Just in time for the Thanksgiving Holiday— the CMS Book Club reviews “How to Avoid Awkward Silences” by Patrick King!

“You set the tone for how people react to this… when you act awkward and diffident, people feel awkward and diffident.”

Join us as eight learning conversation experts debate the value of silence, and how we can get the conversation back to flowing when we feel like we’ve lost touch with what’s happening in the debriefing room, classroom, or around the family dinner table.

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Why is it so hard for healthcare educators to share what they actually think in a debriefing or feedback situation? Jenny shares the story of a participant in an anesthesia clinical simulation who helped guide her to be more transparent: “I’m often talking to providers on the worst day of their career, after a medical error has occurred. If I’m going to ask them to be honest with me about what they were thinking, the least I can do is be honest about what I’m thinking.”

Over the years training faculty in feedback conversations, we’ve run into many who ask, how is it helpful to tell my learner that I think they’re an idiot? But telling the person what you think honestly should not be your feelings or attributions about their character. It should be the impact of their actions, which exist at the level of concrete data.

Workout of the Week: Practice saying to people, “When you did x, it led to y.” One great feature about this workout is that you can use it for positive things! “When you stayed late to help me with that report, it lowered my stress level.”

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

When we lead a conversation where we only bring our conclusions and inferences to the table, rather than the concrete data that helped lead us there, we are influencing (sometimes unjustly) what is even discussable among our teams. By going back down to discussing the data that helped us shape those conclusions, we can make conversations and meetings more fair, more equal, and more productive.

Workout of the week: Note when you have gone up the ladder of inference to a conclusion about a person and perhaps lost track of the data that led you there. Then, go back down and incorporate the data into an observation. Example: “She was defensive” is an inference or conclusion. Go back down the ladder to the data and turn it into an observation: “I observed that she crossed her arms and said, ‘I don’t know,’ twice.”

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

Too often, meetings and announcements, especially around policy changes and new ways of working, are a list of topics that fail to address the fundamental questions that matters to team members—why are we talking about this? Whose decision was it? And is that decision final?

Leaders and team members need to understand how power is being wielded, especially when it comes down the line in seemingly inhumane ways. By simply saying a few key words, we can make our teams feel like they had a voice, like power is not being used unfairly, and safe to say when they don’t understand and when they want input.

Workout of the week: Use the subject line of your emails to practice more clearly telling what the purpose of the conversation is.

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

This week, Jenny and James explore recent conversations that didn’t go as well as they could have, because of different types of failures in the words we chose to use or the things we chose to reveal. Building on the work of recent guest Amy Edmondson, we look at the way that people in fearless organizations can talk—using the conversations that you have to frame the work, emphasize shared purpose to create joy even in everyday work, and demonstrate that you don’t think you have all the answers.

Workout of the week: Observe for conversations where you feel unclear—what was the point of this meeting, why are we having this conversation, what are our goals of care for this patient?

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

Christian Balmer, an anesthesiologist and critical care doctor from Switzerland, joins us to look at the readiness of surgical teams in his organization to recognize and deal with cases that have gone beyond the capacity of the peripheral center to handle.

Far from being a readiness plan around technical skills, the team discovers that it is the gray areas between intersecting teams and intersection institutions where the process of caring for the patient breaks down. Do the ICU teams at both hospitals agree about when is the right time to transfer the patient? Do the surgeons have training on stepping back and declaring that there is a crisis that needs to be managed via transport? Are there communication plans in place to make sure that the ICU has available beds, and to help the main hospital trust that when the peripheral group sends a patient, that patient has a real need for the ICU bed?

Finally, we discuss aligning training programs from healthcare schools all the way to the hospital—if health systems are looking for teams that can talk to one another, work with patients, and provide care in a particular way, how can we make sure that the schools that are training future healthcare workers are in communication and prioritizing the skills and ability to learn that they will need to be ready for the job?

--------------

Host & Co-Producer: Chris Roussin, PhD, Senior Director, CMS-ALPS (https://harvardmedsim.org/chris-roussin/)

Producer: James Lipshaw, MFA, EdM, Assistant Director, Media (https://harvardmedsim.org/james-lipshaw/)

Consulting and readiness with CMS-ALPS: https://harvardmedsim.org/alps-applied-learning-for-performance-and-safety

Readiness Planning in Advances in Simulation: https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-024-00317-z

Dare to Be Ready on Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Dare to Be Ready on Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

In this special episode, Jenny Rudolph and James Lipshaw, producer of Curious Now, debrief our performance so far with the podcast, what we had in our original vision that we haven’t achieved yet, and where we’d like to go next. How can we rachet up the interactivity of the podcast, how do we make the experience of trying to do this work right more relatable and less of a lecture, and how do we tune the difficulty of the workouts to the experience levels of our guests better?

Do you have feedback for Jenny on the first three chapters of Curious Now? Now is a great time to comment—let us know below this post what you’d like to see in the future, and how the workouts are going for you!

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Curious Now on Video: https://youtube.com/medicalsimulation

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

We have an incredibly special guest this week on Curious Now! Amy Edmondson, Professor at Harvard Business School, and author of numerous books including Right Kind of Wrong: The Science of Failing Well, Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy and The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth joins us to discuss her concept of psychological safety, how a failed study led to its invention, and how leaders can create organizations that learn.

An initial study with a well-validated tool found a correlation between having better teams and having HIGHER error rates. Reluctant to bring this result to her thesis advisor, she came to an idea: Maybe better teams don’t make more mistakes, but rather better teams are more willing to talk about mistakes.

Bringing psychological safety to the present day, Amy and Jenny discuss how the best examples of crisis leadership involve what Amy calls “situational humility,” the ability to say, “we’ve never been here before,” and then framing the problem as an opportunity to find solutions and seeking and inviting input, along with a continual refreshment of common purpose.

How can individuals create a “learning frame” to grow in a crisis rather than an “execution frame” where you’re just getting work done; being open to hearing feedback both from your colleagues and your work itself as you do it.

While “learning work” can seem in the short term to take more energy or more bandwidth, in the broader view it creates vastly easier work through an increase in skill and understanding. Dr. Edmondson says, “If you’re not an organization that has found ways to hardwire learning and feedback loops into everything that it does, you will get caught unawares in a fast-changing, complex world.”

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

This week Laura Rock and Janice Palaganas return to crack the code of team culture, map the blueprint underneath what we’re thinking. In the final episode of this chapter, we ask our guests what they’ve discovered about themselves with a Frames, Actions, Results test.

Janice has a glitch with a student where their understandings didn’t match, and Laura shares how being honest about her own critical care strengths and weaknesses with a group of trainees helped them focus on learning the most from her and other members of the team.

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

This week on Curious Now we’re introducing a tool to help us bring the approach of understanding why people did what they did and helping them change the underlying analysis that got them into trouble, called the FAR or Frames, Actions, Results tool.

Where has your team gotten stuck or glitchy, and what were the underlying frames that got your team intro trouble or got the job done great?

Spotify: https://open.spotify.com/show/72gzzWGegiXd9i2G6UJ0kP

Apple Podcasts: https://podcasts.apple.com/us/podcast/the-center-for-medical-simulation/id1279266822

Leadership Coaching from Jenny Rudolph: https://harvardmedsim.org/personal-leadership-coaching-with-jenny-rudolph/

More on the LPG: https://www.aliem.com/improving-debriefing-skills-pathways-grid/