Healthcare Safety

Silence Kills Study

This program is designed to help healthcare providers increase patient safety and employee retention. The intervention is based on Crucial Conversations, VitalSmart’s best selling book, and on Silence Kills­-The Seven Crucial Conversations® for Healthcare, a 2004 study conducted by VitalSmarts and the American Association of Critical Care Nurses.

The Silence Kills research identified seven conversations that are especially difficult, and at the same time, especially essential for people in healthcare to master. These conversations were those related to:

• Broken Rules
• Mistakes
• Lack of Support
• Incompetence
• Poor Teamwork
• Disrespect
• Micromanagement

Fifty percent of the nurses and eighty percent of the physicians in the study have these concerns about the people they work next to. However, only about 10% had ever spoken directly with the person and shared their full concerns. As a result, many of these dangerous problems had continued for months or even years.

The 10% who did speak up and share their concerns were found to be the most effective, satisfied, and committed within the hospital. The quality of these seven crucial conversations has a clear impact on medical errors, patient safety, quality of care, staff commitment, employee satisfaction, discretionary effort, and turnover.

The research found three main reasons people don’t speak up and have these crucial conversations: “There wasn’t time,” “It’s not my role,” and “I was afraid they might retaliate.” One way hospitals can encourage people to have more crucial conversations is to create cultures of safety, where people have opportunities and feel safe bringing up concerns. The added benefits in productivity improvement, reduction in nursing turnover and physician cooperation make improvement in this core competence an overwhelmingly high-leverage objective.

However, it would be dangerous to conclude that the responsibility for breaking this culture of silence depends solely on making it safer to speak up. There are ten percent in every hospital who are already speaking up, and they are not suffering for their outspokenness. They are the most effective, satisfied, and committed in the organization.

Hospitals need to learn from this skilled minority. VitalSmarts has spent 10,000 hours observing these opinion leaders and can recommend a series of steps for spreading their capabilities across a hospital.

The recommended intervention is to :

1. Establish a Baseline and a Target for Improvement
2. Conduct Leader-Led Focus-Group Interviews
3. Focus on Problem Areas
4. Implement Training by Leader-Teachers

Contacts:

Peter Anlyan - President of Observability, LLC and a trainer in Crucial Conversations

Howard Schultz - President of The Learning Consortium, a VitalSmarts partner company