Q & A: Working with a “Disengaged” Colleague

QUESTION:

What are your thoughts concerning health care workers who are detached from the reality of what our patients require when in our care? We have staff members who just seem to want to get done and sit down. They are consistently negative and do not realize how it affects patients and their families.

ANSWER:

Mary-Koloroutis-150x150This is a question we hear often. It’s obvious that care environments include people with varying levels of commitment, and when we see an individual who appears to have a low level of commitment, it’s important to spend time wondering about that rather than automatically opposing it. Just as we recommend wondering in the face of a patient’s or family member’s unexpected or seemingly inappropriate behavior (rather than judging it), we recommend wondering about team members who aren’t engaging in the ways we would like them to. Might these colleagues be suffering from significant burn-out that has taken place over time and is quite possibly permanent? Are these colleagues experiencing temporary compassion fatigue, in which case some support and encouragement may help them restore their connection with themselves, their team, and the patients? Or are these colleagues in the wrong field entirely?

The point is that until you spend some time wondering about the person, you’re not adequately prepared to address the person’s way of being or behavior.

Whether this person is your supervisor, your peer, or your direct report, think for a moment about what a positive outcome with this person could look like. Would you like this person to feel a sense of belonging as a valuable member of the team? Would you like this person to be fully connected with the mission of providing humane and compassionate care? Would you like this person to take the time to be fully present with each patient and family member?

It might help you to look at how to resolve this by asking three questions:

• What can I do as an individual?
• What responsibility do we as a care team have to the disengaged colleague as well as to the patient entrusted to our care?
• What responsibility does the formal unit leader have to assure that all members of our team are contributing fully and meeting our standards for humane, compassionate, and competent care?

What Can I Do as an Individual?

What is the compassionate thing to do in this situation? The companionate thing to do for all involved is to “name the elephant in the room.” Often there are conversations happening about these disengaged team members in the conference room, at breaks, in the hallway—essentially everywhere except with the person in question. The motives for avoiding direct conversation with the person are usually to avoid conflict or hurting the other person’s feelings, but it’s actually less loving to isolate the person in this way. The compassionate thing to do is to hold the conversation. Decide to invite this person into your vision for a compassionate culture in which all relationships matter: “This is what I’m noticing, and we really want you as part of the team. Can I work with you? Can I help?” It’s a courageous and respectful thing to do, and it may be one of the keys to bringing all team members into the culture you envision

What can we do as a Team?

As a team you create the norms and culture for how individuals function. If disengaged behavior is ignored or worked around, you will get disengaged behavior. The team’s responsibility is to a culture in which all individuals feel like they belong, are held to high standards, and share a common pride and commitment in the work.

What is the Responsibility of the Formal Unit Leader?

The formal leader sets the standards and vision for excellence. The leader cultivates the environment in which individuals thrive and in which every person is 100% responsible for their own work.

There is no question that the willingness and ability of our team members to interact authentically with patients are a minimum standard. Just as it would never be thought acceptable that a clinician would fail to be technically proficient, it can never be thought acceptable that a clinician be permitted to lack relational proficiency. (Koloroutis & Trout, 2012, p. 28)

Caregivers, by virtue of accepting responsibility to care for patients, have an ethical imperative to fulfill the trust inherent in their position. When that responsibility and trust are not being fulfilled, formal leaders cannot simply ignore that fact and expect others to work around and compensate for this individual. The leader needs to work with the individual and together identify specific areas for improvement and create a plan for what it will take to get there. The leader is not punitive in her coaching, but is respectful and encouraging, conveying that the true goal is the individual’s success. Success will only be possible, however, if the person accepts full responsibility and fully engages in working the plan and correcting the problem.

Some leaders struggle with how to reconcile being caring and compassionate with their team and taking strong action that could even result in terminating the employment of an individual. It is important to remember that caring leaders are courageous leaders who understand that their ultimate responsibility is to safeguard high quality patient care and to tend to the well-being of their whole group. These responsibilities are met by hiring and developing talented and committed individuals and inspiring high performing teams. When an individual is not meeting his responsibilities it is caring and respectful for all concerned to take action immediately.

~ Mary Koloroutis

Koloroutis, M. & Trout, M. (2012). See me as a person. Minneapolis, MN: Creative Health Care Management.

Commentary/Research: The Secret to Feeling Like You Have More Time

Stanford PhD candidate, Melanie Rudd, and her colleagues, Kathleen Vohs and Jennifer Aker, have written a paper on “how awe expands people’s perception of time, alters decision making, and enhances well-being.”

Daniel Pink, an author on the science of human motivation and one of our keynote speakers at the September 2013 International RBC Symposium, features a video clip of Melanie Rudd describing her team’s thoughts about time, perception, awe, and the power of being present.

We hear from you that time is one of the biggest obstacles to authentic therapeutic interactions and one that you are consistently seeking to conquer. We thought you would find the thoughts of these scholars on awe and the perception of time to be quite compelling.

Play the Video: Daniel Pink The Secret to Feeling Like You Have More Time

Mary and Michael

A Therapeutic Sighting: Fatally Ill, and Making Herself the Lesson

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This article from The New York Times, January 10, 2013 is circulating on Facebook and LinkedIn and being distributed through group emails to many of our colleagues.

Martha Koeochareon was dying of cancer and offered herself to nursing students as a “case study.” She thought it could be meaningful for nursing students to learn about helping terminally ill people die. As you read this article, we invite you to wonder with us about the lessons Martha offered.

We were especially struck by some of the advice she offered—simple wisdom, such as, “The patient isn’t Martha per se, it’s the entire family,” and “Just dig a little deeper—you know?” She guides her young nurses to stop asking so many questions and practice instead what she called “therapeutic communication.” Finally, she offered perhaps the most important learning from her many years as a nurse: “Learning from books was good, but learning from patients was better.”