What the McChrystal debacle teaches healthcare leaders

Talk about a wake-up call. 

It came too late to keep Gen. Stanley McChrystal from being sacked. But hospital leaders might learn something from what transpired this week after Rolling Stone published the highly publicized story that led to the abrupt end of McChrystal's tenure as commander of all U.S. and NATO forces in Afghanistan.

The blogosphere and mainstream media were all abuzz. In the article, McChrystal and his staff criticized almost every member of the president's national security team and expressed contempt for the president and vice president.

And this guy is supposed to be on the president's team? Who knew?

Apparently I wasn't the only one who had questions about the general's conduct.

A day after reading the article and discussing it with senior staff, President Obama said McChrystal's conduct "erodes the trust that's necessary for our team to work together to achieve our objectives in Afghanistan."

In essence, he noted that tensions between military and civilian leaders were threatening the mission. Why didn't McChrystal speak up when he disagreed with what was going on, instead of slinking around, stabbing his "team" members in the back with snipes and gripes?

Sound familiar? Just as poor teamwork and communication gaps could prevent the president's team from achieving its goal, poor communication--which sometimes rises to the level of unruly behavior--can compromise staff morale at best and patient safety at worst.

Because communication gaps account for more than 70 percent of adverse patient events, the Joint Commission added leadership requirements last year aimed at rooting out poor behavior. Leaders must create and carry out a process for managing disruptive and inappropriate behaviors. And each hospital must have a code of conduct that defines what's acceptable and what's not.

In his book Safe Patients, Smart Hospitals, Peter Pronovost, medical director at Johns Hopkins Center for Innovation in Quality Patient Care, gives examples of what some would call disruptive behavior and others might call "communication gaps." The two are tightly intertwined and can have a corrosive effect on patient safety. For example: 

  • Nonverbal communication can be disruptive. A nurse might try to report and abnormal finding, but a physician might turn his back when she is speaking or may not make eye contact. If he shrugs her off, the nurse might think twice before putting herself out there again to be put down or humiliated.
  • Bumpy communications can translate into slower care, which can by extension endanger patient safety. Another doctor regularly ignores a nurse when she tells him her concerns about a patient. To get someone to attend to the patient, she must spend extra time she doesn't have going up the chain of command.

Poor communication "almost always erodes patient care," Pronovost writes. To create a viable culture of patient safety, make sure all your unit and team members are comfortable speaking up and communicating with each other-for their sake and especially the patients'. Anything less would be conduct unbecoming. - Sandra