Crucial Conversations in Hospitals: A Matter of Life and Death

"Research has made it clear that many of the 90,000 fatal mistakes made each year in U.S. hospitals are the result of staff inability to candidly and directly challenge physicians," says Joseph Grenny, co-author of the New York Times best-selling book Crucial Conversations: Tools for Talking when Stakes are High. "We were contacted by one hospital after a woman had her foot amputated when she was admitted for a tonsillectomy. Hospitals call this a `wrong-site surgery.' We call it an unforgivable mistake because any of seven people could have averted that disaster by doing one simple thing: speaking up."

Grenny explains, "Hospital staffers are so intimidated by physicians that they often avoid speaking up even when they notice things that look risky. We will never reach our potential for high quality patient care until we have the full engagement and insight of the entire care-giving team. And that means all have to be willing and able to speak up at any time."

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which gives safety certification to 80 percent of American healthcare facilities, seems to agree. In January 2004, the JCAHO standards will include a mandatory provision to "Improve the effectiveness of communication among caregivers." It turns out, if you want a healthy "outcome" from your hospital visit, you better choose a provider that trains and educates its employees in modern and effective communication.

Grenny adds, "We have known for years that the ability to handle crucial conversations well, determines an organizations performance, efficiency and the quality of its products. Now, we have hard evidence these same skills may make the difference between being healed and being seriously hurt, when you visit your local hospital. We've seen a direct correlation between staff candor about patient-related issues with physicians and almost every measure of hospital performance "from quality, to profitability, to nursing turnover."

"Commit to a culture that supports analysis of why an error has occurred and that rewards such behavior," is the recommendation from JCAHO. Peggy Troy, president of LeBonheur Children's Medical Center in Memphis, Tenn., couldn't agree more. "I have learned that great health care can only be delivered if the caregiver is a skilled communicator as well as a skilled healer. At the heart of our ability to heal is our capacity to challenge anyone at any time about patient-related issues."

After 20 years of teaching communication excellence and researching more than 20,000 individuals, Grenny agrees. "The essential lever within any organization is the ability to handle crucial conversations well. Next time you check into a hospital or visit your local health care provider, ask them how they are doing with JCAHO standard 2(a). Alternatively, if you want to be sure you are going to get the best care possible, begin by having a conversation with your caregiver. If they stay healthy in their conversation, even when the subject turns crucial, you are probably in good hands!"