make the space for the listening

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I’ve learned so much these past ten years in my work in patient and family centred care.  My lessons come from this funny learning loop: my naivety is shattered, I feel deeply humbled and then I recognize how much I don’t know.  Working in the world of pediatrics, the clinicians tell me how family centred they are, but then many families sadly shake their heads and tell me otherwise.  This is disheartening.

I’ve come to believe that the care is generally child-centred, but health professionals aren’t sure what the hell to do with these crabby, stressed, fearful families who come along with their sick children.  Us families are self-professed pains in the asses, as that is our primal job – to protect our children at all costs.

There’s so much talk and very little walk about truly involving patients and families, except by a few lonely champions.  This needs to change.  I believe that the core of all work in health care is compassion.  And compassion comes when you take the time to understand another person’s perspective.  And people share their perspectives, not through data (which is so loved by clinicians) but through stories.  Real people communicate by telling stories.

Nobody has time for stories at the bedside.  Bureaucrats create policies to limit access to programs. Wait lists never end. Once you are finally in the health system, people rush in and out of patient rooms at great speed. Technology takes over for the human touch. Efficiency is held up as king. The bottom line for administrators is costs, not care.  With the explosion of knowledge, health care is fractured into more and more specialty areas and people are categorized by a pecking order of diagnoses instead of by vulnerability or individualized need.

The antidote to all this mess is to make the time to slow down, sit on the edge of the bed, put your hand on the patient’s hand, look them in the eye, ask what matters to you and then sit back and listen.  Simply listen to understand, openly and without judgment.  As a wise physician friend told me, find out what keeps people up at night.  What is their hidden concern?  It is then, and only then, will the care in health care begin.

Listening can happen at both the bedside and at the organizational level, too. But nobody has time for patient stories in rounds or during meetings or at conferences either.  The deep irony is that it is the patients and families who know how to make health care better – you just have to give us a chance.  But you must make the space for the listening.

Yesterday I was given a great gift.  It was the gift of time with thirty pediatric residents.  One of my champions is a beloved pediatrician.  Her heart is fully with the children and families she cares for and serves.  There was a window in the schedule for these residents and she grabbed it – creating a rare half day teaching opportunity for families.  I was honoured that family leader and mama bear extraordinaire Isabel Jordan collaborated with me at the podium.  We talked about partnering with families and best practice in sharing the news/disclosing diagnosis.  The residents – who I’m sure were exhausted from the pace of their training – listened raptly to us moms standing at the front of the lecture room.  They were good sports to participate in our ice-breaker, they asked respectful questions throughout and then at the end, they graciously thanked us for our candor, our passion and our time.  Afterwards, amongst themselves, they talked about ways they could improve the hospital experience for families – by caring for their own hearts, revisiting how family centred family centred rounds actually are, and making more time in their frantic schedules to talk about disclosing diagnosis well.

I cannot how thankful I was for this time with these young clinicians.  I cannot express how impressed I was by the calibre of this new generation of physicians.  In the sanctity of that lecture hall, we were all just people, no longer ‘doctor’ and ‘mom’ – the residents, eager to make the world a better place than when they found it, recognizing our desperate need for improvement, and us moms shining the light to show them the way.

Health care and academic leaders, let your guard down and allow yourselves to be vulnerable enough to let patients and families into your hearts. Vow to never have another patient centred care conference (irony alert!) – or any conference – without patients fully involved.  Invite families to share stories at staff orientation.  Add us to the curriculum to teach health faculty students. We want to help you.  We are ready – just give us a chance.  It all comes down to this:  simply make the space for the listening.  (Bonus points if you actually make positive change based on what you hear). This listening space is the spot where the great transformation of health care will begin.

everything about us without us?

photo credit: David Hungate for Virginia Tech Carilion

photo credit: David Hungate at Virginia Tech Carilion

There’s a movement afoot called Patients Included, whose charter for health conference organizers includes ensuring patients are not excluded or exploited at health conferences.  This includes having patients on the organizing committees, patients presenting and attending the conference, offering subsidies for patient travel, accommodation & registration and modifications made for patients with disabilities.

Now this is interesting stuff.

A couple of years ago, I wrote a blog post called Who Speaks For Patients, Anyhow?  It included a handy table about the spectrum of engagement of patients at conferences.

Since then, I am grateful for having been asked to speak at a number of health conferences.  I have been thinking about why some conferences are patient-friendly, and why others are not.  (True story:  I had an abstract accepted at a conference with a theme of the patient experience, and I was told I had to pay $450 registration fee in order to show up and give my 30 minute talk.  Um, no thanks.  The only way patient speakers will be valued at conferences is if we start saying ‘no’ to these requests to volunteer.  It reminds me of writers writing for free.  Just don’t do it).

But here is how some health conferences ‘get it’ and include patients, the very people who they care for and serve, the very people who are the subject of their conferences.

There is one champion on the organizing committee who puts up their hand and asks:  why don’t we have a patient speaker?  If they are pooh-poohed, then they put their hand up again and ask the same question, persistently and politely.  Eventually this not-so-quiet lobbying pays off, and the organizers decide to try out a patient speaker. Maybe this is just on a panel or a breakout.  That’s ok; it is a start.  Maybe they take a big leap of faith and ask a patient to open their conference.

With the right speaker, the conference participants can be inspired.  The rest of the conference is grounded by the patient voice.  The participants are reminded why they are doing what they do, and this helps rekindle their passion in their profession.

Now, after I got the crap beat out of me after speaking at a conference, I was told that health professionals don’t come to conferences to hear patients – they need a break from patients because they hear them all day long.  That’s pretty sad.  These are perhaps the types of health conferences who should not be asking patients to be involved.

The smartest of health professionals know what they don’t know, and they understand the power of the patient voice at their conference.  For it reminds them of the humanity of health care, the heart of health care and the caring in health care.  Bravo to those champions with their arms raised at those organizing committee tables – this includes Jeff Whissell, Sharla King, Tara Hatch, Arden Barry, Laurene Black, Teresa Bateman, Frank Gavin and Karen Latoszek – amongst others.   I’ll bet if you try including patients in your conference, you will never ever turn back.

amazing grace

On the eve of the American election in 2008, I went down to DC and met up with my American friend, Melissa Steele, to volunteer for Obama in the fading days of his campaign.  I was very fortunate to be at the Washington Post party the night Obama won.  I will never forget the scene after the CNN commentators announced that Obama took Virginia, and was in effect the President of the United States of America.  There was a surge of people to get urgently out of the building, and we all spilled out into the streets.  There, people were laughing and dancing and crying.  We walked past a grocery store, where the employees were jumping up and down and knocking on the windows, eager to join the fray of the celebration.

I’ve watched Obama over the years struggle as President with the bureaucracy, politics and infighting in the government.  But although I don’t agree in all his decisions, I still believe in him and his message of change.  I also believe that he is one of the greatest storytellers ever.  He has this amazing talent to connect authentically with his audience through his words and actions.  I continue to be awed by his rare skill.

Yesterday, I watched the video of Obama delivering the eulogy at the funeral of Rev. Clementa C. Pinckney in Charleston, South Carolina.  Towards the end, he stops and hesitates.  Then he slowly starts singing Amazing Grace. This simple act brought me to tears.  I thought of of the people who died in the church, and the state of America regarding guns and race and hate, and it filled me with great sorrow.

Obama’s gentle gesture was to step outside his carefully prepared speaking notes to connect with his audience, and to reach out to them in the universal language of music.  It was beautiful and spontaneous.  I dearly hope that after he’s done his presidency he will have the freedom to return to inspiring and motivating people, through hope and belief, in changing this messed up beautiful world.

i take this as a sign

After I wrote about getting back up onto the horse, I flew to Edmonton for my next speaking engagement. I was thoroughly spooked after my last experience, and boarded the plane in a proper foul mood.

I had forgotten my headphones, and couldn’t watch television to pass the time.  I tried to sleep and I couldn’t.  I flipped on my Kindle, and started reading Brene Brown’s Daring Greatly.  In it, was the exact wisdom I needed, drawn from Theodore Roosevelt’s ‘Citizenship in a Republic’ speech of 1910, also known as ‘The Man in the Arena’.

man in the arenaIt is not the critic who counts, but the (wo)man who is actually in the arena.  Brene’s book is written around the premise that ‘If I fail, at least I fail while daring greatly.’  She says we will all get kicked down in the arena if we dare to live a courageous life.

I walked off that plane feeling a whole lot better.  My daughter Ella and her boyfriend Eisech were waiting to give me a hug at the airport.  They kindly drove me to my hotel.  I got my room key and took the elevator to the 7th floor.  The elevator doors opened, and I was treated to this:

IMG_7129After all my ‘climbing back onto that horse’ metaphors, I had apparently been assigned to a room on the ‘horse’ floor at Fantasyland Hotel.  I decided to take this as a sign.

I ordered mac ‘n cheese and cheesecake from room service.  I had a bath and drank some tea.  The next morning, Ella generously brought me a flat white from Starbucks.  We went for a lovely breakfast together.  Just before I went up to the conference room, a rather disheveled gentleman walked past me.  Rather than look away, I looked him in the eye and smiled.

Hello, he said.  How are you?
Good! I said.
Good! he said back.  He paused for a moment:  God bless you, he said.
Thank you, said I, and then he was gone.

And with that, I marched right back up behind that podium.  My girl Ella, who is heading into nursing this fall, was in the audience.  Seeing her there gave me great strength.  She and her gentle heart are the great hope for nursing’s future.

The audience at the Canadian Rehabilitation Nurses conference could not have been more engaged, interested and open-hearted.  At the end, the nurse who had introduced me said she couldn’t come up to say a proper thank you because she was crying too hard.  (Crying in a good way, thankfully).  It was such a privilege to thank nurses for the important work they do to help patients and families heal.  In the end, I did feel blessed.

I’m on the other side of being kicked down in the arena.  As Brene says, “to put our…ideas out the world with no assurance of acceptance – that’s vulnerability.”  For those of us championing a worthy cause, please keep climbing onto that horse and back into the arena.  The worst case scenario happened to me, and I survived.  And if it happens to you, you will too.  Don’t give up.  Take a little break and then keep going.

climbing back up on that horse

Cowboy-1Two weeks ago, I was in Edmonton speaking at a health conference.  It went went very sour, very fast.  Fear of this type of response keeps me awake at night.  And then my nightmare – my worse case scenario – actually came to life.

I immediately stopped accepting speaking opportunities.  But I had a problem:  I had two pre-booked engagements, and I public speak a lot in my work at Sunny Hill Health Centre with BC Children’s Hospital.  Well, damn, my avoidance strategy wasn’t going to work.

I considered cancelling my next engagement.  But the program was already printed, and I also considered that I might just be being a big baby.

So the days have ticked by and I’ve been licking my wounds.  I sent letters to the power that be who lead Emergency and Patient Engagement Departments in Alberta.  That made me feel better.  Some people didn’t bother to respond, but I did get a nice phone call from the Patient Care Manager at the University of Alberta Hospitals.  So that helped.  The organizers sent word that despite my detractors, my evaluations from my talk had over 90% satisfaction rate.

So I decided to stop feeling sorry for myself and to carry on.

Tomorrow’s presentation is at the Canadian Rehabilitation Nurses Association national conference.  Oddly, it is back in Edmonton, and even more oddly, it is in the exact same hotel as my disastrous engagement.  I’ve decided to wear the exact same dress.  I’m going to hold my head high and march up to that podium and deliver my message – which is called ‘The Warm Blankets’ – an ode to nurses.  I’ve scoured my notes for anything controversial – I think I’m safe.  I am going to talk about love, compassion, and how nurses can put the humanity back into health care.

I don’t want to become afraid of public speaking because of what happened two weeks ago.  I don’t want one negative experience to define or muzzle me.  So I’m reluctantly climbing back up on that horse.  I don’t mind telling you that I’m really nervous.  But once the worst thing you could ever imagine happens, it is a bit of a relief to be on the other side of it.  Wish me luck my friends.

on hecklers…

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Folks, I’ve been humbled again.   Feeling confident that you have everything figured out? Life has a way of unexpectedly knocking you off your pedestal.

I’ve been heckled three times in my speaking career. Once was in 1995 when I was working for the Alberta Health and presenting a new funding formula to a physician group in Lethbridge. The doctors were very angry about the new formula. I remember telling my co-presenter afterwards – gosh, I wish you had thrown your coat over me and escorted me off the stage. It was that bad.

The second time was about ten years ago. Another mom and I were presenting to genetics clinic staff about the value of peer support for parents who have a baby or baby-to-be with a new diagnosis of Down syndrome. We were showing photos of our kids, who were 3 and 6 at the time.

A geneticist got up in the back of the room and said, “what happens when your kids aren’t so cute anymore?” Both us speakers stood there, frozen and horrified. This was a man who disclosed prenatal diagnosis of Down syndrome to families. Afterwards, how I wish I had retorted: “what happened to you when you weren’t so cute anymore?” But alas, I don’t think very quickly on my feet.

The third time I was heckled was this morning. I flew to Edmonton to speak at an Emergency Department conference. My messages were about kindness and compassion in health care, and how the little things mean a lot to patients and families.

The stop sign above was part of my ‘Seven things that mean a lot to patients’ theme. I talked about the stress of finding parking, and the anxiety associated with the Emergency waiting room, and this big stop sign that awaits patients when they first walk in the door. I asked – why not try to provide a little comfort to patients so they aren’t so stressed out and angry when they arrive? Less agitated patients would help health professionals too.  Why not show a ‘welcome’ sign in a few different languages instead?

My heckler took great issue with my thoughts on the stop sign. He felt that patients should be told to stop and wash their hands and that patients thought that the ‘H’ on hospital meant hotel, and how he didn’t have time for that.

He went on and on about how awful patients were and now it is all a blur to me as I stood there swallowing back my tears. Other people chimed in about how demanding patients were, and I realized, in horror, how awful the Emergency experience must be here in Alberta for both patients and staff. One nurse actually said: I treat patients the way they treat me. If they are mean to me, I’m mean right back.

I had no response to this welling hostility. I needed someone to throw a coat over my head and escort me off the stage, but nobody did. Finally a young nurse put up her hand and was handed the microphone: “Thank you for your talk, she said quietly. I learned some things that I could do better at work. I’m going to try to slow down and not rush so much.” Thank you I croaked out to her, grateful for her bravery to speak up.

Gosh, there are so many lessons here.

  1. Patient speakers are sharing their stories and allowing themselves to be very vulnerable. Audience members, please respect that. Patient speakers, please protect your hearts and be aware that things can go sideways. I had obviously forgotten that – the aggression that came at me felt like a slap.
  1. Patient speakers, not everybody will agree with your message, and that’s ok. Let’s take this as a learning opportunity. At least I sparked dialogue, right? Right?
  1. Organizers, please assess your audience carefully. If your audience is hostile to hearing the patient experience, perhaps consider waiting to invite a speaker until the environment is less adversarial.

The fact is when I stand on a stage behind a microphone, I should accept the risk that comes along with that. (Why do you think that rational people shy away from public speaking?!). Maybe I have been given a free pass up until now because I generally talk to engaged audiences who are open to hearing about love and compassion. I’ve spoken at least 50 times since I’ve begun this work – so two hecklers out of 50 isn’t that bad.

I’m going to take a little rest now from trying to change the world, and focus on what’s important: the people I love.  I’ll be on a speaking hiatus until further notice.

speaking about speaking

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One of the funny things I do for a living is speak in front of audiences.  This is a curious job, which peaks in the spring and fall, the busy time for health conferences.  I spoke last Friday at the Canadian Society for Hospital Pharmacists Banff Seminar, and I have five more scheduled talks until September (Pharmacists, Emergency Room Staff, Pharmacists, Rehabilitation Nurses and University Academics, in that order).  It is an honour for me to be asked to tell my stories.

It is also an odd line of work.  I’ve had speaking engagements when I was awash with cold fear right up until I stepped up to the microphone.  I could feel my heart beating in my throat, and it took a couple minutes of talking in a shrill voice until I actually found my groove and calmed down.  I vividly remember sitting in a pool of public speaking terror for sixteen hours crammed into an economy seat on a flight on my way to a consumer conference in Melbourne.  I’ve spent many a white-knuckled drive to a hotel, thinking:  why do I do this to myself?  (Note:  the fear has faded with time and practice, but I know it is always there lurking inside.  It keeps me on my toes).

These are my top ten truths about public speaking that I’ve gleaned over the years.  All of these lessons are hard-fought.  I’ve learned them from other speakers, watching TED Talks, and reading Presentation Zen.

1.  Yes I still get nervous.  It is good to have nerves.  I don’t want to sound like a scripted robot.  Nerves give you adrenaline which gives you energy.  This is good.

2.  Once I asked my eldest son, a musician – do you ever get anxious when you get up on stage?  He looked at me, totally dumbfounded and said, very slowly:  Mom, I don’t get anxious.  I am excited.  An epiphany – how you frame things is everything.  Your new public speaking mantra should be:  I am excited.  I am excited.  I am excited. This helps. A lot.

3.  Know thy audience is my biggest rule.  I never give a ‘canned’ speech.  I do my best to talk to organizers (or even better, potential audience members) so I understand where they are coming from – what are their challenges, what would they do if they had a magic wand, what would they say if they were me, what are the three key messages they want me to share?  Having this inside knowledge turns a lecture into a conversation.

4.  It is not about you.  Another lightbulb moment:  it isn’t about me;  it is about the message that I’m giving.  Nobody cares about if my hair is fuzzy or that I say ‘um’ too much or what I’m wearing.  And if you are passionate about your message, then, well, you can get excited about your talk (see #2) and share that passion with your audience.

5.  Rehearse with a timer.  If you ramble (as I do), be prepared to drop some speaking points as you go along.  I try never to go over time – otherwise I’m creeping into another speaker’s spot, and I think that’s kind of disrespectful.

6.  Accept and embrace the speaker you are.  I wish I could wander around the stage with a lapel mike without any speaking notes.  I can’t.   I like to stand behind the podium with my 16 point font notes in front of me.  Having the written word there gives me great comfort (even if I don’t look at them), and that’s ok.  Besides, I don’t read bullets off slides (see #8), and I’m a terrible memorizer, so I need my beloved notes.

7.   Watch for the ‘nodders’ in the audience.  These are the kind people who nod and encourage me to continue on.  I love those people.

8.  For the love of god, please don’t read bullets off of slides.  That means don’t put all your speaking notes up on the slides.  You are there to speak, not read.

9.  Come to think of it, don’t create a slide deck full of bullet points, either.  I use images and quotes and lots of white space, but that’s just my style – a few choice words or infographics would work too.  I truly think your slides should compliment your talk, not actually be your talk.

10.  Take some deep breaths.  I use my little meditation app before I leave for a presentation.  Andy, the Headspace narrator, calms me down.

Remember:  Everything’s going to be ok. You can do this.  (And it isn’t about you anyhow, silly).  Also:  Do the thing you are most afraid to do.  You aren’t doing anybody any favours by living life small.

Now go out there and tell your stories.  This is the only way the world is ever going to change.