Stanford Children's COO: How leaders can drive negative emotions out of the workplace

As senior leaders in complex healthcare organizations, we have an enormous privilege. Each day, we support thousands of wonderful people doing amazing work taking care of patients and their families. We set the pace for change. We speed it up, and when appropriate, we slow it down. We are equally charged with managing things simple and complex. We have a small number of key responsibilities: achieving our missions, making our margins and taking care of our people. However, we sometimes forget that the last point — taking care of our people — should always be the first point.

We have to make sure our people feel safe, important and valued. And one of the best ways we take care of our people is by driving negative emotions out of the workforce. We do this by creating systems, processes and cultural expectations that drive fear, guilt, shame and blame out of our organizations.

Here are five ways to jumpstart this process:

1. Create the safest possible environment for your employees and physicians

Whenever I am in front of a group of our frontline staff, I remind them that our executive team at Stanford Children's Health reviews the previous day's safety event summaries every morning. I tell them my favorite is the "self-report." I truly appreciate when I read "I made a mistake, this is why, and here's how I will do things differently in the future." Sharing my learnings from these reports reminds our team that these safety events have the attention of our executive team. It demonstrates the importance we place on having a just culture, that we use our errors to get better, and that our employees can feel safe reporting underperformance.

A team member who feels fully supported, psychologically safe and able to act in the best interest of the patient and their fellow care team members will make much better decisions than one who is afraid to speak up when she sees something unsafe in the organization. Our patients and their families carry so much fear and need so much comfort. If our employees also carry fear, they will not be able to care and give comfort to the best of their abilities.

Questions to consider:

  • How willing are your employees to use your safety reporting system to expose problems?
  • Even better, do they use it to provide solutions?
  • Do you use your safety reporting system to celebrate employees?

2. Create an environment that is free of guilt, blame and shame

Guilt is an emotion that is rarely productive in the workplace. It often emerges when we meet the inevitable conflict between work-life balance. When you leave work early to attend a child's soccer game, and you make sure your team knows that, you give them permission to do the same thing without being burdened by guilt. Talking openly about personal commitments will encourage your team to balance their own family obligations. Having more control over one's time means having more control over one's stress level.

Questions to consider:

  • Are your work life balance habits healthy? Are you a role model in this area?
  • How comfortable does your team feel balancing their personal and professional commitments? Are they using all of their paid time off?

Each of us has a collection of successes and failures that comprise our leadership journey. Similar to the safety event self-report, sharing stories of your own failures, what you have learned from them and how they have made you a better leader, will show your team that their mistakes can be opportunities for personal growth and development. Create a culture where your team feels they can learn from their mistakes, where energy is not wasted blaming.  Eliminating the energy associated with blame does not mean eliminating the virtue of accountability. It means we are in this together and will support each other through difficult times.

Questions to consider:  

  • What personal failures could you use to teach your leadership team in a way that gives them the value of the lessons learned without the pain of the experience?
  • How well do you celebrate mistakes in your organization?
  • How are you creating a blame-free culture that holds individuals accountable without creating an atmosphere of fear?

3. Eliminate the situations which allow frustration to devolve into anger

Tolerating open expressions of anger, from microaggressions to behavioral explosions, creates an uncontrolled environment in which employees will not feel safe. This problem is amplified by the escalating of verbal and physical violence directed at staff from patients, family members and visitors. This serves as a major source of stress from frontline team members in all our hospitals.

For frontline staff and physicians, anger doesn't generally emerge on its own. It is drawn out by processes that don't work, by promises that are not kept. It evolves from a seed of frustration. We owe it to our teams to catch frustration as it begins to germinate. Remember a simple lesson that all military officers are taught: calm is contagious.

We need to have processes and structures – like our lean daily management system at Stanford Children's Health - that give our team members greater control over their environments. This ensures improved responsiveness, promotes psychological safety and prevents small problems from exploding into bigger ones.

System structure becomes even more important for organizations in financial or operational crisis. In nature, we observe "fight or flight" behaviors. In complex organizations, we observe an ever more interesting behavior: panic leading to paralysis. If you are leading an organization undergoing significant challenges, your biggest problem is not that good people will leave. Rather it's that the people who stay will put forth an effort that will be insufficient to help you meet the difficulties before you. Over time, a team in paralysis will only create motion, not movement.

Questions to consider:

  • How do you assist your physicians and frontline staff in better recognizing the pebbles in their shoes during their daily work?
  • Do you have regular forums for them to express frustrations and share proposed solutions?
  • Are you comfortable encouraging radical candor in your organization, so that problems can be identified before they cause major frustration?
  • In what ways are you creating panic and paralysis in your organization?

4. Make your organization about distance, not height

As senior leaders, we are not the "higher ups." We are not "above" the staff. We are farther from the patient. Let our language reflect that fact — more importantly, let our decision making reflect that. Ensure that your meeting structure involves your physician and frontline leaders. Make it easy to escalate problems. Hierarchy should support an organization, not inhibit truth from passing through it. If your frontline employees aren't comfortable talking to you as you round throughout your organization, you might have a problem. The good news — you can be the solution.

Questions to consider:

  • Look at the last three decisions you made. Were they made as close to the patient as possible?
  • Examine your language about the hierarchy of your organization — what messages does your word choice send?
  • When you walk onto a patient floor unannounced, how are you received?

5. Remember the power of a simple thank you for increasing positive emotions – for recipient and giver

We've all received a thank you at some point in our careers that was especially memorable. It may be hanging on your wall, tucked away in a drawer, or a memory that inspires you in times of difficulty. You have the ability to create that moment every day for a member of your team. Challenge yourself to deliver a thank you to someone each day – it costs nothing and can mean everything.

  • Question: Who did you thank today?

Closing thought: It's not all about you, but it's all up to you

Everyone deserves a great leader. Eliminate fear, guilt, blame, shame and anger in your organization, and you will be closer to becoming that leader. You will create an unparalleled employee experience in terms of daily contribution and career development. You will have created a wonderful place for your physician colleagues to practice medicine.

And in some small way, you will have left your imprint on your organization, a legacy to the leaders who follow you.


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