Framing the Discussion of Health Care Reform for Nursing Staff

“Leaders manage meaning when others are unable.” Gail T. Fairhurst

I recently spoke with an experienced nurse manager about her role challenges. Without hesitation, she answered that it was keeping her 85 staff members informed about the changes in their health system that are occurring with health reform. It is interesting, she noted, they have very different perspectives about what is happening. Some are very well informed but others believe that most of the change is coming from inept management at the executive hospital level. It is true that there is a great deal of uncertainty in today’s health care environment. With proposed changes that will accompany health care reform and the declining reimbursements that agencies are already experiencing, there is reason for concern. Nursing staff wonder whether they should be worried about job security. They are often reluctant to consider how the changes might impact their role.. A major leadership responsibility today is to help staff understand the meaning of the changes that are being discussed.

Gail Fairhurst in her book The Power of Framing: Creating the Language of Leadership, suggests that one of the most important but least talked about leadership communication skills is that of “framing”. How leaders use language to frame people, situations, and events has important consequences for the way individuals make sense of the world and their actions. Not all leaders think about this when they communicate but it is important especially during turbulent times.

Case Example

Maria Sanchez is a nurse manager on a 30 Bed Telemetry Unit. At a recent town hall meeting, the CEO of her hospital talked with staff about the implementation of a new aggressive care transition program. With changes in Medicare reimbursement, the hospital has worked diligently to decrease the 30 day admission rate of Medicare patients. He noted that historically in their facility 25% of the admissions to telemetry were readmitted within thirty days but now the number had dropped to 18%. He reported that this had already resulted in a significant impact on inpatient census particularly in telemetry where census was down by 20%. He predicted some inpatient unit closures and movement of more services to the community. Some of Maria’s staff came back from this meeting very upset about the future of the unit. Maria who had also attended the meeting recognized that it was important for her to frame the issue for staff. In thinking about her presentation to her staff the next day at a staff meeting, Maria used the six following rules recommended by Fairhurst:

1. Control the Context

Maria did not minimize the facts that were presented at the meeting but sought to give staff the background about the health policy changes that were driving the changes in medicare reimbursement.

2. Define the Situation

Maria talked about the Care Transition Program , how it was ultimately benefiting the health system and keeping it financially solvent but there was definitely a decline in inpatient census.

3. Apply Ethics

Maria talked about how the organization was committed to their employees and that any unit closures would be fairly managed. She spoke about the core values of the organization and how employees are critical to the mission. She also discussed her plans not to fill any additional unit positions until she could get a better sense of the impact.

4. Interpret the Uncertainty

Maria acknowledged the uncertainty about the impact including potentially on her own role but asked the staff not to over-react until they had more information. She also promised to keep them informed.

5. Design the Response

Maria carefully thought through how she would discuss her own reaction to the situation with staff. She told them that the change was in fact needed and was the right thing to do for patients. She said she looked forward to having their help and suggestions with the Care Transition Program as it was an opportunity to do something very innovative. Maria also discussed with staff how in the future more care would move to the community. They would be on the front lines of this change and needed to consider opportunities in this area when new positions were announced.

6. Control Spontaneity

After the town meeting, Maria made the decision not to talk with staff about what was discussed until the next day. She gave herself time to think about what she would say. She decided not to make any promises or predictions about what would happen but to keep her response as factual as possible.

The response of leaders to change or turbulence has a powerful effect on their staff. Leaders who remain calm, truthful and optimistic in their communications help to prevent the spread of misinformation and reduce staff anxiety. The words of leaders can be very powerful in a positive or a negative way. While the skill of framing may not be easy, it can improve our ability to be effective communicators during times when staff depend on their leaders for information and insight.

Read to Lead

Fairhurst, G.T. (2010). The Power of Framing: Creating the lanuage of leadership. San Francisco: Jossey-Bass.