By Beth Boynton
The Paradox of Interruptions
I want to share some thoughts about interruptions in healthcare. We face a paradox regarding interruptions in healthcare because sometimes they prevent errors and sometimes they cause them.
If we can discern differences, we’ll stand a better chance of fostering the former and eliminating the latter.
As explained in the first few minutes of the YouTube, “Interruption Awareness: A Nursing Minute for Patient Safety”, interruptions can alert us to problems and stop us from making a mistakes. They can also be examples of less than perfect behavior and an opportunity for personal growth.
Interruptions can also be a form of bullying and are hugely dysfunctional. They interfere with our ability to think clearly in the moment. And when tolerated become entrenched in an organizational culture and threaten staff’s psychological safety. In healthcare, interruptions lead to mistakes, (sometimes catastrophic ones), loss of creative problem-solving capacity, and burnout.
When are interruptions Bullying?
Communication is an art and most of us, including myself, have room for improvement. Yet imperfection is vastly different from persistent poor behavior.
With that in mind, here are several ways to distinguish intentional i.e. helpful interruptions and the imperfect behavioral ones from those that should be characterized as aggressive. These three signs will help you determine whether someone is bullying or not.
1. An apology. I’m sorry, I just interrupted you. Please continue. This suggests that the person has awareness of his/her behavior, how it might impact you, and a willingness to work on it. Additional ownership might be nice, but not necessarily essential.
2. The interruptions stop. While an apology shows signs that another person is considering your needs, persistent interruptions show s/he does not. Sometimes, an inability to listen well involves impulsivity and a learning curve. So interruptions may not stop completely, forever, or all at once. However, the trend should be in that direction if the relationships and culture are going to be healthy.
3. There is a clear intention to prevent a perceived problem. Speaking up to stop a wrong-site, wrong-person, wrong-procedure incident in the operating room is one good example. STOP! That is the wrong kidney! Another would be interrupting a gossiping colleague: "stop talking about me behind my back."
Bullying interruptions undermine cultures of safety for patients and the workforce. And there are no excuses for it in healthcare. It is up to us to raise awareness about it, speak up against it, and do our own work to become better listeners.
Learning to listen well is a complex and important soft skill to cultivate. It requires clear expectations from leaders, practice opportunities that are safe, room for learning curves with feedback loops and forgiveness, and ultimately disciplinary action.
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