Boost productivity and improve patient care with one great coaching question

A nurse begins her shift, energized by her commitment to deliver on the promise to provide exceptional patient care. Her first mission of the day is to explain a scheduled surgical procedure to her patient, and outline the preparations that she, as the assigned nurse, will provide.

Unfortunately, the procedure she begins to describe, as detailed in the electronic medical records, isn't the procedure the patient was admitted for. The chart had been inadvertently mixed up with someone else who was scheduled to have a completely different surgery.

You surely can imagine the overwhelming surprise, panic, and drama that erupted as nurse and patient realized the procedure being articulated was incorrect. The patient, already fearful and anxious about having the surgery, became borderline hysterical, questioned the competency of the nurse, and demanded to leave the hospital.

Instead of trying to calm the patient down or reassure her that she would get to the bottom of it, the nurse, equally furious about being put in the position of giving bad information to a patient, told the patient abruptly, "This is not acceptable! Excuse me. I'll be back." And she left the room to go find her manager.

Taking full advantage of her manager's open door policy, the nurse catapulted herself into a state of unmitigated fury. Loudly and angrily, she vented about the incompetence of admissions, demanded her manager's time and help with how this should be explained to the patient, and lectured on the mortal and harmful potential of errors like this. She moaned as to why she had to be the one to clean up this mess with the patient. The nurse demanded someone be fired!

Situations like these, while regrettable, happen on the facility floors in every hospital with good employees, but only daily. But which situation is 100% avoidable—human error, or our over-reaction to it?

Our research has found that the average employee spends two hours and twenty minutes per day in drama and emotional waste – blaming, moaning and whining, taking away precious time that could be spent at the bedside or in action solving immediate clinical issues.

Validated by medical institution research, in partnership with The Futures Company, this two hour and twenty-minute figure resulted from captured data on non-productive, yet widely accepted, management practices from the open-door policy to enabling the office water cooler.

Further research validated that reducing this emotional waste not only improved clinician productivity, but also improved the patient experience by reduction in noise (drama) from nursing staff. Even more astonishing, by recapturing valuable clinician time and productivity previously lost to "emotional" waste, this organization was able to reduce the amount of posted nurse vacancies!

The revolution begins with a few great healthcare leaders who are willing to consider counter-intuitive, yet proven insights that result in profound cost savings through:
• Increased productivity and accountability
• Measurable improvements in engagement
• Cross-departmental teamwork and change readiness
As byproducts, retention of highly-accountable employees improves, as does innovation.

In this situation, the nurse's manager knew the distraught patient was waiting, and there was no time for extensive coaching or problem-solving. She asked the nurse to take a deep breath or two in order to calm down a bit. She acknowledged that it was a difficult situation. And then she asked the question:

"Tell me, what would great look like right now?"

The nurse was taken aback. But to her credit, she took the question seriously.

"Well," she said, "great would be acknowledging to the patient that an error had been made, and then doing my best to calm and comfort a fearful, angry person who is asking to be discharged immediately. Great would mean tracking down the orders for the procedure the patient was scheduled to have. Another way to be great would be to reassure the patient that the situation was not indicative of the quality of care she could expect from this hospital. And it would mean finding the patient's doctors, so they could visit the patient before the procedure and provide additional reassurance."

She said great would be doing everything in her power to serve the patient, doing her utmost to ensure the best possible outcome. And great would mean being helpful to other members of the healthcare team, instead of criticizing and demanding someone lose his or her job. Maybe following up with admissions after, to see if the issue was preventable or fixable going forward.

The nurse manager replied, "Good, then go be great."

So that's what the nurse did. She returned to the patient's bedside, delivering the promise of care the way greatness demanded. She told the patient how happy she was that the mix-up had been caught, and that she was going to take care of her and make sure she got the procedure for which she was scheduled and the best possible care. She emphasized that everyone at the facility was committed to her care.

Did the nurse manager jump in, or tell the nurse what to do? No.

The simple question, "What would great look like right now?" helps diffuse high emotions. It separates the ego from the action, and redirects a person's energy into reflection on their own contribution to great results. It stops the drama that fuels emotional waste in its tracks. It relies on a positive belief that everyone is capable, smart, and knows what great looks like. People often just need the coaching and encouragement, in the moment, to recognize reality, move beyond their egos and make the choices that will lead to greatness.

A great, reality-based leader immediately identifies applicable strategies to reduce the amount of time that teams spend in emotional waste, returning that productivity back to the organization, resulting in improved quality metrics, patient safety and satisfaction.

Reality-based leaders fervently commit to their principal role as "the caller to greatness" and help others be great. That's the definition of leadership.

Cy Wakeman is a dynamic international keynote speaker, leadership expert and New York Times bestselling author who has spent over 20 years cultivating a revolutionary approach to leadership and work. Her Reality-Based Philosophy helps leaders and their teams ditch the drama, turn excuses into results, and find opportunities in every challenge they face. Contact her at

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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