Psychological Safety & Relational Equity: Leadership Solutions in Healthcare (#013)
===
[00:00:00] Not only I was experiencing stress and tension, but my stress and tension sort of rippled through the teams and the people who are in those teams. And everybody was experiencing stress and tension. You know, we're connected. So I would say to a leader who says that, well, come and sit and take a deep breath.
[00:00:22] And let's have a look at what is a first step for you to maybe create a little more space to breathe. Welcome to Safe Space Made Simple, a practical podcast that guides clinical leaders and healthcare managers to create trust and support with their teams. I'm your host, Trace Hobson. Join me for weekly interviews, practical tools, and inspiring transformational stories of bringing people together in healthcare.
[00:00:50] Now let's dive in.
[00:00:55] Hi, everybody. And welcome to another episode of Safe Space Made Simple. The [00:01:00] podcast is created for clinical leaders, managers, and healthcare teams to create and generate a safe space. What is the difference between a leader that creates their leadership based on relationship and a leader that is focused solely and primarily on tasks?
[00:01:19] Well, that's what we talk about today in our conversation. My colleague, Carolyn Vierman, and I talk about healthcare leadership being founded on an either. The old sort of command and control hierarchical approach of being primarily task oriented as opposed to relational equity. What happens when leaders slow down and spend the time necessary to build relationships with their people at every level in the organization?
[00:01:47] We talk about how that becomes a ground swell and how it can, in many cases, if we stick with it long enough, create a systemic effect. Where the leadership at the top [00:02:00] of the organization has relationships that began to create a culture of connection, belonging, and high performance. I think what I was really interested in talking about today relates to how, how do organizations make changes, especially health care organizations that are really complex and have also had sort of a history of being steeped in doing the same thing over and over again, expecting different results.
[00:02:33] I think of like change management programs or projects where people come in, consultants come in, they try to help you change. And. The people push back on it. It doesn't work very well. It's really difficult And i'm curious what you think about what is it that really is necessary? or needed to create change?
[00:02:57] That's a very broad [00:03:00] question. But let me start with uh, I think a prerequisite for any process and that's uh, that there's a healthy and nurturing, uh, maybe open, also safe connection between people. I tend to look at this connection space at the tissue of the organization and that the quality of the tissue of the organization, which is made of all the connections between people and the conversations people have, the communication that is happening, um, the tissue must be really healthy and strong to, to even, to get even started with.
[00:03:57] any process, let alone [00:04:00] a transformation process. So I wonder, so you're, what I, the way I hear that or the way I translate that is that we're talking about relational equity and the kind of relationship space that we have between us. And this is one of the first things that falls by the wayside in really busy, Demanding organizations or or cultures, especially when you experienced what we have in health care, which is staff shortages.
[00:04:35] This is a global phenomenon. People are leaving health care like never before, and they're leaving and saying that the environments they're leaving are no longer a place that they want to be that's healthy for them, and they're leaving their career sometimes in decades. of a career and going to do something else that serves them and their family.
[00:04:58] And so it makes me [00:05:00] wonder if relationship, you know, having a psychologically safe space for relationships to happen is what we need. How do we do that inside of cultures where it's really difficult and sometimes, um, chaotic and even toxic sometimes. Yeah. Um, well, I don't know if it's difficult. Um, you know, giving the word difficult or labeling it as difficult already sort of shuts a door, uh, in whatever wants to happen.
[00:05:36] So, um, Maybe it needs a different attention or, uh, it needs something else than that's been done before. But it doesn't necessarily need to be difficult to build relations. Because we're already having and experiencing relations between human beings all the [00:06:00] time. We're always in a relationship with the people around us, uh, whether we speak to them or not.
[00:06:07] And, um, or meet them often or not. And, uh, it's not so difficult to have interest in someone and to ask, how are you doing? You know, how difficult is that? Listen. And, um, it starts so close in, uh, and so it's so easy to start with building a healthy relationship space. I think I say it's difficult because I'm thinking about the, the, the natural, maybe it's not natural, but the conditioned thinking of a lot of leaders and managers who say, I don't have time to, to have a relationship with all of the people in my, that report to me, I've got 150 people, 200 people, I've got a [00:07:00] really busy, shorthanded, Um, department and so carving out the space, even using that word, like carving out the space.
[00:07:09] It seems like, Oh my goodness, it's so hard to find the time and space to develop relationships. And yet when we do, there's some really tangible things that start to take place for people. That is different than when we don't. So I'm curious about what you think about that. Like, what would you say to a leader who's saying, man, I don't have time to do that.
[00:07:34] Uh, I would say, uh, come and sit with me. Uh, let's have a talk because anyone who says this and I've also said it before. So I was one of those leaders also saying. I don't have the time and went on and kept going. And with that keeping going, I also admitted a lot of stress and [00:08:00] tension to the, the, the teams.
[00:08:04] I am responsible for. So not only I was experiencing stress and tension, but my stress and tension sort of rippled through the teams and the people who are in those teams and everybody was experiencing stress and tension. You know, that's how we're connected. So I would say to a leader who says that, well, come and sit and take a deep breath.
[00:08:31] And let's have a look at how it is. What is the first step for you to maybe create a little more, a little bit more space to breathe? Sorry. Keep going. Yeah. So when you do that, you breathe and you give yourself a little bit more space. Then what happens is that your, the creative [00:09:00] part of your brain is switched on again.
[00:09:03] Because when you're in this state of survival, basically, I'm so busy and there's so much to do. So I don't have time for a conversation or breath or whatever. the creative part of your brain is really switched off and you're in freeze, uh, uh, fight or flight mode. So it's really important. Uh, and again, I'm talking from my own experience.
[00:09:39] to help yourself find a, another state of being a more, uh, some relaxation so that you can use your, um, the other parts of your brain and find solutions for things that maybe are not so [00:10:00] difficult, but you can't find those solutions when you're under pressure. And, um, yeah, that's where it all starts with.
[00:10:08] When you do that, You mentioned earlier that when you were a manager or a leader that was stressed out that that kind of spilled over on to people that you led. I'm curious when you find that other space you just described, what do you notice the ripple effect of that is? Yeah, it's interesting, Trace, how, how that works.
[00:10:31] So after a struggle myself, I finally found some more space. And, uh, in which I, uh, was able to breathe and be more present with whatever was going on. Uh, so what happened was, um, that the conversations I had were more helpful for the people I was talking with. Um, so those more helpful conversations, um, [00:11:00] uh, to more fluency in the processes where we're going through and people also individually were experiencing and going through.
[00:11:12] And, um, at a certain moment, uh, my team leader, for example, she shared with me that, um, after I, um, I came back, uh, actually, uh, out of a burnout, uh, when I finally found this. space, what I'm talking about now. She said, I'm so glad with how we are working now together because I noticed that you are present and from a different place.
[00:11:45] There's more, um, there's more.
[00:11:52] presence, I think that's the word, in you. And it really helps me to be present with what it is that [00:12:00] I am doing. And I feel there's more space also for me to do what I need to do, coming from a different place. So my work and the pleasure I experience in my work has really improved. Um, so yeah, that's, that's so powerful.
[00:12:27] That sounds like relief. Yes. Relief. And at the same time, everything that needs to be done is done, but more in a flow, much more in a flow and in, uh, in a way that really nurtures people. Yeah, I love that. that you sort of die in what you're doing and really sort of. [00:13:00] Uh, lose yourself in what you're doing.
[00:13:06] What a difference. You nurture yourself and you nurture other people rather than smashing yourself against all that stuff. Right. So, uh, it makes me also kind of curious about the fact too, that, you know, what you're describing actually systemically. What the system is asking for is relief relationship and it scales us.
[00:13:29] We don't scale it. And so there's this sense of momentum and expansion and spaciousness that happens when you do this. And so one of the things that I wonder about with that is on a larger scale. And I think about some of the sea level leaders that we have here in North America. I'm curious about the sea level leaders you have in Holland and in Europe.
[00:13:54] Um, I'm looking at them and going, okay, many of them fly around at 10, 000 feet and they know everything [00:14:00] that's going on, but they don't really know it in a relational way. And so I'm curious what your thoughts are on whether or not this is something that could actually happen throughout a large organization through the leaders that are in a position to do that.
[00:14:16] Yes, yes, definitely it can. Uh, I'm experiencing it myself in this organization where I work. It's organization, uh, uh, a national organization, 5, 000 people working there. Maybe not so big for, uh, a Canadian organization. Uh, I don't know, but in the Netherlands, it's quite a big organization, especially for healthcare.
[00:14:43] And, uh, we have at the top of the organization to, uh, we call them board members. Uh, I guess that's sort of C level, uh, uh, manager. or director. Anyway, they, [00:15:00] uh, so they know, I spoke with them about, uh, this, what we are talking about now, about this place where you come from, presence and the affected households, on all the people that, uh, you work with and that you are uh, holding a sort of a responsibility for when you're a manager or a leader and what they, they are aware of their responsibility as a board member and they know that they set something in motion that is either helpful for everyone in the organization or not.
[00:15:39] And, uh, they want to be of help for Uh, what they set in motion, they want to be it, uh, uh, of a quality that is nurturing, helpful, uh, and, uh, uplifting, supportive, et cetera. So they found a way of working in which they [00:16:00] visit one of the locations we have all over the country. I don't know exactly how many locations, I guess it's about.
[00:16:10] three or 400 locations where people in smaller or bigger teams work with the clients. Um, so every week they visit one of those locations and they land there, they work there, they do their work. It's not that they are visitors there, uh, but they have their lunch with the people who work there. They have their meetings online with other people.
[00:16:38] So there. actually working there while meeting people at the coffee machine, having a conversation, having a lunch together. Um, you know, and this is how they know what is really between people going between teams going [00:17:00] on, what is happening in the organization and they are bringing their unique, um, vibrancy or their unique energy, uh, At the same time, also in all those locations, and you know, people are talking about it.
[00:17:17] because they have an experience with both of them. And then they talk about, uh, uh, the feeling it left with, uh, it left with them or it, it left behind, which is a positive feeling. And this is how it ripples through the whole organization. It's amazing. And they're doing their job at the same time. That's really cool.
[00:17:42] So what are you noticing? Um, how, how long has that been happening? And what are you noticing that started starting to become, um, evident in the organization as you're listening to people talking and, and stuff? Yeah, this is going on now. They work [00:18:00] like they are very fresh in the organization. This is now going on for, I think maybe three months.
[00:18:08] And what is happening is that more and more people have a direct experience. with, uh, those two board members and that there's, there's a sigh of relaxation really going through the organization. There's, um, more energy in the conversations I have with, uh, the people I work directly with and, uh, have projects to, to, to work on.
[00:18:41] There's more energy. There's more, uh, there's more flow. It's people feel that they are seen and valued for their specific knowledge and expertise. Right. [00:19:00] Things are sort of flying at the moment while before it felt heavy.
[00:19:11] Like sometimes walking through mud or something, you know, really heavy. And we're doing the same things, but it's easier and there's more joy. So in my team, for example, I notice that as a, it seems to be an, uh, direct effect of the way I show up since. Uh, a year now and now these new board members, uh, my absenteeism, um, rate has gone down significantly.
[00:19:49] And, um, yeah, people are enjoying their work more. So people are engaged. You're, you're [00:20:00] able to have people come back to work that have been off of work and people are not going off as much. I love this. This is great. This is the same thing we're noticing too in Canadian health care that I see nationally as well as there's these big sort of organizational dots in the organization.
[00:20:18] So there's the, we have the frontline line. Of health care, where we're delivering care to patients and families, and that's the front line of staff that are doing that practitioners that are doing that doctors, nurses, um, therapists, and then we have the clinical leaders that are the next big dot. And those are the nurse educators and the patient care coordinators and the specialists that are clinical nurse leaders.
[00:20:48] Then we have the manager who is. Sort of the person in charge of that unit or that team of nurse leaders, and they're responsible for an area, then there's the [00:21:00] executive director. Oh, actually, no, then there's the director and that director oversees many parts of the programs that they oversee. And that's just 1 line.
[00:21:09] There's probably many. Then there's the executive director and that executive director oversees a large portfolios of, um, or a large portfolio of people. And then there's the, the C level leaders, which are two or three C level leaders, vice presidents, presidents, CEOs, et cetera. And then there's the health authority, which oversees all of it.
[00:21:32] And that's the province of British Columbia. So now when you look at those big dots, those organizational dots, The gaps in between them seem to be getting bigger and bigger and bigger. And so what that causes is all kinds of distress and disconnection and dysfunction. It causes a lot of feeling of isolation for a lot of people that are on the front line of health care.
[00:21:57] Even leaders within health care are feeling [00:22:00] isolated because they don't. Always feel like they're on a team of the supportive. And so as you look at all of that, I'm noticing there's very distinctly two kinds of leaders that we are experiencing in health care today. And one of them is, uh, the one the leader that's very command and control hierarchical.
[00:22:18] Task focused, trying to get lots done in a short period of time. Efficiency, efficiency, efficiency. And those folks, um, don't really value relational equity as high as getting the job done. And so that's not wrong. That's just a philosophy that's been there for a long time. Then you have this other group.
[00:22:39] Prioritize relationship to the point where I've talked to leaders that have done exactly the same thing you're talking about with your C level leaders, they've chosen to embed themselves on the unit with their team and spend the time to embody the kind of culture that they want to have there [00:23:00] and enrolled people into that and spent, you know, the really, it's not easy work at first, it can be difficult, but They've really spent and invested the time there and so if you look at two leaders now, you've got the old version or the, um, the first one task oriented and the second one, which is what I call presence based or relational based, even in teams that are exactly the same where you have those two kinds of leaders, the team with.
[00:23:28] Task focus has the problems with absenteeism, retention and recruitment that everybody else has in health care today, but the one that is presence based and embodies and prioritizes relationship, they don't have the same problems with absenteeism, retention and recruitment. It's very interesting. Yeah.
[00:23:51] And they find so much faster. Uh, um, well, that's my experience faster, more [00:24:00] creative solutions for the problems that keep going because the problems keep the, um, Uh, the challenges, they keep going, you know, it's not sort of a magical pill or something, but, uh, the way that you work with those challenges, that changes drastically when you're present and when there's a connection and then everybody, uh, can feel that they are part of the.
[00:24:32] the next step, the solution for the moment and feel connected to that. So that's basically why it works so well. What do you think helps? Um, cause I, I too used to be a command and control leader for sure. And very directive with the way that I would lead teams. I used to get a lot of things done, but I also suffered and my team suffered sometimes too.[00:25:00]
[00:25:00] And. It took an evolution for me to move into a different way of being in a different way of leading. I'm curious, what would you say to the earlier version of yourself that would help them to understand how to move from that? Old world leadership to something that's vibrant and more nurturing? Well, to be honest, I don't know if, uh, anything that I would say would've helped
[00:25:32] So you were, so you're stubborn, that's what you're saying, ? Yeah. No, um, because it's only words, right? I, yeah. You need to have, uh, I needed to have an experience. So what was the experience that shifted it for you? Well, the, the, the big shift was my burnout. Oh, God. So everybody has to burnout before they're gonna change.
[00:25:56] No, no. I wouldn't, , I wouldn't, I wouldn't recommend that . [00:26:00] But before that I had experiences and talks, et cetera, and I sort of, sort of thought that I was coming from this place of presence. And, um, I maybe was on a certain level, and I was doing it as a, I was using it as a trick. A trick. A trick. Yes. A trick to What do you mean by that?
[00:26:27] A trick to get things done more easily and, um, to, uh, to make people feel better and have these connections, et cetera. So on the outside. I was focusing on relationship and safety and all that stuff, but inside there was this urge. I have to get things done now. Come on a little bit quicker, you know, so there, it wasn't really [00:27:00] congruent inside and outside.
[00:27:01] And I guess I did a very good job because there were not many people who really noticed that, but I know I knew it. Yeah, me too. Me too. And then in the end, that didn't work. So that was for me, it was the burnout. It really sort of was a reset. So for, I really appreciate what you're saying right now because I can relate to that too.
[00:27:27] There was a, I did all the right things on the surface, but oftentimes internally I felt a sense of anxiety and that would come out. At different times, and I think I did a good job at times to hide that, but I also know that people still felt that from me as well, even though I had the nice smile or I was, you know, trying to make conversation, they could still feel that internally there was that was going on.
[00:27:55] And as you were talking, I was thinking about what was for me, what happened for me. [00:28:00] And I think what happened for me is that I actually started to notice that. As an invitation for me to begin to take care of that inner work and to also redefine what success is and to stop saying, yeah, people are the most important and actually starting to act like and practice that as a relational practice.
[00:28:28] Because I used to say, yeah, people are important because it was like the trendy thing to say it wasn't like I really if I really felt that way, then I wouldn't have been owned by that anxiety inside. I would have been going. I would have been and maybe that's it too. I was like, I started to become honest with myself and with others.
[00:28:46] And I would say, you know what? I am really feeling things. Anxious about this right now or being vulnerable and having courage to share. I was talking to a leader the other day and she said to me, yeah, you know, I feel like I'm supposed [00:29:00] to have all the answers. But when I. When I honestly share that I don't have all the answers, it's scary to do it.
[00:29:07] But when I do, it feels so empowering. And I think that's, we're tapping into something like what we're talking about here. Yeah, that's true. And, uh, I don't know if the, the, the process that. Um, every human being goes through that brings you to this point of what we're talking about now, this point of getting aware of yourself and, uh, what's really there.
[00:29:39] That process has a gestation time. You can't. force it. You can't force people into new modes of being. Um, uh, but it helps to talk about it and to, to be with people maybe who, [00:30:00] who already do things differently. And then there's also an invitation for all of us to, yeah, to be compassionate with ourselves and with our leaders who Or if you're the, if you are coming from this place of getting things done, or you have a leader who comes from that place to be compassionate with yourself or with that person too.
[00:30:30] Yeah, I appreciate that. That's yeah, compassion is key. And I think you're right. Gestation happens in the time that it needs to have. And I also know that when I was ready, what was helpful was to have some tools and frameworks to understand it. And one of the things that I've developed now in my systemic, uh, the safe space systemic coaching that I've created is a lighter, faster framework.
[00:30:58] That does help [00:31:00] me to listen, interpret, and translate the energy of resistance inside of me and to find those places inside that are causing me fear or frustration, anxiety, or anger. Um, To find those places that are causing stress and tension, even unresolved or unaddressed trauma as well. And the energy of resistance that oftentimes comes up for me, which is in the form of complaints, criticisms, and condemnations, because I I'll complain about what I'm doing.
[00:31:35] I'll condemn myself or others. I'll criticize myself or others and totally miss the fact that that is the. part of the problem. That's, that's actually perpetuating the problem. I'm, I'm giving it energy that keeps it going. And so that framework I found really helpful to slow down and notice the invitations for me inside.
[00:31:59] And then [00:32:00] inevitably I started to notice, Oh, wow, I can show up with you differently now because I'm taking care of myself in a different way. Right. Yeah, yeah, irritation and anxiety. It's the red flag, uh, that, uh, should, uh, warn you, uh, uh, something is, uh, is not right here. There's something to do in alignment or whatever.
[00:32:23] So the, so it used to be that that was the red flag. That would cause me to try and change you or change what's outside of me. Now it's become on a good day, not always, but on a good day, it's become a signal to notice what's going on inside of me. And that's, that's a big shift. That's taken me a long time to get to that point.
[00:32:45] Yeah. You see, and that's for me the same. That's gestation again. Right. Right. Yeah. So what's in a couple of words, what would you love to say to a manager or a leader who really [00:33:00] wants to lead in a new way like this and they're also afraid or, or not sure about how to do that? What word of encouragement would you leave them with?
[00:33:10] Every big change or transformation or systemic change starts with the first step. So look for the first step. For me, you know what it was? It was to take one deep breath. Okay. That felt like the hardest thing in the world. One deep breath, and then the next, the, the first step. Right. Right. That's great.
[00:33:38] Thanks for that, Caroline. All right. Thank you so much for listening to the show. And if you have any comments or questions for us, please reach out to us on LinkedIn. I look forward to seeing you next time. But until then, remember to be a safe space. Thank you again for getting to the end of this podcast.
[00:33:56] And if you enjoyed this and you found that there was value [00:34:00] in it for you, my invitation is for you to subscribe for future episodes that come out weekly on Tuesdays. Thank you again and I'm looking forward to being with you next time. And remember to be a safe space.
