Rippling conversations

Ripples - try to make them positive

There is a school of thought that looks upon the culture of an organisation as the sum total of the conversations taking place within it.

(this is an interesting blog with application to patient safety)

This seems fairly abstract when you first hear it – and it is possible to dismiss it easily as some sort of sociology psych-babble.  However, I would recommend that you give it a chance.

In the past few weeks I have been on call – taking referrals from GPs, other teams, and the Accident and Emergency department – and attending emergencies for inpatients.  This has led to a LOT of conversations.

I made a conscious decision at the start of this set of shifts that I would take a positive, engaging approach to each of the interactions I had with others.  Wow – what a surprise, someone willing to be positive at work. (Believe me, it seems far easier sometimes just to play to type and be the grumpy medical registrar)

So how did I do this – well, taking the advice of my mate Riaz (who has an excellent blog HERE and HERE   by the way) and starting to expect to be on first name terms with everyone I converse with.  This met with mixed success – and some consternation from the A+E nurse who was confronted with “No – I am not “Medics” – I am Toby, and I happen to be the medical registrar on call” but by the end of the first few shifts, I was on great terms with the A+E Sisters and Charge Nurses, most of the A+E SHOs and a large number of the site managers etc.

My experience of being on call, as a result of this charm offensive was far more pleasant, involved far more positive conversations, and I believe that this showed through in the attitude from my team, in the experiences my patients had, and, I hope will show through the outcomes for the patients I helped to manage.

One case in particular was a highlight.  An elderly patient had come in with a suspected DVT, and this was confirmed.  The A+E SHO referred the patient to be admitted as there was concern about the patient being formally anticoagulated (standard therapy) as an outpatient.  As a consequence of my previous interactions with the SHO, I was able to coordinate a ring-around of the various specialists who might need to manage this patient, and then with a final phone call from me, managed to get the patient home, and treated in their own, familiar environment with safety nets in place to make sure that any side effects were detected and managed swiftly.

I believe that if, earlier in the block of shifts I had taken to shouting, berating and generally being abrasive to my A+E colleagues, this patient would have been admitted for several days, and owing to their mental state, may well have suffered with delerium, acquired a health-care associated infection,  and generally would have been the poorer for it.

So – being nice to people helps to grease the cogs, and can help out occasionally. So what?

Well, having been taking note of the conversations I had throughout this time on call, I think that the vibe generated from the positive interactions I was having actually spread beyond my team, and I can easily see that if sufficient numbers of people in an organisation are having positive conversations – the culture of that company / hospital / institution will change for the better .

Indeed, such an intervention was studied at Indiana Medical School – and the resulting report makes for fascinating reading.

So next time you are on call, or even next time you are at work – pay attention to the conversations you are having – like a stone thrown into a pond, they will have ripples.  Make those ripples positive and who knows what benefits lie ahead…



In the lift today I overheard a really positive conversation between a few senior matrons and service managers – although I did not know what on earth they were talking about – it felt positive to be in a place where those with senior roles were excited about their jobs, and enthusiastic enough to be chatting about a meeting in the lift!


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