0:01

Ted Audio Collective

0:06

Hi there. We are not Atosa,

0:09

and this is not TEDxShorts, but

0:11

we hope you'll stay with us. I'm Anne Morris.

0:14

And I'm Frances Fry. And

0:16

this is something a little different. This is an

0:18

episode of Fixable,

0:19

our new show from the Ted Audio Collective.

0:22

We really hope you enjoy it. And if you do,

0:24

you can find and follow Fixable wherever

0:27

you get your podcasts. Thanks for listening.

0:31

This is a new segment we like to call Anne and

0:33

Frances' Favorite Icebreakers. We

0:35

do a lot of work with teams, and we try to get

0:38

them to start communicating honestly very quickly. So

0:40

we think a lot about what are the questions

0:43

at the beginning of meetings that's

0:45

really creating an environment where people can have an honest

0:47

dialogue.

0:49

A low-stakes one I often

0:51

use is, tell us about a piece

0:53

of art that means something to you.

0:56

Oh, good. I'll tell you the one that moves me the

0:58

most. And it's a photograph that

1:00

our dear friend, Emmy, took when she was visiting

1:02

us. And our oldest son was two

1:05

or three. On the weekend, we took him

1:07

to the classrooms at the Harvard Business School.

1:10

Not break into the classroom. Not break in. I mean,

1:12

it's really an overstatement. But find our way into the classrooms,

1:14

which have just magnificent layers and layers

1:16

of boards. And we would rearrange

1:19

the furniture a little bit so that he could stand on it

1:21

and draw. Such a light footprint. No

1:23

one ever knew we were there. No.

1:26

But there's this one particular picture where

1:28

he's standing on the desk that's pushed up against it. And

1:31

he's drawing. And his head is tilted

1:33

as if he is an experienced artist

1:36

looking up at the work. He's appraising it.

1:38

But we can only see him from behind. But we can see

1:40

you and I from the side, and we're also

1:43

joining him in the gaze.

1:46

And so all three of us are sharing a

1:48

gaze.

1:48

And I don't know why it's so powerful

1:51

to me, but it is my favorite

1:53

piece of art. So thank

1:55

you, Emmy, for that. And thanks for

1:58

letting me think about that. I love it. I

2:00

love it too. All

2:05

right, I'm Anne Morris. I'm a company builder

2:07

and leadership coach and I'm here with my wife. And

2:09

that would be me. I'm Frances Fry and

2:11

I'm a professor at the Harvard Business School. And

2:13

you're listening to Fixable. This is a podcast

2:16

where we work very hard to fix

2:18

work problems fast. And

2:20

by fast, we mean hopefully in less than 30

2:23

minutes. That's the goal. Many

2:25

of our listeners know that this

2:27

has been a dream of ours for years to

2:30

have a podcast, an excuse to talk to

2:32

each other. It's a date.

2:35

Once a week. I'm

2:37

so excited to dive in with our first Fixable

2:39

caller.

2:40

Who is she? Her name is Kelly. She's

2:43

a nurse in a cardiovascular

2:45

acute care unit at a teaching hospital.

2:48

We won't say which one, but it's a very

2:50

high stakes job. It's a lot of work

2:53

and a tremendous amount of commitment

2:56

and generosity. Oh my goodness. Such important

2:58

work. Do we know what Kelly's

3:00

calling about? Yeah, so Kelly

3:02

says patient care. It takes a

3:05

ton of coordination, as you can

3:07

imagine, between lots of different people

3:09

and teams.

3:10

And she's really feeling like the communication

3:13

among all of these people and teams is

3:15

really suffering right now.

3:17

I work in a place where

3:20

you've got doctors, you've got nurses, you've got a whole

3:22

bunch of people, and sometimes there's

3:25

really poor communication

3:28

and it leads

3:30

to resentment and animosity

3:33

and ultimately it comes down

3:35

to quality of patient care.

3:38

If the people who are making life

3:40

altering decisions for these people are not

3:42

all on the same

3:43

page, these people aren't going to receive

3:45

good care and it's going to be extremely frustrating.

3:48

And I just, I want to know how to help foster

3:50

an environment that

3:52

can be overcome. industry

4:00

on the planet. And so I

4:03

look forward to diving in and finding

4:05

out how do we fix communication

4:08

problems that could have real health outcomes.

4:11

Yeah, I mean, communication is it's

4:13

a universal problem in organizations made

4:16

more difficult by hierarchies, which

4:18

we sometimes have to put in place, particularly

4:20

in environments with high stakes outcomes.

4:24

And so I'm super motivated to try to

4:26

be useful here. I'm super excited as well.

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5:16

Kelly, thank you so much for doing this with

5:18

us. Of course. Thank you for reaching

5:20

out to me. Yeah, we're really thrilled. We're really

5:22

thrilled.

5:23

And let me start there with what

5:25

would make this conversation most useful to

5:28

you? So I work

5:30

in a unit where lots

5:32

of the patient population that I have, they

5:34

are cardiac specific patients in

5:37

the hospital I work at. They are

5:39

the sickest people I can work with without

5:41

being in the ICU. So

5:44

the issue that I really have is that you've

5:46

got doctors, nurses, you got nursing

5:49

assistants, and then like x-ray

5:51

techs and phlebotomists, just all

5:53

these different teams and everyone needs to

5:55

work together to be this cohesive group.

5:58

But a lot

5:58

of the time, the.

7:49

to

8:01

figuring out this problem and how we can make progress.

8:03

If you were gonna do a summary of what you're hearing as the

8:05

problem, where does your

8:08

beautiful operations mind go? That

8:12

I do think that the diagnosis that it's a communication

8:14

problem is right. I would say

8:16

that part of the communication is transparency.

8:19

So why are we doing it? And I think if the

8:21

patients knew why, if you knew why. So

8:24

that's one part of it. And

8:26

then the other part of it is the, let's

8:29

make sure when one person says

8:31

it, we all hear it. So

8:33

I think there's a breakdown in the number of people that are

8:35

hearing. And I think there's a breakdown on

8:38

transparency. And so the question is, how

8:41

to foster communication in a very

8:43

complicated system where you're not at the

8:45

top of the hierarchy, but how do you do it from the middle?

8:48

And I think many more

8:50

of us face that situation than being

8:52

at the top of the hierarchy. With

8:55

all the decision rights. How

8:57

common, when you think about the problem

9:00

with that framing, how common

9:02

is this challenge? Oh, so

9:05

a phrase that our colleague and friend,

9:08

Amy Edmondson, who studies teams, she

9:10

uses a word teaming. And teaming

9:13

is when a group of people comes together

9:16

around a patient, but it could be a different

9:18

group of people around another patient and another.

9:20

So it's not like there's an intact team that

9:23

all covers each one. That's

9:26

inherently more complicated. I think anytime

9:28

there's that level of complexity,

9:31

this is gonna be at the center of it.

9:32

It makes me think in fast

9:34

moving environments, in tech, for

9:36

example, when there's fast moving and we're coming together

9:39

for this or we're coming together for that. Anytime there's

9:41

a temporary coming together, I think this

9:43

applies. And I also find

9:45

myself thinking about hierarchy here

9:48

because hierarchy gives us

9:50

a lot of comfort in

9:52

the complexity, because there's, who

9:55

outranks who is super

9:58

clear.

9:59

There are very material trade-offs in

10:02

one of them as communication, unless the

10:04

systems are impeccable. Yeah, and I'll be stunned

10:06

if hierarchy is part of our solution. All

10:10

right, Kelly, back to you. So

10:12

first of all, before we jump in, does that summary of the

10:15

problem resonate to

10:16

you? Yes. OK.

10:19

There were moments of light

10:21

and truth and beauty in some

10:24

of the relationships between doctors and nurses

10:26

in this system. Yes. And

10:29

what's happening with those

10:31

that are distinct from what's happening with the relationships

10:34

that aren't working? You

10:37

know, I work with my older brother. My older

10:39

brother and I work on the same unit. We went to

10:41

nursing school a few years apart. And

10:43

there's one physician assistant

10:45

who I work with who got wind

10:48

of that my brother and I work together. And

10:50

whenever I work a weekend shift with this provider,

10:53

he's always like, are you going to Sunday dinner at your

10:55

mom's with your brother? He

10:57

wants to get to know

10:59

who I am as a person, not just sees

11:02

me as one of the nurses.

11:04

He knows me. And whenever

11:07

I take anything to him and I say, hey,

11:10

I've got this problem with this patient.

11:13

Their heart rhythm is showing this. We

11:15

need to get on top of this. We need to give them this medication

11:18

to get ahead of this before things deteriorate.

11:20

He immediately is like, yep, I hear what you're saying.

11:22

Let me go check on the patient. Make sure they're OK. And

11:25

then we're going to do X, Y, and Z to

11:27

make sure that they're OK. And I think

11:30

that that has so much

11:32

strengthened our ability to work

11:34

together for these patients

11:37

is that we know each

11:39

other as people and not just another

11:43

member of the group. Yeah. Why

11:45

did this particular relationship have the oxygen

11:48

for you guys to get to know each other? Or

11:50

the space? Or what happened differently here? I

11:55

think that it's partially

11:57

a personality thing. also

12:00

that a lot of the doctors, a lot

12:02

of the teams, when it comes to

12:05

sitting down and doing their charting and

12:07

their computer work, they go back

12:10

and hide in an office. And

12:12

he's one tool kind of hanging out at the nurses

12:14

station and do a lot of his stuff at the nurses

12:17

station. And there's a lot of chitchat

12:19

at the nurses station. That's where we all kind of

12:21

talk about our days and see

12:24

how the others are doing and talk about our lives

12:26

outside of the hospital. And

12:29

that's where you can learn that, oh, these two random nurses

12:31

who work together and are always hanging out are actually

12:33

siblings. Like, I think it's just important

12:36

to

12:37

have environments where we're able to get

12:39

to know each other outside of our

12:41

jobs as healthcare workers.

12:43

So I wanna start there in

12:45

the fixable portion of this conversation.

12:48

I wanna start in that sandbox, Francis, if

12:50

that works for you. So

12:54

one place my head is going is, is there a possibility

12:56

in this system to

13:00

not rely wholly

13:02

on the personality and social competence

13:05

of the physicians for that

13:07

moment to happen? Right. One

13:09

thing we learned from Agademy, if I can channel like

13:12

your freshman year and

13:14

the awkward ice cream social moment,

13:17

like would it be even structurally

13:20

possible to introduce some

13:23

kind of formality for new

13:25

doctors, like new providers

13:27

coming on, new nurses to say, okay, here's

13:29

what you do in your first week

13:31

to get to know your colleagues

13:34

in this system. We're

13:36

gonna make the implicit explicit. Instead of

13:38

going back to your room, we're gonna tell you what to do.

13:41

We want you to do this work out here in the open

13:43

air where this kind of informal and

13:46

organic get to know you can happen.

13:48

So let me just get your reaction to that. Is that it?

13:51

Okay, and cause I'm gonna push on it. I'm gonna push a lot harder

13:53

if there's any traction there. I

13:56

think absolutely that can make a difference

13:59

for people to get to know you. to know each other that way. That

14:02

makes much less of a divide. Because

14:04

here's what we see happen all the time. And I'm gonna use

14:06

my wife who's an introvert. Total

14:09

introvert. I'd be back in, with no disrespect,

14:11

I would be back in the office with the lights

14:13

low. With the lights low. If

14:16

no one told you, you have to come

14:18

interact with the humans, your default

14:20

reaction would be to wander away. Yes.

14:23

So now for

14:26

you, for me, right? I

14:29

would be super energized by, like who are my

14:31

new colleagues? I'm super curious, I wanna get to know them.

14:34

I'm gonna say I'm more likely to be in option

14:37

A. You are definitely. Of the

14:39

doctor who finds out sooner or later that you are working

14:41

with your brother and thinks that's the coolest thing

14:43

in the world. I'll work with you for 30 years and not know

14:46

it. Right. And I'm also

14:48

more likely to be the human in the system that

14:50

watches you go to your enclosed

14:54

little office space, which I don't have, and

14:56

sit there and do your important work, which you're

14:58

deciding is more important than mine. I'm not deciding,

15:01

right?

15:02

I'm more likely to make a negative attribution to

15:04

that behavior. You're totally gonna make a negative attribution. In fact,

15:06

we haven't even done it, and you're making a negative attribution

15:08

to me right now. I'm already mad at you. I

15:10

haven't even done anything. I'm not even a physician. So

15:15

there is this category of can we shake

15:18

up this entry moment and

15:20

say, okay, this is just what we do

15:22

on this floor. We're gonna lower the stakes.

15:25

We're not gonna require approval from the higher ups.

15:27

We're just gonna say, this is how things operate

15:29

on this floor or in this unit, is

15:32

that the first week you're on the job,

15:35

you do the following five things.

15:37

You do your work out here in this open space. You

15:40

have one-on-one rapid dating meetings with

15:44

all of the nurses on the team. We're gonna use a different metaphor.

15:47

You go to lunch over the first three

15:49

months, you go have a cup of coffee

15:52

with everyone you're working with. Pick

15:54

the five things, lower the stakes,

15:57

don't look for anyone's approval. Stay within

15:59

the zone of the...

15:59

things you can control, but really

16:02

go after this variable that you identified

16:04

that I think is so important, and we see happen all the

16:06

time, of the humans, the flawed

16:09

multidimensional human beings having

16:12

a chance to get to know each other

16:14

as fellow flawed multidimensional

16:17

human beings.

16:18

Right, I would so love to see that happen.

16:22

I feel like the pushback would be

16:25

that we don't have time for an ice cream social.

16:28

But I think that if it's going

16:30

to make communication better

16:33

between the nurses and

16:35

the doctors, then I don't think

16:37

it's that big of a price to pay. Yeah.

16:40

Where I would suggest starting is pick one idea

16:43

that you think is within the realm of possibility

16:46

in the system, and

16:48

brainstorm with two other people who are as

16:50

frustrated as you are about, what

16:53

could we do proactively to

16:55

introduce one element

16:58

that creates the space and structure

17:00

where this thing that's so important that we're relying

17:03

on organically, spontaneously,

17:06

relying on the personalities of the physicians,

17:09

which is random and out of our control,

17:11

can we introduce a little bit of

17:14

structure and control into

17:16

this scenario? And if you

17:18

don't have the power to introduce

17:22

such an idea, figure

17:25

out who do you think would be your most likely

17:27

ally in the system, and could

17:29

you use their power to do something

17:32

like this? Right.

17:36

Hold that thought. We'll be right

17:38

back after this quick break.

17:46

I

17:49

love the diagnosis that when

17:52

you're given a great personality and somebody with great

17:55

social competence, this isn't an issue. So

17:57

the issue is when the physicians

17:59

don't have it.

17:59

either the personality and

18:02

or the social competence. So I love

18:04

the narrowing down there and what do you do? So

18:07

what we just heard is something you can do by

18:09

giving a secret memo to the doctors, like telling

18:11

the doctors what to do. I want to look

18:14

at it from what can you do? So it

18:16

doesn't require telling someone else,

18:18

but what might you do? And

18:21

here's what comes to mind to me. How

18:23

might you welcome them? So,

18:26

you know, I mean,

18:27

a sign, like welcome

18:30

Francis, welcome Francis on

18:33

your, you know, first day on the floor. We're

18:36

thrilled to have you like. So instead

18:39

of relying on their noticing our humanity,

18:41

we're going to notice their humanity.

18:44

I love the whole structure,

18:47

but my mind, and you can say

18:49

which one is better. My mind is what can

18:51

you do with superior

18:53

personality and social competence? And

18:56

this is talking from someone who's on

18:58

the inferior personality and social

19:01

competence side. And so that

19:04

would be the only thing I would add to it. And my wife loves

19:06

a good competition. So she's going to. I'm

19:08

going to want to know which one you like. She's going to frame this as

19:10

an either or, but I think there's actually

19:13

quite a beautiful blend where

19:14

you're still accomplishing this

19:17

goal of creating a space for

19:19

our shared humanity. You're just

19:21

doing it in this beautiful form where

19:24

you have total control. This is a nurse driven

19:26

initiative, and it's really centering

19:28

and celebrating the physicians.

19:31

And I loved your example, Francis, and these

19:34

are small things that I'm hearing you propose.

19:36

Totally small, just small bits

19:38

of welcoming. Bits of welcoming. Let

19:41

me show you around the floor, like,

19:43

you know, making that a meaningful moment,

19:46

adding a little bit of time and space and

19:48

joy to that moment. I love

19:50

that. Yeah.

19:52

What's your reaction to that? So

19:54

one interesting thing is we've been thinking about this in

19:58

a teaching hospital, other. and

20:00

like the attendings and some

20:02

of the doctors who were just like a little bit below them,

20:04

the residents and the interns, the ones

20:07

who I'm really interacting with, they

20:09

switch out every couple of weeks, if

20:12

not every week. Like they'll all get to know

20:14

them and it's like, peace out, I'll probably never see you again.

20:18

And I have one coworker who I

20:20

watch her every couple

20:23

of weeks. There's a new resident on the service

20:25

and she goes up and she says, hey, this is my name. What's

20:28

your name? Where'd you go to medical school? Where are you from?

20:30

And I have noticed that she does tend

20:33

to have better

20:34

relationships with

20:36

the doctors because of it. And

20:39

I think that incorporating that

20:41

into my own practice personally

20:45

would make a big difference for

20:48

me. And I think the informality

20:52

of your suggestions, Francis, I feel like that's something

20:54

I can manage with my social-

20:58

expertise. Energy.

21:01

I love that, Kelly. And I just went for

21:04

the record. I want to say that Francis has won this round.

21:07

She's gonna want to hear that on

21:09

the recording. So let's please not edit this

21:11

out. And what I so

21:13

love about this as a focus of your energy

21:16

is you're back in the zone of things that you have

21:18

total control over,

21:20

which is your own behavior.

21:23

Now, I am gonna push

21:25

you to experiment

21:28

with one or two things that

21:31

are a little bit outside of

21:33

your zone of control, because

21:35

I want to start firing up the muscles

21:38

of how do I start to influence

21:41

this larger system around me.

21:44

That could be as simple as

21:47

talking to this colleague of yours

21:50

and saying, first, I want to learn from what you're

21:52

doing, I notice it, I want

21:54

to do it. The other opening

21:56

that gives you is also, can you have a

21:58

conversation with this one other-

23:52

I

24:00

love it. I love it. Thank

24:02

you so much. Thank you. And please

24:04

keep us posted, Kelly, and say

24:07

hello to your brother. I will. All

24:10

right,

24:16

Frances, what do you think

24:18

about this larger issue of

24:21

communication breakdowns in

24:24

organizations? So if we use

24:26

this as an example, part of a communication

24:28

breakdown is that we didn't give the why, right?

24:31

So we just didn't give enough transparency. That

24:33

is, we just gave you the

24:35

tip of do this. But

24:38

we didn't tell you do this because

24:40

of so-and-so and if this changes, do that. So

24:42

the do this, putting people into

24:45

order-taking role is actually

24:47

going to require your effort all day,

24:49

every day. It's an exhausting

24:51

way to do it, but it feels like

24:54

less time in any given moment. And

24:56

then the second thing is process was just

24:59

shouting to me throughout this whole conversation. How

25:01

do we make sure in a teeming context

25:05

that when

25:05

one person says something, everyone

25:07

hears it? Well, word of mouth

25:09

is okay, but we are really

25:12

advanced species now. Let's

25:14

figure out a way, and perhaps even a technologically

25:16

enabled way, to

25:17

do it. So transparency

25:21

and that everyone gets to hear it seem

25:23

to me to be the two ways there. And

25:26

a lot of the transparency is the why. Yeah,

25:29

I was thinking about where you started your academic

25:31

career in operations, and

25:34

that the outcomes here where there is

25:36

reliable miscommunication, there's a reliable

25:39

breakdown in communication is entirely 100% predictable

25:42

based on the way the system has been designed.

25:45

But because of the way it's designed, where there's such

25:47

a scarcity of time

25:48

and space for the operators within

25:51

it to actually reflect, this problem is not

25:53

being surfaced and it's not being dealt with. And

25:56

the system is relying on the Kelly's of

25:58

the world to make incremental progress.

25:59

when it's begging for really

26:02

a top-down solution to meet the

26:05

warriors in the middle who are working

26:07

bottom up. Yeah, and

26:09

so if this were the person with a different perspective

26:12

on this calling in, giving them the

26:14

fix to that would actually be straightforward.

26:18

Organizations that surface problems at a faster rate

26:20

improve at a faster rate, full stop.

26:23

And what's happening here is that problems are

26:25

getting sublimated. And what

26:27

I mean by that is that

26:29

when problems aren't surfaced, when we

26:31

push them down, we have no chance of

26:33

improving. And so we want to

26:36

elevate problems and enjoy

26:38

the experience of elevating problems because those

26:40

problems, when surfaced, are precisely

26:43

our improvement opportunities. And

26:45

the more problems that are surfaced, the faster

26:47

we

26:47

improve. Amen. And

26:49

so it would be super fun to talk to

26:51

that person, hopefully, if you're listening, call. All

27:00

right, that's it. That's our show. Thank

27:02

you all for listening and

27:04

for being part of this. We want to hear

27:06

more stories. We want to hear from you. We want

27:08

to hear your story. Let us

27:11

take a swing at fixing your

27:13

problems together. Email us at

27:15

fixable at TED.com or call us

27:18

at, thank you, Frances, for delivering

27:20

on the phone number 234-Fixable. That's

27:23

234-349-2253. We

27:26

didn't used to have a number that ended in Fixable,

27:29

but that

27:29

problem was Fixable. Like

27:31

so many, give us a call. Thanks,

27:34

everyone.

27:37

Fixable is brought to you by the TED Audio

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Collective. It's hosted by me, Frances

27:42

Frye. And me, Anne Morris. This

27:45

episode was produced by Isabel Carter. Our

27:47

team includes Isabel Carter, Constanza

27:50

Gallardo, Lydia Jean Cott, Grace

27:52

Rubinstein, Sarah Nix, Jimmy

27:55

Gutierrez, Michelle Quint, Corey

27:57

Hageam, Alejandra Salazar, and

27:59

Ban Ban Chang and Roxanne Highlash.

28:02

Ben Chenow is our mix engineer. We'll

28:05

be bringing you new episodes of Fixable every

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week. So please make sure to subscribe

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please leave us a review. Particularly

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if you like the show.

28:16

See you soon. ILVENTi