Rudy is an HR director at a hospital with a nagging problem: One nursing unit isn't getting along with another. The nursing director is in Rudy's office all too often, complaining about constant gossiping, back-biting and ill will. But recently the problem escalated—nurses from the different units have stopped answering patient call lights in an effort to get their counterparts in trouble. With patient care potentially compromised, it's time to find a solution and hold everyone accountable.
Rudy suggests a "team turnaround intervention," in which HR will partner with the unit nursing director to address the matter openly, give everyone on the team a chance to reinvent their relationships and start over, all the while enforcing hospital policy and reminding everyone of the consequences of continuing down this risky road.
"Turnarounds are more than just about operational interventions where organizations are restored to financial profitability—they're likewise about people and team turnarounds where groups can be reset to a higher standard of performance and productivity," said David Gerard, Ph.D., C-suite executive coach and leadership development consultant in the San Francisco Bay Area. "The beauty of the team turnaround in situations like this is that it benefits the operation and, in this case, patient safety, but also gives team members the chance to reinvent themselves and end the self-inflicted misery that may have festered over months or years."
Step 1: The All-Hands Meeting
Start by scheduling a meeting for the entire team—or two half-team meetings for 24-7 staff operations, as is typically seen in nursing—and explain the problem. Three leaders should be on hand: the immediate supervisor (nursing director), her boss (in this case, the chief nursing officer, or CNO), and the HR director.
"This way the entire team hears the same, consistent message and there's less of a chance of their playing mommy off against daddy. In other words, complaining to the CNO about the problem, complaining to HR when they don't get the answer they want to hear from the CNO, or reaching out anonymously to the internal complaint hotline or even to an outside regulatory agency," Gerard said. "Having everyone in the room hearing the same message creates a greater sense of fairness and consistent treatment, so claims of favoritism or bias will subside. The overall goal should be to create a 'safe container' for all the staff concerns, where differences can be aired without the fear of being attacked or blamed."
The CNO can open the meeting as follows:
"Everyone, we've called this meeting to get on the same page. As the chief nursing officer, I've heard a number of ongoing complaints from several of you as well as from your managers. I can assure you that the concerns and issues have risen to the highest levels of hospital management, and it's time we address this together as adults. I also know from those of you I've spoken with that you simply want the antagonistic behavior to stop, and you're willing to do your part to turn a new leaf and start over again. We're here to help you do just that.
"Over the next two days, the nursing director and HR will be holding three additional meetings. The first meeting is for one half of the group, the second meeting is for the other half of the group, and the third meeting will have us back together again to address our findings. These won't be gripe sessions, but we would like to hear from you all directly about the problems you've experienced. More important, we're going to ask you what you'd be willing to do to fix the problem at hand. If any of you would like to meet with HR, your nursing supervisor, or me after your group meetings to discuss things you didn't feel comfortable sharing, you are welcome to do so. Once we have all of your ideas and suggestions, we'll come together for that larger group meeting to share what you're willing to do and what we're willing to do to fix the problem once and for all. We're all adults, we'll handle this respectfully and maturely, but we'll be holding you all accountable to a new standard of performance and conduct going forward. What comments or suggestions do you have about our intended approach?"
Step 2: The First and Second Small-Group Meetings
Each of the two small-group meetings can be handled the same way:
"Welcome to the small group meeting. In this first part of the meeting, we'd like to hear about the problem from your perspective. How did it get to the point where patient call lights are going unanswered if the patient belongs to a nurse from the other unit? And what would you be willing to commit to in order to fix the problem at hand?"
If the group is hesitant to talk, tease the information out of them by asking, "How would you grade teamwork and camaraderie on a scale of 1 to 10, 10 being best?" That typically will get them talking, even if you have to ask them by name to offer an answer. "Expect to hear 2s and 3s, which is not uncommon when group relations have degraded to this level," said Steve Axel, a senior executive and transition coach in La Jolla, Calif. Then follow up with two critical questions:
- Why would you grade us that way?
- In an ideal world, what would make us a 10?
"That forced ranking typically triggers lots of opinions and engages the team in a healthy debate about the situation," Axel said. You may hear specific names, such as who the bully is, who gets preferential treatment, who instigates most of the problems, and the like. After hearing a healthy number of anedcdotes, move the conversation in a new direction:
"OK, we hear you. Fair enough. Believe it or not, though, the other team will likely make the same accusations about you. But here's the more important question: What would you be willing to do both individually and as a group to change the dynamic of the team and make it more friendly, congenial and inclusive?"
Jot down their responses in preparation of your larger group meeting with the combined team once the small group meetings are concluded.
Step 3: The Large-Group Reconciliation Meeting
When you come together again as the larger team, open your meeting as follows:
"Everyone, we've had a chance to sit and listen to both sides, and we hear you. We hear your frustrations, we hear your concerns, and most important, we hear how you want things to change. And we fully agree: As a leadership team, we not only want you to perform more cohesively as a group, but we want you to feel more engaged and motivated at work. We know that you'll perform your best when you feel like your boss and your peers have your back. And we want you to enjoy your work and assume good intentions, eliminating the angst and tension that seeps into the culture when people feel like they have to walk on eggshells around one other or fear that someone is out to get them in trouble.
"The purpose of this large-group meeting isn't to discuss the what of it all: We've talked about that with each group individually, and there's no need to rehash the issues that have gotten us to this point. Instead, we want to focus on the how: How do we move beyond this in a healthy manner, how do we reinstitute a sense of good faith and support for one another, and how do we reinvent ourselves going forward to lighten up a bit and enjoy our working relationships more?
"To do that, I want to hand out what's known as a 'start-stop-continue' plan. These are the things you've committed to during our small-group meetings, and I'm putting them on paper because this will serve as our go-forward contract. These are your ideas and commitments, codified to ensure we're all on the same page. We can add to it now if we're missing anything, but this is our very own code of conduct going forward until the matter is resolved. Do you understand the significance of this handout and what it represents?"
Wait for the group to respond "yes." Then distribute your plan and read it out to the group. Emphasize what everyone will start doing, stop doing and continue doing. "Reinforce the key ideas that everyone can agree to, and hold them accountable going forward," Axel said.
Conclude that document with the following language:
"Team, these are your suggestions and your commitments going forward. Fulfilling your commitments will not only end the conflicts we have all experienced in the past, it will also result in better patient care and a much more satisfactory work environment for everyone concerned."
This healthy intervention allows each side to be heard. It permits them to vent in a safe manner. Yet it also gives you the opportunity to share the key insight that both sides are accusing each other of the same things. You'll have treated your team like adults, and you now have the opportunity to wipe the slate clean and welcome everyone back to the organization as if it were their first day. No, not everyone will play nice overnight, as wounds heal differently. But you'll have given everyone an equal chance to end the misery, encouraging each individual to be the first to demonstrate the change they wish to see in others.
Further, if anyone can't or won't comply with the new commitments they've made, the plan you've established will serve as a critical part of the written record, should the matter proceed to progressive discipline or termination for anyone.
Rudy's solution provides the nursing leadership team with critical insights into the challenges facing the units while giving leadership the opportunity to reset expectations and re-establish accountability. That's a triple win for the management team, the nurses and the organization, which now has a much better chance of removing toxicity from the workplace and replacing it with a more cooperative and smooth-functioning nursing service.
Paul Falcone is a frequent contributor to SHRM.org and is the author of a new third edition of his best-selling book, 96 Great Interview Questions to Ask Before You Hire (Amacom/Harper Collins Leadership, 2018).