My passion for history began in middle school. In fact, much of my elective reading has always been about important historical events or the lives of famous people. Most of all, I really enjoy reading about the lives of presidents. Given the fact that I grew up in Springfield, Illinois, it probably would not surprise you to find out that I love to read about Abraham Lincoln. As a child, I grew up visiting Lincoln’s home and tomb, the Old State Capitol where the Lincoln/Douglas debates were held, and New Salem where a young Abraham Lincoln studied law by candlelight. Perhaps it also is not surprising that I love to read about President John F. Kennedy. When President Kennedy was shot, I was in middle school. That day was a defining moment in my youth. Even now, I read as much as I can about these two presidents.
Traveling a couple of weeks ago, I had forgotten my book. (I have a Kindle, but I still love to turn pages!) In the airport, I saw a paperback book called “Killing Kennedy: The End of Camelot”, written by Bill O’Reilly. I decided I would buy it, and I read it on the plane. To me, the best part of the book was about John F. Kennedy’s time in the Oval Office. In particular, I was fascinated by the account of the Cuban Missile Crisis and the Bay of Pigs.
In April of 1961, President Kennedy had made the decision to authorize the invasion of Cuba. First, however, he wanted to hear from his top advisors to determine if this was the best course of action. At the time, his Secretary of State was Dean Rusk, an Oxford-educated Rhodes Scholar who had served as a chief of war plans during World War II. He was experienced in organizing covert missions similar to this.
Dean Rusk had not been President Kennedy’s first choice as Secretary of State, and Secretary Rusk knew that. Consequently, he was not confident of his relationship with the new President. In a time when the President truly needed his advice, Secretary Rusk felt he should remain silent, despite the fact that he had shared with others that this operation was misguided and that it had a “snowball’s chance in hell” of succeeding.
Secretary Rusk was not the President’s biggest problem. His largest problem was that not one of his advisors was willing to give him their advice, because it was contrary to what the President wanted at that time. As a result, Kennedy gave the go-ahead on April 14, 1961 to proceed with the invasion. Almost immediately, the invasion was a disaster. Fidel Castro, who had recently overthrown Cuba’s American-backed president, had learned about the attack in advance from informants; meanwhile, the operation of attack did not go as planned. As a result, the Bay of Pigs invasion failed, and after less than a day of fighting, 110 men on the American side were killed and nearly 1,200 were taken prisoner.
This story resonated with me because perhaps the outcome of all of this could have been avoided if the people surrounding the President had been willing to speak up. But when they did not, many people paid the price for that decision.
Sally Hogshead, an author and professional speaker, once stated, “You will not make a difference by being quiet. You will make a difference by being heard.”
As a leader, I want people to challenge my thinking. It may not change my decision, but good decisions are made when all perspectives are heard. This does not mean the leader will always change his or her mind, but it does mean that all voices have been heard and considered.
Best Care requires that we speak up when we see something that can or may result in patient harm, and it requires that the person receiving the message listen carefully to what is being said. At UTMB Health, we are dedicated to serving others and improving the patient and family experience. We achieve this through demonstrating respect for our patients, their loved ones and our colleagues. When we respectfully offer constructive feedback, we do so with the intent to offer information that calls attention to a problem or prevents a potential problem. The objective is to have a conversation that leads to the best solution or course of action. Whether you are the individual receiving the feedback or the person delivering the message, maintaining a spirit of mutual respect and learning is of paramount importance.
As the person speaking up, we need to remember the following:
- Whenever possible, convey your positive intent by choosing a good time to talk, when the other person can listen and respond thoughtfully. In instances when you are caring for patients, you may have to speak up at that moment in order to avoid patient harm.
- Let the person know that you respect his or her position/role, and that is why you are willing to share this feedback. It is always best to discuss concerns directly with the other individual—avoid communicating through a third party. Take care with your words—focus on the behavior or action that needs improvement, not on the person. It is helpful to link the behavior or action to patient safety or other important business needs.
- Maintain an objective tone. Listen objectively, as well.
- Try to keep your message brief and concise. When possible, consider picking out one or two significant consequences of the action and discussing them.
- Be sure to include specific descriptions as part of the conversation. Facts generally point toward a solution.
- Leave the responsibility for action with the other person. If there is still the possibility for patient harm and the appropriate action is not taken, escalate the concern immediately.
- Always thank the other person for their time, and ask them to reflect on the message, if that is possible.
As the person receiving the message, we need to make sure that we:
- Focus on the content of the message, not on the person.
- Realize and be appreciative that someone is making sure every action taken is being done in the best interest of our patients.
- Listen calmly and attentively. Try not to plan a response while the other person is speaking (we are not really listening when we are busy thinking of how we will respond).
- Listen with an open mind and acknowledge the other person’s concerns.
- Ask questions to confirm your understanding.
- Try not to take offense—instead, welcome suggestions.
- Maintain an awareness of your feelings, but also try to suspend judgment or reaction until you have had time to consider the suggestions that were offered. Truly consider what is being said.
- Respond respectfully, and thank the other person for expressing their thoughts or concerns.
The story of Secretary Rusk and President Kennedy is a great reminder of why every member of the team must be willing to speak up and be heard. It is only when we do this that we will achieve Best Care!