1 ©2008 The Bedside Project LLC The TRUST Cycle:5 Fundamentals to Control Your Collective Destiny Brian Wong, M.D., C.C.H.O

1 ©2008 The Bedside Project LLC

The TRUST Cycle™: “5 Fundamentals to Control Your Collective Destiny”

Brian Wong, M.D., C.C.H.O.

www.mybedsideproject.com

http://www.mybedsideproject.com/


T.

R.

U.

S.

T.

E.

D.

The “Wind Chill” Factor

the influence of “red” over “green” is up to 4:1


T.

R.

U.

S.

T.

E.

D.

“Get the Red Out”


“You don’t need to move EVERY physician”

“Magic Number” for most = 20

(and as few as 5)


The TRUST Cycle – “The Cure”

“Common Ground”

“Have the conversations we need to have, the way we need to have them”

“Diagnose, THEN treat”

“T.R.U.S.T.E.D.”


“The conversation is the relationship… the relationship is the conversation”

Susan Scott

“Fierce Conversations”


Relationships succeed or fail…one conversation at a time

“see one, do one, teach one”

“the way we were”


“Having the conversations we need to have, the way we need to have them.”

“Crucial Conversations”

By Patterson, Grenny, McMillan & Switzler


3 reasons why I like “Crucial Conversations”

1. The physiology of poor conversations

2. The link to graffiti and the “Universal Attributes”

3. The Dialogue Model one simple diagram


SILENCE

VIOLENCE

WITHDRAWINGAVOIDINGMASKING

LABELLINGATTACKING

CONTROLLING

SAFETY

SAFETY

Our PoolOf SharedMeaning

The Dialogue Model, page 183Patterson, K. et al, Crucial Conversations

ME OTHER


SILENCE

VIOLENCE


LABELLINGATTACKING

CONTROLLING

SAFETY

SAFETY


The Dialogue Model, page 183Patterson, K. et al, Crucial Conversations

ME OTHER



LABELLINGATTACKING

CONTROLLING

PERSONAL

SAFETY


From “Crucial Conversations” to… “safe conversations”

ME(“Universal Attributes”)

Other(“Universal Attributes”)

Best placeto practice, work & get

care

“Graffiti”

“Graffiti”

SILENCE“Flight”

VIOLENCE“Fight”

Rigid/InflexiblePoor listenerDisrespectfulArrogantIntimidatingThreateningJudgmentalUnforgiving

Rigid/InflexiblePoor listenerDisrespectful

ArrogantIntimidatingThreateningJudgmentalUnforgiving

“Universal Attributes”T. = Team playerR. = Responsive/respectfulU. = UnderstandingS. = SafeT. = TalentE. = Execution D. = DedicationBring out my/our best

“Universal Attributes”Team player = T.

Responsive/respectful = R.Understanding = U.

Safe = S.Talent = T.

Execution =E. Dedication = D.

Bring out my/our best


Exercise #5:Practice with “UN-Safe Conversations”

“the way we were”


Consider this “universal situation,” Part I

Dr. Black is Mr. Greenbottom’s regular physician Mr. Greenbottom is referred to the ED at 5 pm Friday afternoon by

Dr. Black’s nurse. The office is closing and Dr. Black has just signed out for the

weekend. Mr. Greenbottom has congestive heart failure, diabetes, and

peripheral vascular disease. His leg hurts and is cold and dusky. Dr. White is the primary care physician on call for Dr. Black; Dr. Gray

is on call for vascular surgery until 6 pm; Dr. Silver comes on call at 6 pm.

Dr. Gold is the hospitalist on call until 6 pm; Dr. Bronze comes on call at 6 pm.

After an evaluation by Dr. Ruby, the emergency physician, a call is placed to secure admission and care for Mr. Greenbottom. The time is 5:45 pm.


Exercise #11: “universal situation,” Part I

Form groups of 4-6 people: Role #1: 2 of you are role-playing the ER physician Role #2: 2 of you are the doctor who has been called Both of you are “slammed” Imagine for a minute this is a conversation that “does not

go well” (e.g. it is laden with your personal graffiti) Role-play the conversation; you have up to 2 minutes

“Play it to the hilt”


Consider this “universal situation,” Part I




peripheral vascular disease. His leg hurts and is cold and dusky. Dr. White is the primary care physician on call for Dr. Black; Dr. Gray

is on call for vascular surgery until 6 pm; Dr. Silver comes on call at 6 pm.




Discussion

1. Was it real?

2. How did it feel?

3. Were we on one team, or two tribes?

4. Did we give and get respect?

5. Did we listen to understand our counterpart?

6. Did we make it safe for each other?

7. Were we building TRUST with each other?

8. Was it productive or efficient?

9. Were we innovative or creative?

10. Did we help solve the problem?


Exercise #6: Practice with Safe Conversations

Now, let’s go to the movies!


Scene set up:

Wednesday morning, July 1, 1863 About 25 miles south of Gettysburg, PA Col. Joshua Chamberlain, of the 20th Maine Regiment has been

ordered to receive the 2nd Maine Regiment These 120 men mistakenly signed 3 year papers and were told

they had one more year to serve Rather than fight, all 120 have decided to “disengage” As Col. Chamberlain receives this group of men, he is

authorized to use whatever force necessary to keep them in line; including shooting them

We will pause the movie at each of 5 different “moments of truth” Now, let’s watch…


Worksheet for 5 Moments of Truth from “Gettysburg”

“Obnoxious” response(“Graffiti”)

Stimulus or “Moment of Truth”

“Healthy” response(“T.R.U.S.T.E.D.”)

1.

2.

3.

4.

5.






“I just have to shoot ONE of them.”

1. “you want to shoot them, go right ahead”

“BANG” “don’t we all” “get in line”

2. “Colonel, we’ve got grievances”

“None of your business” “I’ll be asking the

questions here”

3. “how many engagements have you been in?”

“We’re DONE.” 4. “the courier, sir”

“I’m not going to… YOU are.”

5. “you can’t shoot them, you’ll never go back to Maine if you do”






“I just have to shoot ONE of them.”

1. “you want to shoot them, go right ahead”

“That won’t be necessary.” “I said, ‘You are relieved.’”

“BANG” “don’t we all” “get in line”

2. “Colonel, we’ve got grievances”

“Go eat first, then I’ll come listen to you.”

“Fine, come along with me.”

“None of your business”

“I’ll be asking the questions here”

3. “how many engagements have you been in?”

“We sure could use men with a lot of experience.”

“Not that many.”

“We’re DONE.” 4. “the courier, sir” “Please tell the courier to wait until I’m finished here.”

“Don’t go away.” “I’m not going to…

YOU are.” 5. “you can’t shoot them, you’ll never go back to Maine if you do”

“I’m not going to.” “I know that, I wonder if they

do.”


Exercise #7: Moment of Truth #6:“now what do I say to them?”

Take out a piece of paper As an individual, jot down a few key things you would

do or say to a group of mutineers in order to re-engage them and “pick up the rifle”

Share this with your table Arrive at a table consensus for one or two key points

you would do or say together Report back in 5 minutes


Report back:“Now what do I say to them?”

Show them respect Hear their grievances Common goals Nobody’s shooting anybody We need you Why did they join in the first place We’re all from Maine; we don’t quit; give them a purpose Bond against the south Stay focused on the big picture Provide perspective and context If we don’t do this, someone will do this for us


Moment of Truth #6:“now what do I say to them?”

ONE team (America is free ground; in the end, we’re fighting for each other)

2-way communication (listen AND give them information) We all have VALUE… you and me. Set the boundaries AND the consequences (you can have

your muskets back; you have a choice; nothing more will be said)

Make it safe (dismiss the guards, feed them, listen) Make it personal (I’ll personally be very grateful) Give them space (walk away; let them talk)

T.

R.

U.

S.


Let’s rewind the tape…

The concept of a “Mulligan”

“Can I have a do-over?”


Exercise #8b: Practice with "Safe Conversations"

Form groups of 4: Role #1: 2 of you are role-playing the ED physician Role #2: 2 of you are the doctor who has been called Both of you are “slammed” Imagine for a minute that “between stimulus and

response the ED physician chooses a different response” (i.e. one pair becomes a “T.R.U.S.T.E.D. Colleague”) The other group will resist but will not be impossible; they can

change, if they hear what they need to hear

Role-play the conversation; you have up to 2 minutes “Play it to the hilt”


Consider this universal situation, Part II




peripheral vascular disease. His leg hurts and is cold and dusky. Dr. White is the primary care physician on call for Dr. Black; Dr.

Gray is on call for vascular surgery until 6 pm; Dr. Silver comes on call at 6 pm.




Discussion

1. Was it real?

2. How did it feel?

3. Were we on one team, or two tribes?

4. Did we give and get respect?

5. Did we listen to understand our counterpart?

6. Did we make it safe for each other?

7. Were we building TRUST with each other?

8. Was it productive or efficient?

9. Were we innovative or creative?

10. Did we help solve the problem?


“Fierce Conversations often do take time. The problem is, anything else takes longer.”

The value of a “Mulligan”


The TRUST Cycle – “The Cure”

“Common Ground”

“Have the conversations we need to have, the way we need to have them”

“Diagnose, THEN treat”

“T.R.U.S.T.E.D.”


Using The TRUST Cycle™ to address the ED Call Coverage problem

NEW Section


The TRUST Cycle™: “5 Fundamentals to control your collective destiny”

Brian Wong, M.D., C.C.H.O.

www.mybedsideproject.com

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1 ©2008 The Bedside Project LLC The TRUST Cycle:5 Fundamentals to Control Your Collective Destiny Brian Wong, M.D., C.C.H.O