Leading an organization from a culture of bullying or blaming to a culture of safety is a daunting initiative. Unhealthy alignments are deeply embedded in toxic cultures, and informal power dynamics may influence how people behave. Instead of respectful communication where giving and receiving constructive feedback is ongoing, common behaviors include:

• gossip
• exclusion
• humiliation
• sabotage
• withholding

All of which perpetuate a cycle of broken trust and poor conduct.

While patients, the workforce, and key outcomes are way better off in a culture of safety, the process from toxic to healthy culture requires a challenging shift from relationships rooted in distrust to trusting ones. To ensure long-term meaningful change, leaders must steadfastly create a foundation of trust.

An apology that acknowledges poor behaviors have occurred, are hurtful, and will not be tolerated will help build trust and open hearts and minds to new ways of being. It will also model ownership and create rich opportunities for listening. All are integral to healthy cultures. Such an apology could look something like this:

Dear Staff at ABC Hospital,

As your CEO, I am writing to announce our organizational initiative to create a culture of safety. This initiative includes a policy of zero tolerance for abuse which goes into effect immediately, and a long-term plan for training and enforcement. This letter is the first of many important steps.

As you know, bullying and blaming behaviors are insidious and pervasive in many health care organizations. Sadly, I am aware of some such behaviors here at ABC Hospital and recognize there may be incidents I am not aware of. There may be individuals in all departments, at all levels, and in all specialties who have experienced disrespectful treatment in the past.

I want to clearly and publicly apologize for any inappropriate behaviors that have occurred in this workplace.

No one deserves to be treated disrespectfully! I am truly sorry for any behaviors that have been perceived as disrespectful. I cannot erase the past, but I can acknowledge it and offer resources to help build a better future.

If you have been the target of, or have witnessed, disruptive behaviors at ABC Hospital or another facility and would like to share your experiences openly, please reach out to Human Resources. If you prefer to remain anonymous, please contact the Employee Assistance Service we have set up to help with our culture change. In addition, I will be available if you would like to make an appointment to speak with me personally, please do.

Also, please sign up to attend these two mandatory training sessions: Identifying and Addressing Inappropriate Behavior and Giving and Receiving Constructive Feedback.

Finally, thank you in advance for joining me in creating a culture where we can work safely and respectfully together and offer the highest quality care.

Sincerely,
CEO

Leaders may feel reluctant because of short-staffing, recruitment challenges, or liability concerns. Clear expectations, resources for staff, coaching, forgiveness, good listening, PRN disciplinary action, and trust-building interventions like medical improv will contribute to long-term meaningful change.

Beth Boynton is a nurse consultant and author specializing in research, training, and writing about emotional intelligence, communication, teamwork, and complexity leadership. She’s a pioneer in developing medical improv as a teaching modality for health care professionals and the founder, Boynton Improv Education. Find out more about upcoming open events, videos, and articles related to medical improv. She can also be reached on Facebook and LinkedIn.

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