Tools and Strategies

Mindset

I always spend a lot of time on mindset. It is foundational and under-discussed. However, if we only change mindset without also learning strategies and new tools, many things will stay the same.

For instance, you may have a whole new outlook on your inbox. But if you want to improve communication, you still need better processes.

So in honor of some semblance of balance, I want to offer a few specific tools today and an example of someone using them.

Practical Tips: Clarity Upfront. Less Energy Lost to Repair.

Structured Thinking

Use your favorite nurse’s SBAR skills beyond patient care. Pre-structure your email, proposal, request, or difficult conversation: Situation, Background, Assessment, Request/Recommendation.

Make your “R” clear. Spell out exactly what you’re asking for, from whom, and by when.

Balcony Practice

Before reacting, step back to get the 10,000 foot view and ask:

• What else might be going on here?

If you want a quick primer on responding vs reacting, this short clip is helpful: https://www.youtube.com/watch?v=KFbnoCPt5lQ

60-Second Email Edit before Hitting Send (if it’s emotionally charged, employ the mandatory 24 hour waiting period)

• What is the core message?
• What decision am I asking for?
• Can I say this in five sentences or less?
• Would this be better in person?
• Who else needs to be, cc’d if anyone?

Tools in action

I once worked with a physician who was frustrated with the MA she worked with. The MA seemed jumpy and nervous and would always grab her as she exited a patient room (which we all know is a high cognitive load moment.)

It was always something that felt urgent to the MA: a person on the line, someone in the waiting room, or the patient in the next room.

She tried to be kind to the MA. But by the end of each day, she was seething.

As we talked, I asked her to step onto the balcony above the clinic and peer down inside and notice:

• Who are the players?
• What do you notice about yourself?
• About the MA?
• About the system?

That allowed her to recognize some important things.

Exiting a patient room when mental notes, orders, and clinical questions were swirling was the worst possible time for interruption. Her cognitive load was maxed out.

She also realized the MA was anxious and compassionately concerned. She just hadn’t yet learned which issues were true emergencies versus urgencies versus routine. And there was a system in place: a triage nurse in each pod.

With those realizations, she used SBAR to prep and eventually have a conversation.

Situation “When I’m exiting a patient room, I have a lot of mental balls in the air: orders, clinical questions, documentation plans, after care summaries, and follow-ups. When I’m stopped in that moment, I feel overwhelmed and it’s hard for me to think clearly.”

Background “I’ve noticed this happens most often right as I leave the room. I know you’re trying to make sure patients are cared for quickly, and I really appreciate how attentive you are.”

Assessment “That timing is the hardest possible moment for me to absorb new information or make new decisions. It increases my cognitive load and makes me more reactive than I want to be.”

Request/Recommendation ”Please don’t interrupt me at that exact moment. I’d like to offer you some alternatives..."

She was able to come up with three alternatives to offer (choice is so powerful):

• "Wait until I’ve completed my brain dump at the computer,
• Leave me a sticky note I can review after I close the encounter, or
• Take concerns to the triage nurse first."

Talking further about the MA's self-efficacy and normal development, she decided to also offer an “empowerment valve”:

“If you truly believe fifteen minutes could mean life or death and the triage nurse isn’t available, knock on the door. I will come. And afterward, I’ll give feedback so you can build your clinical instincts and feel less anxious over time.”

Bonus: she named her boundary clearly:

“If you try to talk to me as I’m exiting the patient room when I have a lot on my mind, I will not stop to talk. It’s not because I’m being rude.”

Clear is kind.

The conversation went well, and later she was even commended by her clinic manager.

Reflection:

In what situations are you spending energy repairing issues and relationships that clarity upfront could prevent?

What would it look like to structure one conversation this week instead of seething through several small resentments?

How might you apply the balcony lesson?