
I agree. I think people can sense when you're being genuine or not, you can't fake authenticity. And so you made a point, like if you don't value the relationship, don't say that. I agree with you. There are some people we just don't mess with, right? That doesn't mean I don't value their contribution. And so really think about what does this person bring? What are their strengths? You know, I firmly believe that we can always find that gem in there. Now, the hard work comes on the other end. People have to receive the feedback. But no, I have learned that if I'm uncomfortable, I'm just going to say it to you, I'm going to tell you this is hard for me, but it's still important that we do it. And I'm going to say, nine times out of ten, it's gone very well.

Renee Thompson:
How do you handle it when you get pushback?

Barry McElyea:
So I have some phrases in my pocket, I will listen, and then I will say something like, I'm going to respectfully push back against that, and let me give you a different perspective. So actually, there's kind of a joke here. My team says, I'm going to use a Barryism today because I am known for saying, I'd like to give you a different perspective. Thank you for that feedback, I'm going to respectfully push back and say, and so, you can actually respond without it becoming a tit-for-tat. So it's practice, it's scripting. Something else we learn when we work with you is scripting. You develop a muscle memory when you start to use this kind of phrasing, and I think it's important also to listen to people, let them say what they want to say so that you can actually get the nugget of truth. Because you mentioned earlier, our first reaction oftentimes is a defensive posture, and if we haven't developed that relationship and that's the first time I'm coming to you, I would expect maybe some of that, and I'm going to give you the grace. And then I've even, the other phrase in my pocket is, I don't need you to respond to this today. I just want you to reflect. Let's pick a day, a couple days from now, to come back and revisit this. I'd love to hear what your thoughts are on this. So, the first conversation should not be the conversation where we're terminating someone, right? We need to build up to it. One of the things I also say, one of my Barryisms is I don't fire people, they fire themselves, and they are never surprised.

Renee Thompson:
Exactly. And I think a couple of things you said really reinforce something that we always recommend to our leaders too, is when you, let's say, you've never had this uncomfortable conversation with someone before, okay? You've never had the conversation, you've always known you needed to, but you just haven't. When you finally have that conversation, don't think you're finished, because you need to circle back and circle back and circle back because one of two things will happen. Either they will step up, for some people, you know, oh my gosh, like you, Barry, you stepped up right away. I had no idea I was being perceived this way, and you said basically, I'm going to work on this. But we know some other people, they don't see it that way. They may stay in that defensive sort of mode forever, perhaps, and that's why, and I'm really curious to know how you also do this, where you have the conversation, you give them time to reflect, and I love that Barryism. You know, I don't need you to respond to this, I need you to reflect, but we're going to circle back, and then you circle back with them. And again, that might, you may be meeting with that person weekly for a period of time or biweekly. So what does that look like for you when you have an employee who does get defensive, who maybe isn't as open to reflection and doesn't see that they're the problem?

Barry McElyea:
So I think that's a great question, and I will tell you, that's been less common for me. So I don't know if I'm fortunate, but what I will do in that instance is say, is there anything in this discussion or this document or whatever it is we're talking about? Can you see this from my perspective or the person's perspective who's reported this behavior? Start to find somewhere where there's an agreement, try and find an agreement, even if it's on the smallest thing. Okay, well, I can agree that I had a bad day that day, and maybe, I've seen this, maybe I wasn't as nice as I could have been. Now, mind you, the Bob in front of me has cussed someone out. But if you can get them to agree, you know, I had a tough day that day, and so I wasn't myself. And I'm like, oh, so maybe there was some interaction that was less than pleasant or appropriate, so start to get some agreement. I've always been able to get someone to agree at least some point that there was some truth in the conversation, right? Which starts to break down barriers.

Renee Thompson:
I love that. And I think if we start looking at, okay, what are some of the strategies that you've already shared with our listeners? I love how you say the thing. So be willing to have that honest and respectful conversation with someone, to then, it's okay to admit that you're uncomfortable having the conversation, but be objective in your delivery of that feedback and really keep your emotions out of it because you're coming at it from an intention where you want to help them. And then, for some people who need a little bit more time reflecting and even some of them may have a hard time seeing how they really contributed, find something that they can agree to. I think those three things, if you're listening, if you adopt them in having conversations with your team members who you really need to have conversations with, I think you might be almost as good as Barry in having honest conversations with your team too. So I wanted to thank you for that, Barry. Is there anything else that you want to add? Any other actions you think leaders who are listening could take?

Barry McElyea:
I would just say, again, you've touched on this, get comfortable in the uncomfortable space. If you truly want to help people, it's messy helping us, helping people. And in our profession, nursing, and you know, what I love is that the younger generations coming in have a very different perspective. So I came up in a time when bullying was to be expected, and you had to earn your way, right? And that was just sort of how we were trained in school, and now these younger folks coming in are not willing to participate in that. And so I think it's refreshing, because I joke sometimes and say I'm about five minutes away from holding my fist and saying, get off my lawn, but I learned so much from new people coming into our organization because people, every person has this great story. I love learning people's stories, and so, yeah, that's it. And I think if you have a genuine interest in people, if you don't have a genuine interest in people, you should not be leading, you should be leading yourself and not other people.

Renee Thompson:
We always say that you need to show your team that you care about them, and if they believe you care, they'll do anything for you. And then I always stop and think, Wait a minute, you can't fake that. If you genuinely don't care and aren't interested in people as human beings, then leadership is not the right fit for you, because it does have to come; it has to be genuine. So I can't thank you enough, Barry, for just sharing some of your real raw experiences and helping the listeners to get, I would say, more comfortable being uncomfortable and having these conversations that we know are critical if you really want to cultivate a healthier work culture. And I always like to end with a couple of questions. I'm always curious because like you, I'm a voracious reader, although I'm not reading, you know, the police investigation types of books, but I might have to now because that sounds really interesting, but what are you reading right now? And then, if you could recommend a book for leaders, like what's a leadership book that you say hands down, every leader should read this book?

Barry McElyea:
Yes, so two things. I'm reading from my own personal edification. I'm reading a book called The Body Keeps the Score, which was recommended to me, and it's really about how our brains process experiences. Some people refer to it as trauma, etc., but it's a tough read. I will tell you, it's not a book that you just peruse through. So I've been reading it in small chunks, but it's really interesting because what's so beautiful about it is as humans, we're extremely resilient, and we can overcome, and our brains can, we can identify patterns of behavior, and understand what triggers them and change them. So that's sort of my personal journey, maybe sounds a little midlifey, I don't know, but I'm enjoying that book.

Renee Thompson:
So fascinating.

Barry McElyea:
But for leadership, there's a book that I keep on my desk, I open it all the time, it's called Lead the Way in Five Minutes a Day by Jo Anne Preston, and basically, it takes all of these really high-level theories and breaks them down into chapters that are very, actually, I have it in my hands right now, but it breaks it down into really practical strategies. Things like how do you deal with an epic failure or pet projects? It's just a book that I will oftentimes go back to and reread a chapter. It's not nursing-focused, it's really for any leader or any industry, which is why I recommend it. Lots of nursing theory books, but Lead the Way in Five Minutes a Day. I guarantee you'll get some nugget out of it that's helpful.

Renee Thompson:
Okay. I will definitely have to check out both books because I don't know if you know this about me, Barry, but I'm an old neurosurgical nurse, and I minored in psychology, I thought I was going to be a psychologist at one point, and so I love anything related to how the brain works. And so I definitely want to take a look at The Body Keeps the Score, I think that would be something that I would enjoy myself. And then the five minutes.

Barry McElyea:
Lead the Way in Five Minutes a Day.

Renee Thompson:
In Five Minutes a Day, okay. That sounds like one of those, yep, you could read a chapter a day or a little nugget a day, and.

Barry McElyea:
It's one of those books that you take on a plane flight, but I've gotten some real nuggets out. And I'd love to talk to you about The Body Keeps the Score after we both finish it.

Renee Thompson:
Sounds good to me, I will definitely put it on my list. I will get it from the library. And some of you have heard me talk about my love affair with the library, the public library. I get all of my books from the library, first, because it's free, and that way, I don't have to spend money on a book that I think, Oh, I can't even get through the first two chapters, definitely not. But if I really enjoy it, then I actually purchase that book, and becomes part of my permanent library. And I support the library, I'm always supporting them financially because they just provide a great service.

Barry McElyea:
First thing I do whenever I move is get a new library card, so I'm with you.

Renee Thompson:
Exactly, that's what I did too. And as we wrap up, I want to just remind you all, if any of you want to connect with Barry, can we just send them a link? You have a LinkedIn profile.

Barry McElyea:
I do, Yes, would love, absolutely.

Renee Thompson:
We will include in the show notes a link to Barry's LinkedIn profile, you can connect with Barry there. If any of you are interested in exploring this Department Culture Change Initiative and then our certification program that Barry and I have been involved in for the last couple of years, just email me through our website HealthyWorkforceInstitute.com. And I just want to thank you, Barry, for being a guest on our podcast and I've learned so much from you. I know you said you've learned from me, I've learned from you, and that's the one really great thing about this work, even though, as you said earlier, boy, this is not easy. Oh, my gosh, you know, who would on purpose pick this topic, okay, to actually tackle? Because it's so complex, it's so uncomfortable, but it's meeting amazing leaders like you that makes it so much easier and actually enjoyable for me, because I learn too. So I just want to thank you for being a guest on our show.

Barry McElyea:
Oh, thank you so much. This was a great time for me. I appreciate it.

Renee Thompson:
Thanks, Barry. And all right, everyone, until our next conversation, be kind, take care, and stay connected.

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found these practical strategies helpful, we invite you to click the Subscribe button and tune in every other week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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