How to solve burnout with communication [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“How does it work? We teach people to speak to one another’s values. Have you heard of listening to answer vs. listening to understand? Well, we take that one step further. We teach first to use personality science to find the values of everyone around you, then listen to, and speak to their values. Don’t speak in your code of values. Speak in the code of values of the other person. Do you know what this does? First, it makes the other person feel valued. Secondly, it causes you to place more value on that person. You value them more as a person! This is huge. We spend a lot of time on just this concept. This alone can turn a dysfunctional physician into a leader.”

Nanette Nuessle is an obstetrician-gynecologist and physician coach.

She shares her story and discusses her KevinMD article, “The relationship between communication and burnout.”

More information about the BANKCODE personality report.

Did you enjoy today’s episode?

Rate and review the show so more audiences can find The Podcast by KevinMD.

Subscribe on your favorite podcast app to get notified when a new episode comes out.

Click here to earn 1.0 AMA PRA Category 1 CME for this episode.

Also available in Category 1 CME bundles.

Powered by CMEfy – a seamless way for busy clinician learners to discover Internet Point-of-Care Learning opportunities that reward AMA PRA Category 1 Credit(s)™. Learn more at about.cmefy.com/cme-info

Do you know someone who might enjoy this episode? Share this episode with anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

Today on the show we have Nanette Nuessle. She is a pediatric hospitalist and a physician coach. She wrote the KevinMD article “The relationship between communication and burnout.” Nanette, welcome to the show.

Nanette Nuessle: Thank you, Kevin. I really appreciate it.

Kevin Pho: We’ll get into the article in a little bit, but first off, just share your story and journey to where you are today.

Nanette Nuessle: My journey to where I am today is that I am a pediatric hospitalist. I started out as a traditional pediatrician, and after several years, I started working as a locum physician. After a few years as a locum, I transitioned into being a pediatric hospitalist and found that that was really my niche. I really prefer stamping out fires and going from emergency to emergency rather than being in the office all day and answering the same questions over and over and over again, and it just really suited me.

Kevin Pho: Tell me about that transition from a pediatric hospitalist to what you’re doing now as a physician coach.

Nanette Nuessle: Oh, goodness. So I was working in a small rural hospital, a 50-bed hospital, and I had gone there to help them reopen their L&D unit. They’d had an L&D unit, they closed it for a couple of years, and they were trying to reopen it. They brought back a nurse manager out of retirement, and she told them that she would give them three months of her time, but then she wanted to go back into retirement. She actually gave them six months of her time, but then when her husband retired, she retired also.

They had been searching for a nurse manager the entire time she’d been there. They hired someone, but then they didn’t give that someone the nurse manager position. They gave her the charge nurse position, because she only had five years of experience and they wanted someone more experienced in the managerial position. So she came in with a chip on her shoulder and took it out on me.

I have 30 years of experience as a physician, 10 of those as a pediatric hospitalist, and she started arguing with every order I wrote. Since I was in the hospital eight to 10 hours a day, I spent a lot of my time educating the parents about their new babies and a lot of my time educating our new nurses. A lot of our nurses were only a year or two out of nursing school. She would go back behind me and undo all of that education, not just with the parents but also with the nursing staff. Then she started arguing policy with me, including policies that I’d helped write, and eventually she got to where she would be throwing things at me, and always when there was never a witness.

I went through a coaching course, and I learned that my code is primarily Action. We use what we call the BANK methodology, a personality science, and BANK is an acronym that stands for Blueprint, Action, Nurturing, and Knowledge. My primary code is Action. Well, I speed-coded her code and learned that hers is Blueprint, and the Action code and the Blueprint code are opposites, and they tend to clash. The Action code values things like flexibility and freedom, and the Blueprint code values things like structure, systems, and rules. Whereas the Action looks at rules as the spirit of the rule, and there can be exceptions to rules, the Blueprint doesn’t look at rules that way.

Now, in the BANK methodology, for each of the four personalities, there are 12 core values. When I started speaking to her in the language of her values, in her core values, all of a sudden she had no traction to start an argument.

The anxiety level in our unit was so high that people were starting to leave labor and delivery and go to med-surg, or go to the ER, or even leave our hospital altogether and go to other hospitals. That does not normally happen. People vie for spots in labor and delivery, because it’s normally a happy place to work. You get to cuddle new babies, you bring new life into the world, and it’s less stressful than a lot of the units. No, people were leaving labor and delivery to go to more stressful areas of the hospital to work.

Within three days, the anxiety level in our unit went from a 10 out of 10 to a three out of 10. Within three weeks, managers from other areas of the hospital were coming to me and asking me to do conflict resolution on their units. Physicians from around the hospital were coming to me and asking me to help them negotiate contract renewals. And so I started going around the hospital and teaching this system at lunch-and-learns, and we got the anxiety level throughout the hospital lowered. That’s how I became a coach.

Kevin Pho: So tell me some of the cases that physicians come to you with as a coach. What are some of the major issues that you find when they talk to you?

Nanette Nuessle: I’ve had physicians come to me because someone in the hospital had put something false in the chart that resulted in an accusation against the physician. For example, I had a physician who got a call from the nursing staff about something going on with a parent. The nurse didn’t actually call the physician to come back, but said, you know, “Well, this family needs to speak to you.” So the doctor got on the phone, spoke with the family, and thought it was all straightened out. What the nurse documented in the chart was, “Doctor refused to come in.”

So we sat down, and we spoke about how the communication went in that situation: teaching the nurse to ask for what she wanted, teaching the nurse to know the difference between whether the family actually wanted the physician to come in or the nurse wanted the physician to come in. The doctor would have been happy to come in, but he wasn’t actually asked to come in. And we got all of those sorts of things straightened out.

I had a situation where a nurse got written up for sleeping on the job. Now, this was at a refugee camp, where he was working 6 p.m. to 6 a.m., and they had long stretches during the night where none of the refugees came into their acute care clinic. They would work their butts off from 6 p.m., when they arrived, and then somewhere around 1 o’clock, the patients would sort of peter off. There might not be anybody coming in between then and when they went off duty, or they might have two or three patients come in, or they might have a whole other wave come in. You never knew.

So they were encouraged to work on stores and things like that, but if there was nothing to do, sometimes they would just lie down in their swamp area, or, I don’t know, the command station, whatever they called it there, and snooze for a while. Some of the nurses, however, would actually lie down in the treatment rooms and sleep, and he was one of them who got caught doing that. He felt that it was because he was Black and gay, and I got called in to look into that.

It turns out that there were two other nurses who were also Black and gay who were doing that, and nobody wrote them up. The difference was that he was a type A personality. He was one of these people who drew attention to everything he did. That was his personality; he loved attention. Well, if you draw attention to everything you do, and then you do something that might be borderline breaking the rules, you might get written up for that. So what was recommended by the superior officer was, “If you want to take a nap, perhaps you should go out and take a nap in your car.” They didn’t tell him he couldn’t sleep when there were no patients. They just suggested that he do it in a more subtle way. So it came down to personality and communication again.

So what I do is I teach people to look at how your personality comes across. Look at the personalities that you’re working with, and how do you communicate with those personalities? How do you shift from dealing with this personality to that personality to that personality? Can you shift into those personality roles and communicate with them better?

Kevin Pho: And speaking of communication, you talk more about that in your KevinMD article titled “The relationship between communication and burnout.” Now, for those who didn’t get a chance to read that article, just briefly walk my audience through it and share the story of why you decided to write it.

Nanette Nuessle: Yes. I was talking to some colleagues of mine who could not believe that communication could help with burnout. The relationship gets back to what I was speaking about earlier, about values. When we speak to one another’s values, we actually learn to value that person better, and we learn to value what it is they’re talking about. And then that other person actually feels acknowledged, and they feel appreciated. They feel valued.

What is the biggest thing we’re dealing with in burnout right now? People don’t feel valued and appreciated, and those are the biggest drivers of burnout. They’re the biggest drivers of staff retention. They’re what is driving people out of care. And so if we can teach people to use this personality science to learn one another’s values, to listen to other people’s values, and to speak to those values, we can do a lot to stop the drivers of burnout and to deal with staff retention.

And I know this works because I’ve actually done it, and I’ve actually taught it and trained it, and I’ve seen it make a difference in organizations in under four hours. We went into an organization and did a training, and I was told that two of the doctors wouldn’t attend. They simply weren’t going to show up; there was no reason to even expect them to be there. So what I did was I picked up the phone and I called those two doctors. They weren’t going to attend because they hadn’t spoken to one another in 18 months. When they would see each other in the hallways, they would turn and go the other way.

So I called each one of them, and they each told me, “Oh, I’m going to be on call. I won’t be able to make it.” So I said, “Look, it’s just a two-day weekend retreat. Come in the morning after you finish your rounds, and stay for as long as you possibly can.” When they showed up, they each sat at opposite ends of the back of the room, which I thought was OK. I kind of expected that. And the person who was co-leading the training with me intentionally put them in breakout sessions together twice that first morning, with other people, but intentionally put them together.

By noon, those two gentlemen chose to sit down at a table together for lunch, and I thought, “This could be either really bad or really good.” And again, the person who was co-leading with me said, “Don’t worry about it.” I came back from our lunch break early to check on them. These two gentlemen, who had not spoken to each other in 18 months, were at opposite ends of the table originally. They had scooted together and were sitting right across from each other, laughing and telling stories and telling jokes and catching up on everything that had happened in their personal lives over the last 18 months. That’s how powerful this can be when you start appreciating each other and speaking to one another’s values.

Kevin Pho: So let’s say I’m a physician leader running a group of clinicians, and you mentioned things about staff retention being an issue. What are some specific ways that I can understand someone else’s values?

Nanette Nuessle: The best way is to reach out to us and go through one of our trainings, because it’s difficult to get into all of it in just, you know, 15 minutes over a podcast, and we do offer several levels of training. Short of that, just really, really listen to what is important to people. Buying them pizza doesn’t cut it anymore.

Kevin Pho: We’re talking with Nanette Nuessle. She is a pediatric hospitalist and a physician coach. She wrote the KevinMD article “The relationship between communication and burnout.” Nanette, what are some of your take-home messages that you want to leave with the KevinMD audience?

Nanette Nuessle: My take-home messages: The first one would be that there are three levels of listening: listening to answer, listening to understand, and listening to value. And I can teach people how to listen to value. That will change your world.

The next one is that communication is everything. There are a lot of leadership values out there. I used to think that integrity was my top leadership value, and I have since learned that communication is absolutely everything.

And the third is that we all make mistakes. You can come back from it. We can help you.

Kevin Pho: And how can people reach you?

Nanette Nuessle: You can reach me through my email, which is DrNan, D-R-N-A-N, at beatdownburnout.com, or by going to my website, beatdownburnout.com.

Kevin Pho: Nanette, thank you so much for sharing your time and insight, and thanks again for being on the show.

Nanette Nuessle: Thank you. It’s been an honor.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes