What I Really Meant Was…

Culture is what happens when we interact!

“…cultures-and the specific norms that

define these cultures-emerge as

unintended byproducts of interpersonal

interaction.” Lehman et al., Ann Rev Psych 2004;55:689-714

“Communication is the joint establishment of meaning.”

14 Operating Rooms in BC

High Power Distance Index Cultures

• Those in authority openly use their rank.

• Subordinates expect clear guidance from above.

• Subordinates take the blame (Second Victim).

• Politics is prone to totalitarianism.

• Class divisions within society are accepted.

NSQIP

NSQIP

• Frequency of events reported

• Non-punitive response to errors

• Perception that management promotes patient safety

• Organizational learning/continuous improvement

• Feedback and communication about safety incidents

• Handovers and transitions

• Teamwork within units

• Teamwork between units

Co-Creation of Value in Healthcare?

It’s Not Just What We Say… It’s How we Say It!

Non-Verbals

Stand Up!

The Poses

Primates and Other Animals

Pride

Powerless

Characteristics of Powerful People

Amy Cuddy, 2012

Amy Cuddy, 2012

In Summary

• Adopting expansive, open postures changes our physiological state.

• Our feelings of confidence and self-control are enhanced.

• Our feelings of stress are diminished.

So What?

• We feel better and more effective.

• We feel less stressed and anxious.

• We feel more happy and optimistic.

• We feel more powerful, confident, and assertive.

So What?

• It enhances our leadership ability.

• Our body posture has a stronger effect on role power than title.

• Can play a role in balancing the power distance index.

Activity

• At your tables, consider how this information is relevant in your work.

• Where could you leverage your physical state to influence your mental?

• How can we use this to improve patient outcomes?

Source: Cuddy, 2015

How We Communicate

Mark Bowden

Mark Bowden

• Genuine Smile

• Eyes and Eyebrows

• Head Tilt

• Open Hands

The power of a smile

”Duchenne” or Genuine Smile

• A smile which raises the corners of the mouth and which raises the cheeks and forms crow’s feet around the eyes

“Say Cheese” or Fake Smile

• A smile that only raises the corners of the mouth

https://www.theguardian.com/science/2015/apr/10/psychology-empathy-distinguish-fake-genuine-smiles

Let’s practice

Eyebrows

Eye Contact

Head Tilt

Open hands

Video - Congruence

Sensemaking

Mush

What is It?

Mush

Where does it come from?

“4/5 problems that cause dysfunctional patterns in an organization are based on

mush.” Bushe, 2009.

Perception Generation

Sense-making

Interpersonal Competence

Objective Truth

Subjective Truth

Inter-Subjective Truth

External Sensory Input • Sights • Sounds • Tastes • Smells • Touch

Internal Input • Memories • Biochemistry • Culture • Education • Values • Mental Maps

Percepts

Experience Conscious • Observations • Thoughts • Feelings • Wants Unconscious • Observations • Thoughts • Feelings • Wants

Perception Generation and the Elements of Experience

What is Your Mush?

Perception Generation: • What do you think happened? Who messed up? Sense-making: • What did you observe and how did this lead to filling in the blanks

with your story? Interpersonal Competence: • Objective truth: What did you observe to be true? • Subjective truth: From your personal experience, what do you

believe is true? • Inter-subjective truth: Does your truth match those of your table?

No More Mush!

Can’t You Just Listen to Me?

Listening………..

Chinese character: “Listening”

Just Listen

• Get into pairs

• Randomly select a topic

– Twenty on your table

• For 1 minute

– Partner 1: what you think and feel about topic

– Partner 2: just listen

• After 1 minute, partner 2 recaps what partner 1 said

Just Listen

• Next, switch roles

• For 1 minute

– Partner 2: what you think and feel about topic

– Partner 1: just listen

• After 1 minute, partner 1 recaps what partner 2 said

Just Listen: Debrief

• How did you feel about your partner’s ability to listen?

• Did your partner’s body language communicate how they felt about what was being said?

• How did listeners feel about not being able to speak their own views on the topic?

• How well did the listener summarize?

• How can we apply in our work?

If you want to understand your barriers….

…..ask your partner!!

Co-Creation of Value in Healthcare?

Co-Creation of Value in Healthcare?

What I Really Meant Was…

Questions/Discussion