By Rose O. Sherman, EdD, RN, FAAN
In his best-selling leadership book on communication, Simon Sinek notes, “All great leaders communicate in the same way. They always start with the Why.” He notes that people won’t buy into what you ask them to do without knowing the rationale behind a change. He describes this as upending the conventional path that many leaders use to discuss the what and the how of change. Sinek explains that this order needs to be reversed to achieve better results, especially in times of change.
I was reminded of this when a critical care nurse leader recently told me of her hospital’s plan to move back to 24/7 visitation in their critical care units. This was something that had been part of their patient-centered care initiative pre-COVID. After some initial resistance from staff, it worked well and improved patient and family satisfaction. The Unit HCAHPS scores were much higher during that time than now. During COVID, visiting hours were restricted, and those hours remained in place until the medical center recently issued a new policy opening visitation. She related the following story:
“None of us were prepared for what happened next. Staff revolted when the signs were placed on the door with the new hours and guidelines. I suddenly looked around and realized that very few of my current staff were in the unit when we had 24/7 visitation. We assumed that they would understand the why behind increasing visitation hours. Instead, they saw it as an obstacle to their work, and despite the sign on the door, they continued their old practices. We are unionized, and one of my nurses told me that a change in patient visitation was a change in working conditions and should have been negotiated. I was stunned by this reaction but realized we had poorly communicated the new plan and its rationale. I also realized that some of their concerns about family behavior were well-founded and had not been discussed.”
Starting with the Why as an evidence-based patient-centered best practice would have been a more effective approach. This manager had excellent patient experience data from their organization and nursing research to support the change in practice in her conversations with staff.
Moving to the How – after discussing the rationale for change, would have allowed staff to voice any special concerns and iterations on the policy that might be needed.
Finishing with the What – the what should come last, not first. Nursing staff need to understand the context of the why and how before they hear about the direct changes that might impact their practice.
Change is occurring at an incredible pace in health care today. Sinek’s research shows that leaders who use the golden circle of leadership communication from the inside out are more effective and gain the respect and buy-in of their staff. This is advice worth taking, as the manager above learned the hard way.
Read to Lead
Sinek, S. (2011). Start with why: How great leaders inspire everyone to take action. Portfolio Trade Publishers.
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